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75: PNEUMOTHORAX

Eric Shamus, PhD, DPT, PT, CSCS; Lindsey (Davis) Hornecke, DPT

CONDITION/DISORDER SYNONYMS

  • Collapsed lung

  • Pneumothoraces (plural form of disorder)

  • Spontaneous pneumothorax

  • Tension pneumothorax

  • Traumatic pneumothorax

ICD-9-CM CODES

  • 512.0 Pneumothorax and air leak

  • 860 Traumatic pneumothorax and hemothorax

  • Associated physical therapy diagnoses

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

ICD-10-CM CODES

  • J93.0 Spontaneous tension pneumothorax

  • J93.11 Primary spontaneous pneumothorax

  • J93.12 Secondary spontaneous pneumothorax

  • J93.81 Chronic pneumothorax

  • J93.82 Other air leak

  • J93.83 Other pneumothorax

  • J93.9 Pneumothorax, unspecified

  • J95.811 Postprocedural pneumothorax

  • J95.812 Postprocedural air leak

  • S21.309A Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, initial encounter

  • S27.0XXA Traumatic pneumothorax, initial encounter

  • S27.1XXA Traumatic hemothorax, initial encounter

  • S27.2XXA Traumatic hemopneumothorax, initial encounter

PREFERRED PRACTICE PATTERNS1

  • 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders

  • 6B Impaired Aerobic Capacity/Endurance Associated with Deconditioning

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction

  • 6F: Impaired Ventilation and Respiration/Gas Exchange Associated with Respiratory Failure

FIGURE 75-1

Tension pneumothorax with collapse of right lung field and deviation of heart and trachea. (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 68-year-old male presents with complaints of shortness of breath and chest pain. His chest pain is worse while coughing and deep breathing. His symptoms began after a motor vehicle accident 8 weeks ago. Chest x-ray revealed two broken ribs, which most likely occurred when the air bag deployed. He has chronic obstructive pulmonary disease (COPD) and a history of cigarette smoking, which he has quit 3 months ago.

After his ribs have healed, his primary care physician refers him to physical therapy. The physician tested his pulmonary function and noted he has decreased vital capacity and total lung capacity and increased residual volume. Physical therapy examination reveals postural abnormalities of rounded shoulders, forward head, and increased thoracic kyphosis. His scalene musculature is shortened and rope like on palpation. The PT also notices he mostly uses his accessory muscles for normal breathing. He ambulated 450 m on a 6-minute walk test.

FIGURE 75-2

Pneumothorax involving 40% of lung field. (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Collapsed lung occurs from air in the region around the lung

  • Pressure on the lung prevents expansion of the lung with inhalation

  • Chest pain with breathing

Essentials of Diagnosis

  • Spontaneous pneumothorax (PTX) can occur with no etiology

  • Focal area of absent ...

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