1. Primary spontaneous pneumothroax (PSP)
• spontaneous
• Ø primary pathology
• <45y
• Contralateral lung normal on Xray
2. Secondary spontaneous pneumothorax (SSP)
• pre-existing pathology
• pulmonary symptom preceeding PT
• >45y + smoker
• contraleteral lung with Xray abnormalities
3. Iatrogenic → THoracocentesis, transbronchial biopsy, CVC, Barotrauma
4. Post-traumatic

5. Catamenial

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💬

6. PT during pregnancy

• Pulmonary blebs are small subpleural thin-walled air-containing spaces, not larger than 1 or 2 cm in diameter (with the precise limit varying by source).
• Their walls are less than 1 mm thick.
• If they rupture, they allow air to escape into the pleural space resulting in a spontaneous pneumothorax.
• Blebs are a very common finding in otherwise normal individuals. They are often found in young patients. They are more common in thin patients and in cigarette smokers 1

SSP → ↑mortality, more difficult treatment, longer hospitalization

• COPD/emphysema
• lung cancer
• Pneumonia
• lung fibrosis

⇒ but every lung disease can cause SSP

1. Partial - Incomplete pulmonary collapse 📷
2. Total - lung collapse 📷

1. Closed 📷
• #1
• small lesion visceral pleura
• mostly benign evolution
2. Open ("sucking chest wound) 📷
• open penetrating trauma
• severe respir. insuff.

T

T

• smoking
• age
• sex
• constitutinal size (skinny+ tall)

• Pleuritic pain → sudden onset
• Dyspnea (progressive)
• Cough (non-productive)
• Physical exam:
• Signs of unilateral air accumulation
• ↓/absent breath sounds
• Percussion: Tympanism/Hyper-resonance
• Tracheal deviation
• Subcutaneous emphysema
• Tachycardia+tachypena + hypotension (obstruct. shock), distended neck veins ⇒ tension P.

1. Xray #1 → pleural line is moved more medially and lateral part shows Øvascular signs 📷

if tension p → mediastinal/tracheal deviation

2. US → intens. pleural reflex + recurr. ecchos (A-line); loss of Sea shore sign → bar code sign; 📷
3. CT → Underlying cause of SSP, esp in TRAUMA❗, DDx with emphysem bulla or ruptured pulmonary cyst

Acute:

• reexpansion of the lung
• prevention of recurrence

Observation and Aspiration

1. Aspiration (Thoracocentesis)
2. Chest drainage(Tube thoracostomy or catheter)
3. and Pleurodesis (↑connection betw parietal+viscel pleura due to fibrosis) 📷 📷

• classic treatment fails
• P. recurrence
• persistent P.
• prolonged air leaks (> 5 days)
• tension P.
• bilateral P.
• professions at risk (pilot, diver)
• need for pulmonary biopsy

atypical resection of affected lung and partial parietal pleurectomy (VATS or thoracotomy(open) 📷

severity of symptoms