מרכז רפואי קפלן
DESCRIPTION
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) - PowerPoint PPT PresentationTRANSCRIPT
מרכז רפואי קפלן
החזה בית כירורגית
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 thinCigarette smokingNormal lung
Etiology
Localized subpleural blebs (1-2 mm) :90% upper lobes10% lower lobes 80% by CT75% by SurgeryNormal lung
Recurrence:16%-54% I episode>83% II episode
Clinical Presentation
No symptoms
Symptoms
Clinical Presentation
Sudden pleuretic chest painDyspnea Classic findings (PE):Diminished breath soundHyperresonanceFremitusNormal findings
Complications
Respiratory FailurePleural fluid 20% ( 3% Hemothorax)EmpyemaTension pneumothorax (2%-3%)
Imaging
Chest radiography
CT is seldom required
Management
Depend on:SizeStability of the patientSymptom complexInitial PSP onset or recurrent episodePresence/absence of structural lung disease
Size
Rhea JT, DeLuca SA, Greene RE (1982)Belgian Society of Pneumology (2005)SEPAR (2008)British Thoracic Society (2010)
How to Treat
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 PxStable 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
RecurrenceLarge or Persistent air-leakIncomplete lung expansionBil. SPOccupations risk
How To Do
It is all ways the size and the consistency that count…
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