​Pathology - Pneumothorax

​Pathology - Pneumothorax
Etiology 
Primary spontaneous: Blunt or penetrating trauma resulting in subpleural bleb rupture
A secondary spontaneous complication (PCP, TB, CF, COPD) is a result of an earlier lung disease.
Tension lung infection; positive-pressure mechanical ventilation
The majority of spontaneous pneumothorax cases are in tall, skinny males who smoke.
Air in the pleural space causes the lung to compress and collapse.

Patients arrive with hypoxia, dyspnea, and chest pain.
Reduced breath sounds, less tactile fremitus, and lung hyperresonance to percussion on the pneumothorax side are all seen on physical examination.
Imaging features include deep sulcus sign (abnormally radiolucent costophrenic sulcus) on supine CXR, visceral pleural line on upright CXR, and tracheal deviation away from the side of the pneumothorax.

Handling 
Aspiration needles or chest tubes to drain pleural air; oxygen; stopping smoking; and, if necessary, surgical bleb resection to avoid future recurrence
In addition to air, other substances that can fill the pleural space include lymphatic fluid (chylothorax), inflammatory exudate (empyema), blood (hemothorax), and serous fluid (hydrothorax).
To reduce respiratory distress, these fluids might need to be emptied and the triggering circumstances addressed.