מרכז רפואי קפלן

החזה בית כירורגית

Spontaneous Pneumothorax

The Overlooked Issue

Definition

Accumulation of air in the pleural space that leads to partial or total collapse of the affected lung.

Spontaneous Pneumothorax

Primary Spontaneous Pneumothorax (PSP)

Secondary Spontaneous Pneuomothorax (SSP)

Epidemiology

Young patient (10-30 years)Usually tall and thinCigarette smokingNormal lung

Etiology

Localized subpleural blebs (1-2 mm) :90% upper lobes10% lower lobes 80% by CT75% by SurgeryNormal lung

Recurrence:16%-54% I episode>83% II episode

Clinical Presentation

No symptoms

Symptoms

Clinical Presentation

Sudden pleuretic chest painDyspnea Classic findings (PE):Diminished breath soundHyperresonanceFremitusNormal findings

Complications

Respiratory FailurePleural fluid 20% ( 3% Hemothorax)EmpyemaTension pneumothorax (2%-3%)

Imaging

Chest radiography

CT is seldom required

Management

Depend on:SizeStability of the patientSymptom complexInitial PSP onset or recurrent episodePresence/absence of structural lung disease

Size

Rhea JT, DeLuca SA, Greene RE (1982)Belgian Society of Pneumology (2005)SEPAR (2008)British Thoracic Society (2010)

How to Treat

Treatment-observation

Small Px (3 cm) Asymptomatic

Monitoring,Physical ex, Pulse oximetry, Repeated x-ray

0.9%-1.25%Intrapleural air absorbed daily

Treatment-Aspiration

Larger PxStable Patient

Success Rate:PSP 66%-83%SSP 37%

Treatment-Thoracostomy

Larger (tension) Px Symptomatic (PSP-SSP) PSP 90%,50%,15% Recommended only for definitive management of PSP of the first event

Treatment-Surgery

RecurrenceLarge or Persistent air-leakIncomplete lung expansionBil. SPOccupations risk

How To Do

It is all ways the size and the consistency that count…

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