Thyroid & Adrenal
Treatment of choice in young patient with small pneumothorax (< 20%):
a. Pneumothorax is the presence of gas in the pleural space.
b. A spontaneous pneumothorax is one that occurs without antecedent trauma to the thorax.
c. A primary spontaneous pneumothorax occurs in the absence of underlying lung disease, while a secondary pneumothorax occurs in its presence.
d. A traumatic pneumothorax results from penetrating or nonpenetrating chest injuries.
e. A tension pneumothorax is a pneumothorax in which the pressure in the pleural space is positive throughout the respiratory cycle.
Primary Spontaneous Pneumothorax
a. Primary spontaneous pneumothoraces are usually due to rupture of apical pleural blebs, small cystic spaces that lie within or immediately under the visceral pleura.
b. Primary spontaneous pneumothoraces occur almost exclusively in smokers, which suggests that these patients have subclinical lung disease.
c. Approximately one-half of patients with an initial primary spontaneous pneumothorax will have a recurrence.
d. The initial recommended treatment for primary spontaneous pneumothorax is simple aspiration.
e. Thoracoscopy or thoracotomy with pleural abrasion is almost 100% successful in preventing recurrences.
a. Most secondary pneumothoraces are due to chronic obstructive pulmonary disease, but pneumothoraces have been reported with virtually every lung disease.
b. Pneumothorax in patients with lung disease is more life-threatening than it is in normal individuals because of the lack of pulmonary reserve in these patients.
c. Nearly all patients with secondary pneumothorax should be treated with tube thoracostomy.
d. If the patient is not a good operative candidate or refuses surgery, then pleurodesis should be attempted by the intrapleural injection of a sclerosing agent such as doxycycline.
a. Traumatic pneumothoraces can result from both penetrating and nonpenetrating chest trauma.
b. Traumatic pneumothoraces should be treated with tube thoracostomy unless they are very small.
c. If a hemopneumothorax is present, one chest tube should be placed in the superior part of the hemithorax to evacuate the air, and another should be placed in the inferior part of the hemithorax to remove the blood.
d. Iatrogenic pneumothorax is a type of traumatic pneumothorax that is becoming more common.