כירורגית בית החזה

The Overlooked Issue

Accumulation of air in the pleural space that leads to partial or total collapse of the affected lung.

Primary Spontaneous Pneumothorax (PSP) Secondary Spontaneous Pneuomothorax (SSP)

Young patient (10-30 years) Usually tall and thin Cigarette smoking Normal lung

Localized subpleural blebs (1-2 mm) : 90% upper lobes 10% lower lobes 80% by CT 75% by Surgery Normal lung Recurrence: 16%-54% I episode >83% II episode

No symptoms Symptoms

Sudden pleuretic chest pain Dyspnea Classic findings (PE): Diminished breath sound Hyperresonance Fremitus Normal findings

Respiratory Failure Pleural fluid 20% ( 3% Hemothorax) Empyema Tension pneumothorax (2%-3%)

Chest radiography CT is seldom required

Depend on: Size Stability of the patient Symptom complex Initial PSP onset or recurrent episode Presence/absence of structural lung disease

Rhea JT, DeLuca SA, Greene RE (1982) Belgian Society of Pneumology (2005) SEPAR (2008) British Thoracic Society (2010)

Small Px (3 cm) Asymptomatic Monitoring,Physical ex, Pulse oximetry, Repeated x-ray

0.9%-1.25% Intrapleural air absorbed daily

Larger Px Stable Patient Success Rate: PSP 66%-83% SSP 37%

Larger (tension) Px Symptomatic (PSP-SSP) PSP 90%,50%,15% Recommended only for definitive management of PSP of the first event

Recurrence Large or Persistent air-leak Incomplete lung expansion Bil. SP Occupations risk

It is all ways the size and the consistency that count…

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