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Pneumothorax

Pneumothorax
  • Occurs when a ruptured pleural sac allows air to enter the thoracic cavity; the lungs collapse due to pressure changes.
Spontaneous vs. Traumatic
– Primary spontaneous: no underlying respiratory disease; thought to be caused by bleb ruptures. This type is most common amongst smokers, especially young, tall, thin men. Be aware that primary spontaneous pneumothorax is often recurrent, especially in women. – Secondary spontaneous: caused by underlying respiratory disease. – Traumatic: caused by blunt or penetrating trauma. – Iatrogenic: caused by medical intervention (most commonly from pulmonary needle biopsy).
Tension pneumothorax:
One-way valve allows air to accumulate in pleural cavity,* raising pressure on mediastinal structures.
  • Heart and lungs can be compressed, leading to hypoxia, and trachea may deviate away from affected side.
In addition to dyspnea, look for distended neck veins, hemodynamic instability (including hypotension).*
  • Because hypoxemia and even shock can occur, tension pneumothorax requires emergency treatment.
In Menstruating Women: Catamenial pneumothorax is recurring pneumothorax associated with menstruation; various theories, including migration of endometrial cells. Associated with diaphragm fenestrations, nodules on pleura.

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