Souheil M. Abdel Nour, MD Moderator: Thomas Roy, MD Pulmonary and Critical Care East Tennessee State University Diagnosis and Treatment of Pneumothorax.

Souheil M. Abdel Nour, MD Moderator: Thomas Roy, MD Pulmonary and Critical Care East Tennessee State University Diagnosis and Treatment of Pneumothorax

Disclosure Statement of Financial Interest. I DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

Definitions Primary Spontaneous Pneumothorax (PSP) No underlying lung disease Secondary Spontaneous Pneumothorax (SSP) Complication of underlying lung disease Traumatic Pneumothorax Caused by penetrating and or blunt trauma Iatrogenic Pneumothorax Complication of diagnostic or therapeutic intervention

Prognosis Prognosis varies among the pneumothorax classifications Recurrence rate is about 28% for PSP and 43% for SSP over a period of 5 years. Mortality rate of 1-17% in patients with COPD 5% of patients with COPD died before a chest tube was placed Patients with AIDS: inpatient mortality rate of 25% and a median survival of 3 months after the pneumothorax. Difficult Decisions in Thoracic Surgery: An Evidence- based Approach, By Mark K. Ferguson. 2nd ed. 2011

Prognosis The overall mortality was 1.26 per million per year for males and 0.62 per million per year for females. Epidemiology of pneumothorax in England.Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Thorax. 2000 Aug; 55(8):666-71.

Primary Spontaneous Pneumothorax (PSP) No precipitating event No known lung disease Actually most PSP have unrecognized lung disease (subpleural bleb) The incidence: men 7.4 (USA) - 37 (UK) per 100,000 population per year Women

Matching?! 1. Pneumatocoele 2. Cavity 3. Cyst 4. Bleb 5. Bulla a) Thin-walled (< 1mm), gas-filled space in the lung developing in association with acute pneumonia b) Intrapleural cystic space c) Thin-walled, air- or fluid-filled, with a wall that contains respiratory epithelium, cartilage, and smooth muscle d) Thin-walled( 1 mm thick

Air-containing Structures Pneumatocoele: Thin-walled (< 1mm), gas-filled space in the lung developing in association with acute pneumonia, such as staph, and frequently transient Cavity: Gas-containing space in the lung having a wall > 1 mm thick Cyst: Thin-walled, air- or fluid-filled, with a wall that contains respiratory epithelium, cartilage, smooth muscle and glands Bleb: Intrapleural cystic space Bulla 2 bullae (pronounced bully): Thin-walled(

Souheil M. Abdel Nour, MD Moderator: Thomas Roy, MD Pulmonary and Critical Care East Tennessee State University Diagnosis and Treatment of Pneumothorax.

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