Pneumothorax

Etiology
 Primary spontaneous
pneumothorax
• It occurs in young healthy individuals without
underlying lung disease.
• It is due to rupture of apical sub-pleural bleb.
Predisposing factors:
• Smoking.
• Tall, thin male.
Recurrence:
• 50% on the same side.
• 10% on the opposite side.
 Subpleural bleb
• Pocket of air within the visceral pleura.
• < 1 cm & usually apical.
 Secondary spontaneous
pneumothorax:
Due to underlying lung disease.
• Cavitary lesion.
• Cystic lung disease.
• Emphysematous bullae.
• Pneumatocele.
 Traumatic pneumothorax
Accidental trauma:
• Blunt trauma: with fracture ribs.
• Penetrating trauma: stab wound or gun shot
injury.
Iatrogenic trauma:
• Positive pressure ventilation:
Alveolar rupture  interstitial emphysema 
pneumothorax.
• Interventional procedures:
Biopsy, thoraco-centesis, CVP line.
 Pathology
Pneumothorax

Closed Open Tension

pneumothorax pneumothorax pneumothorax
 Closed Open Tension
pneumothorax pneumothorax pneumothorax

The pleural tear The pleural tear The pleural tear

Is sealed is open act as a ball &
valve mechanism

The pleural The pleural The pleural cavity

cavity pressure cavity pressure pressure is > the
is < the is = the atmospheric
atmospheric atmospheric pressure
pressure pressure
 C.P
• Dyspnea.
• Pleuritic chest pain.

Dyspnea is more common in 2ry spontaneous pneumothorax rather than

1ry spontaneous pneumothorax due to poor pulmonary reserve.
Radiological manifestations
Pneumothorax Pneumothorax
in erect position in supine position
Air in apicolateral pleural Air in anteromedial pleural
space space.
Small pneumothorax
Small pneumothorax
Large pneumothorax
Large pneumothorax
Large pneumothorax with
mediastinal shift
Large pneumothorax with
mediastinal shift
Tension Pneumothorax
Tension pneumothorax
Tension pneumothorax
Visceral pleural line
 Recurrence of spontaneous
pneumothorax
•50% on the same side.
•15% on the contralateral side.
More common in
•2ry spontaneous pneumothorax.
 Tension pneumothorax
• It is life threatening condition.
• The pleural pressure is more than the atmospheric
pressure.
Radiological manifestations of large pneumothorax
• Mediastinal shift,
• Flattening of the hemidiaphragm &
• Lung collapse.
Associated with clinical manifestations of circulatory
collapse (tachycardia, hypotension & sweating).
It is more common with
• Positive pressure ventilation &
• Traumatic pneumothorax.
Tension pneumothorax
Tension pneumothorax complicating
lymphangioleimyomatosis
 Hydropneumothorax
• Due to rupture of pleural adhesions.
• Bronchopleural fistula.
 Encysted pneumothorax
• Due to pleural adhesions.
 Failure of re-expansion of the
collapsed lung
• Due to pleural adhesions.
• Or tracheobronchial injury.
 Re-expansion pulmonary edema
• Due to rapid re-expansion of collapsed lung.