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PNEUMOTHORAX

Gas in the pleural space

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DIAGNOSIS

Pleuritic chest pain

Acute-onset dyspnea

Decreased breath sounds on affected side

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Plain x-ray

Usually diagnostic

Expiratory film

• May demonstrate small pneumothoraces that are not visible on inspiratory films

Only slightly more sensitive than inspiratory films

Not routinely recommended

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Chest CT

To identify associated pathology

Differentiate pneumothorax from emphysematous blebs

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Types

Traumatic

• Penetrating or nonpenetrating chest injuries

Spontaneous

• Without trauma to the thorax

Primary spontaneous

• No underlying lung disease

Secondary spontaneous

• Underlying lung disease present

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Primary spontaneous pneumothorax

Due to rupture of apical pleural blebs

• Small cystic spaces that lie within, or immediately under, the visceral pleura

Almost exclusively in smokers

50% will have a recurrence

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Treatment

Simple aspiration

Thoracoscopy with stapling of blebs and pleural abrasion

• If the lung does not expand with aspiration

• Recurrent pneumothorax

100% successful in preventing recurrences

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