Pneumothorax With Soft Tissue Emphysema

Pneumothorax, the loss of air from the lung into the pleural space, is described as being spontaneous or traumatic in origin. The spontaneous pneumothorax (SP) can be further subdivided into primary (ie, no underlying pulmonary disease) and secondary (ie, related to underlying pulmonary pathology). The general pathologic mechanism of the development of SP occurs from either a visceral pleural tear from rupture of a sub-pleural bleb during normal breathing or from hyperinflation of the lung during bronchiolar obstruction resulting in excessive distal airway pressure with subsequent alveolar rupture. Multiple thoracoscopic studies have shown the existence of blebs and bullae in 48-100% of patients with SP. Potential causes for traumatic/iat-rogenic pneumothorax within the practice of anesthesia are often related to subclavian catheterization, positive pressure ventilation, supraclavicular nerve blocks, traumatic intubation, abrupt awakening with an endotracheal tube in place, and needle thoracentesis from a mis­diagnosed pneumothorax. canadian discount pharmacy