18 Pneumothorax
Background
Types of pneumothorax
• Open pneumothorax – an open communication between the outside world and the pleural cavity. This is a medical emergency which is often caused by penetrating trauma. Sealing the connection between the outside world and the pneumothorax converts it to a closed pneumothorax.
• Tension pneumothorax – requires immediate treatment as it is a life-threatening condition, which can lead to cardiovascular collapse. Tension pneumothorax is caused by a ‘one-way valve’ communication between the lung and pleura or outside world and pleura which allows air into but not out of the pleural cavity. This causes rapid build-up of air, which compresses adjacent vascular structures such as the superior vena cava. This reduces venous return to the heart and thus rapidly leads to cardiac arrest.
Tension pneumothorax is a clinical diagnosis. By the time a CXR has been arranged, the patient may be dead. If suspected it must be treated immediately. (See Figs 18.6–18.8.)
