0071643192.pdf

THORACIC AND RESPIRATORY

DISORDERS

SPONTANEOUS AND IATROGENIC PNEUMOTHORAX

Pneumothorax is defined as the presence of air in the pleural space.

■ Spontaneous pneumothorax:Not caused by any obvious external factor
(eg, trauma)
■ 1 °spontaneous pneumothorax: No clinically apparent lung disease;
usually tall, thin males
■ 2 °spontaneous pneumothorax:Occurring in patients with underlying
pulmonary disease process (see Table 10.18)
■ Iatrogenic pneumothorax: The result of diagnostic (thoracentesis) or ther-
apeutic intervention (central venous catheter placement)

SYMPTOMS/EXAM

■ Most patients present with unilateral chest pain (either sharp or steady
pressure) and acute shortness of breath.
■ Patients with significant underlying lung disease may present with signifi-
cant distress, even with a small pneumothorax.

TABLE 10.17. Exudative Pleural Fluid Analysis and Interpretation

PLEURALFLUIDTEST INTERPRETATION

RBC count Grossly bloody or >100,000 cells/mm^3 suggests trauma,

malignancy, PE, pneumonia

Neutrophils >50% suggests acute pleural process (infection, PE).

Lymphocytes >50% suggests chronic pleural process (TB, malignancy)

Eosinophils Presence suggests air or blood in pleural space.

Glucose <60 mg/dL suggests a complicated parapneumonic effusion,

malignancy, ruptured esophagus, TB, or rheumatoid arthritis.

Triglycerides >110 mg/dL suggests chylothorax.

pH Pleural pH <7.2 with parapneumonic effusion indicates the

need for drainage.

TABLE 10.18. Common Causes of Secondary Spontaneous Pneumothorax

COPD (most common)

Asthma

Pneumonia (eg, PCP)

TB

Interstitial lung disease

Cystic fibrosis

Malignancy

Endometriosis