08/0

4/20

23

Spontaneous Pneumothorax

By: Dr. IsmahReference: Management of spontaneous pneumothorax,

British Thoracic Society pleural disease guideline 2010

1

08/0

4/20

23

2

08/0

4/20

23

3

08/0

4/20

23

4

08/0

4/20

23

5

08/0

4/20

23

6

08/0

4/20

23

Suction• Not routinely used because may cause re expansion

pulmonary edema• Indicated when persistent air leak with or without incomplete

re-expansion of the lung after 48 hrs• High-volume low-pressure systems such as Vernon-Thompson

pumps or wall suction with low pressure adaptors

7

08/0

4/20

23

Bronchopleural fistula• Communication between the bronchial tree and pleural space.• Persistent air leak or a failure to re-inflate the lung despite

chest tube drainage for 24 h.• Chest drains inserted into the lung parenchyma• Management: - Large bore chest drains (multiple if necessary) and the use of

drainage system- Refractory cases surgical repair of the air leak by

thoracoplasty, lung resection/stapling, pleural abrasion/decortication

8

08/0

4/20

23

Thoracic surgeon

Indications for surgical advice: • Persistent air leak (despite 5 to 7 days of chest tube drainage)

or failure of lung re-expansion.• Synchronous bilateral spontaneous pneumothorax.• Professions at risk (eg, pilots, divers).• Pregnancy.• Second ipsilateral pneumothorax.• First contralateral pneumothorax.• Spontaneous haemothorax

9

08/0

4/20

23

Advice & f/up• Avoid air travel until 1 weeks post fully resolution• Avoid diving unless has undergone bilateral surgical

pleurectomy and has normal lung function and chest CT scan postoperatively

• Observation/ NA F/up in 2-4 weeks

10

08/0

4/20

23

THANK YOU 11

08/0

4/20

23

Tension Pneumothorax

12

08/0

4/20

23

13