Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pneumothorax Polymyositis and Related Disorders 1189

Special Situations

■HIV infection and ptx: most often secondary to PCP; contralateral

recurrences common; high rate of recurrence with tube drainage

alone; pleurodesis recommended even without air leak (therapy

depends on underlying prognosis – outpatient care with small-bore

chest catheter and Heimlich valve is an alternative)

follow-up

■As needed for recurring symptoms; no routine follow up if CXR is

normal after removal of chest tube

complications and prognosis

Complications

■Acute complications

➣Tension ptx: progressive dyspnea and tachycardia, tracheal shift

away from and increasing tympany of affected side, HR>140,

hypotension, increased JVP, cyanosis.

➣Management: decompress immediately with transthoracic nee-

dle into affected side (waiting for CXR can be lethal)

➣Acute respiratory failure: assisted ventilation as needed

■Long-term complications

➣Failure to reexpand

➣Recurrence rates: healthy patients with primary spontaneous

ptx treated with observation, needle aspiration or chest tube

drainage∼30%; secondary spontaneous ptx recurrence rate 39–

47%; most occur within 6–24 months; asthenic habitus, smoking

history, younger age are independent risk factors for recurrence;

bullae not predictive of recurrence.

Prognosis

■Good in healthy patients with primary spontaneous ptx

■Poor in patients with AIDS (most die of AIDS-related complications

within 3–6 months of initial ptx), and COPD

POLYMYOSITIS AND RELATED DISORDERS

ROBERT WORTMANN, MD

history & physical

■Polymyositis (PM)

➣Insidious onset

➣Proximal (shoulder & pelvic girdle) muscle weakness