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TENSION PNEUMOTHORAX
Pediatric Respirology Division
Helmi Lubis
Ridwan M. Daulay
Wisman Dalimunthe
Rini S. Daulay

Pneumothorax
Abnormal collection of air in the
pleural space outside of the lung
Air enter the pleural space by a leak
in either the visceral or parietal
pleura

Classification of Pneumothorax:
Spontaneous:
Primary
Secondary
Traumatic
Iatrogenic

Spontaneous Pneumothorax
Primary occurs without trauma or
underlying lung disease
Secondary complication of
underlying lung disorder:
Pneumonia
Pulmonary abscess
Asthma
Foreign body in the lung

Traumatic Pneumothorax
Result of blunt or penetrating trauma
to the chest wall
Injury from a diagnostic or
therapeutic procedure Iatrogenic
Pneumothorax

Iatrogenic Pneumothorax
Complicate of:
Tracheostomy
Thoracentesis
Transbronchial byopsi

Catamenial Pneumothorax
Unusual condition
Associated with menses

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Clinical Manifestations
Sudden onset of chest pain
Tachypnea
Dyspnea
Tachycardia
Cyanosis

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Phisical Examination
Involved lung:
Decreased breath sounds
Percussion: hyperresonance

Larynx, trachea and heart shifted


toward unaffected side
Gurgling sounds synchronous with
respiration open fistula connecting
with air containing tissues

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Diagnosis
Radiographic examination:
Chest X Ray AP and lateral:
Air in the pleural space outlining the
visceral pleura/pleura line
Hyperlucency
Attenuation of vascular & lung marking on
the affected side

CT of the chest:
Detect bullae & blebs recurrent
Pneumothorax

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Tension Pneumothorax ???

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Inspiration air enter the pleural


space
Exhalation air can not exit
Lead to collapse of the affected lung &
shift of mediastinum away from the
affected side

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Evidence of tension:
Shift of mediastinal structure away
from the side of air leak
Basis of evidence of:
Circulatory compromise
Hearing ahiss or rapid exit of the
air with the insertion of
thoracostomy tube

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Tension Pneumothorax causes:


Limit expansion of contralateral lung
May compromise venous return

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Definitive Treatment

Closed thoracotomy:
Drainage trapped air through a catheter
External opening in a dependent
position under water adequate to reexpand the lung
Open thoracotomy:
Plication of blebs
Closure of fistula
Stripping of the pleura apical lung

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Chemical pleurodesis:
Talc
Tetracycline
Silver Nitrate
Pleural pain analgetic treatment

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