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מרכז רפואי קפלן. כירורגית בית החזה. 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.
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מרכז רפואי קפלן כירורגית בית החזה
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 thin Cigarette smoking Normal lung
Etiology Localized subpleural blebs (1-2 mm) : 90% upper lobes 10% lower lobes 80% by CT 75% by Surgery Normal lung Recurrence: 16%-54% I episode >83% II episode
Clinical Presentation No symptoms Symptoms
Clinical Presentation Sudden pleuretic chest pain Dyspnea Classic findings (PE): Diminished breath sound Hyperresonance Fremitus Normal findings
Complications Respiratory Failure Pleural fluid 20% ( 3% Hemothorax) Empyema Tension pneumothorax (2%-3%)
Imaging Chest radiography CT is seldom required
Management Depend on: Size Stability of the patient Symptom complex Initial PSP onset or recurrent episode Presence/absence of structural lung disease
Size Rhea JT, DeLuca SA, Greene RE (1982) Belgian Society of Pneumology (2005) SEPAR (2008) British Thoracic Society (2010)
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 Px Stable 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 Recurrence Large or Persistent air-leak Incomplete lung expansion Bil. SP Occupations risk