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Pneumothorax

Pneumothorax is a topic covered in the 5-Minute Emergency Consult.

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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 underlying pulmonary pathology present
    • Rupture of small subpleural cyst or bleb
    • Primarily young, healthy patients (20–40 yr old) with tall, thin body habitus
    • Risk factors: Smoking, family history, Marfan syndrome, homocystinuria, thoracic endometriosis
  • Secondary spontaneous pneumothorax from underlying pulmonary pathology (see Etiology)
  • Tension pneumothorax:
    • Air continues to enter pleural space through bronchoalveolar disruption and becomes trapped via “ball-valve” mechanism.
    • Intrapleural pressure increases.
    • Venous return to right heart decreases, resulting in decrease in cardiac output.
    • Mediastinum shifts toward uninvolved side, mechanically interfering with right atrial filling.
    • Ventilation compromise and ventilation/perfusion mismatch result in hypoxemia

Etiology

  • Idiopathic
  • Airway disease:
    • Chronic obstructive pulmonary disease (COPD)
    • Asthma
    • Cystic fibrosis
  • Infections:
    • Necrotizing bacterial pneumonia
    • TB
    • Fungal pneumonia
    • Pneumocystis carinii
  • Neoplasm
  • Interstitial lung disease:
    • Sarcoidosis
    • Idiopathic pulmonary fibrosis
    • Lymphangiomyomatosis
    • Tuberous sclerosis
    • Pneumoconioses
  • Connective tissue diseases
  • Pulmonary infarction
  • Endometriosis
  • Blunt chest trauma
  • Penetrating trauma to neck or trunk
  • Iatrogenic:
    • Central line placement
    • Other vascular access procedures

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Citation

Rosen, Peter, et al., editors. "Pneumothorax." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax.
Pneumothorax. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax. Accessed April 25, 2019.
Pneumothorax. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax
Pneumothorax [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pneumothorax ID - 307236 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -