Pneumothorax

Basics

Description

  • Presence of free air in the intrapleural space
  • Spontaneous pneumothorax is due to atraumatic rupture of alveolus, bronchiole, or bleb
  • Primary spontaneous pneumothorax (2/3 of incidences):
    • No identified pulmonary pathology
    • Rupture of small subpleural cyst or bleb
    • Primarily young, healthy patients with tall, thin body habitus
    • Risk factors: Smoking, family history, Marfan syndrome, homocystinuria, thoracic endometriosis
    • Possible increased incidence due to weather/atmospheric pressure
  • Secondary spontaneous pneumothorax from known underlying pathology
  • Tension pneumothorax:
    • Continued air leak into pleural space creating a “ball-valve” mechanism
    • Intrapleural pressure increases
    • Venous return and CO decreases
    • Mediastinum shifts toward uninvolved side, decreasing right atrial filling
    • Ventilation compromise and perfusion mismatch with hypoxemia/hypotension

Etiology

  • Idiopathic
  • Airway disease:
    • Chronic obstructive pulmonary disease
    • Asthma
    • Cystic fibrosis
  • Infections:
    • Necrotizing bacterial pneumonia
    • TB or fungal pneumonia
    • HIV/Pneumocystis carinii
  • Neoplasm
  • Marijuana and cocaine use
  • Interstitial lung disease:
    • Sarcoidosis
    • Idiopathic pulmonary fibrosis
    • Lymphangiomyomatosis
    • Tuberous sclerosis
    • Pneumoconioses
  • Connective tissue diseases
  • Pulmonary infarction
  • Endometriosis
  • COVID-19 pneumonia
  • Blunt chest trauma
  • Penetrating trauma to neck or trunk
  • Iatrogenic: Vascular access

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