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Pneumothorax

 
 
 
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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
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    Large right-sided pneumothorax
     
  • Right-sided rib fractures with a right pneumothorax and subcutaneous emphysema
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    Overlay
    Right-sided rib fractures with a right pneumothorax and subcutaneous emphysema
     
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