Pneumothorax (PTX)

Etiology

  • Air in pleural space
  • Primary (spontaneous) pneumothorax: acute disruption of visceral pleural in someone w/out known preexisting lung disease (often from rupture of previously unknown bleb)
  • Secondary pneumothorax: disruption of visceral pleura in someone w/underlying lung disease
  • Iatrogenic pneumothorax: complication of a procedure (central line, thoracentesis) - can occur with or without underlying lung dz
  • Traumatic pneumothorax: secondary to blunt or penetrating trauma

Risk Factors

  • Primary pneumothorax: Risk factors include tall, thin, male, smoker
  • Secondary pneumothorax: Risk factors include trauma, chronic infection extending to pleura→ hiv, severe copd, other chronic lung disease; thoracic endometriosis (catamenial ptx)→ ptx occurs around time of menstruation

Symptoms

  • Acute
  • SOB
  • Pleuritic cp

Physical Exam Findings

  • Absent or diminished breath sounds
  • Crepitus if air dissects into sub-cu tissues
  • If tension→ trachea deviated away, more likely hemodynamic compromise
  • If small and compensated, may not have exam findings