Pneumothorax means “air” in the pleural space.
Pathology
1. Chest Trauma
2. Spontaneously occurs in
- Chronic bronchitis.
- Emphysema.
- Bronchial asthma.
- Carcinoma.
- Lung Abscess
Clinical Features
- Sudden onset of unilateral pleuritic chest pain and increasing breathlessness are usual complaints.
- Severe cases have pallor & tachycardia.
- Decreased chest movements in affected side.
- Trachea is displaced to healthy side.
- Percussion note is hyper-resonant.
- On auscultation, there is no air entry on affected side.
Investigations
X-Ray chest PA view shows collapsed lung with mediastinal shift.
Treatment:
Depends upon severity of disease
- In mild pneumothorax, no active treatment, just avoid severe exercise & after two weeks, air is absorbed simultaneously.
- In severe cases e.g. Tension Pneumothorax; aspirate air by inserting wide-bore needle in 4th intercostal space in midclavicular line followed by intercostal drainage tube with underwater seal in the triangle of safety for 2-3 days. Review the tube if pneumothorax is not resolved. Surgery in the form of pleurectomy or pneumolysis.
Indications of Thoracotomy in Chest Trauma
- More than 1000 ml on initial intubation
- 200-300 ml/h over a period of time
- Signs of cardiac temponade
- Evidence of any visceral injury
