Pneumothorax - Overview

Pneumothorax means simply gas in the pleural space
a)Spontaneous Ptx- implies PTX in the absence of trauma and underlying lung disease like ILD
most common in smokers with normal parenchyma other than ptx, which suggests smokers have microscopic lung changes that predispose them
may treat by simple aspiration of ptx

b)Secondary Ptx- PTX + presence of underlying lung disease ie) COPD
due to underlying disease, usually require chest tube +/- pleuredesis

c)Traumatic Ptx- seen in extra and intra-thoracic trauma (See recent NEJM image attached)
need urgent needle decompression followed by chest tube

d)Tension ptx- pressure POSITIVE throughout respiratory cycle, may cause mediastinal shift
often from resuscitation, intubation
urgent decompression, then chest tube

(Ellen Eaton MD, 10/21/10)