Pneumothorax
February 15th, 2021
Overview
Signs of Pneumothorax on Chest X-Ray
- Reduction in lung markings in the apices (erect)
- Deep sulcus sign - abnormally sharp costophrenic angle (supine)
- Diaphragmatic flattening
Signs of Tension Pneumothorax
- Tracheal deviation away from the pneumothorax
- Mediastinal shift away from the pneumothorax
Causes of Pneumothorax
Primary Spontaneous Pneumothorax
- Idiopathic (ruptured pleural bleb / bulla)
Secondary Spontaneous Pneumothorax
- Connective tissue disease - Marfan syndrome, Ehlers-Danlos syndrome, rheumatoid arthritis, scleroderma, ankylosing spondylitis, dermatopolymyositis
- Airway disease - emphysema (bullous rupture), cystic fibrosis, severe asthma
- Infections - PJP pneumonia, tuberculosis, necrotising pneumonia
- Interstitial lung disease
- Lung cancer
- Thoracic endometriosis
Non-Spontaneous
- Traumatic - blunt, penetrating
- Iatrogenic - CVC placement, transthoracic procedures, mechanical ventilation
Tension pneumothorax is a life-threatening condition which is diagnosed clinically - waiting for an x-ray may cost the patient their life.
Examples
- Large right-sided pneumothorax
![Large right-sided pneumothorax]()
- Right-sided rib fractures with a right pneumothorax and subcutaneous emphysema
![Right-sided rib fractures with a right pneumothorax and subcutaneous emphysema]()
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