Lec two

What is the definition of haemothorax?

a) Blood in the pleural cavity

b) Air in the pleural cavityAnswer: a

c) Fluid in the pericardium

d) Blood in the peritoneum

What is the definition of haemothorax?

a) Blood in the pleural cavity

b) Air in the pleural cavityAnswer: a

c) Fluid in the pericardium

d) Blood in the peritoneum

A

Which of the following defines massive haemothorax?

a) More than 500 mL of blood

b) More than 1500 mL of blood or 1/3 of blood volume

c) More than 1000 mL of blood or 1/4 of blood volume

d) More than 2000 mL of blood

Answer: b

What is the most common cause of traumatic haemothorax?

a) Pulmonary artery rupture

b) Intercostal or internal mammary vessel injury

c) Coagulation disorders

d) Tumors of the lungs

Answer: b

The usual source of bleeding in traumatic haemothorax is injury to the _______ or _______ vessels.

Answer: intercostal, internal mammary

True or False

Tumors and leaking aortic aneurysms are pathological causes of haemothorax.

Bleeding from a lung laceration is typically profuse in haemothorax.

True

False

Name three pathological causes of haemothorax.

Tumours of the lungs, pleura or mediastinum leaking aortic aneurysms, and coagulation disorders

Define massive haemothorax.

More than 1500 mL of blood or 1/3 of the patient’s blood volume in the pleural cavity.

راجع فهم الباثوفيسلوجي للهيمو ثوراكس

Cardiac&respiratory movment defibbrilate the blood

يعني هو ع الاغلب يبقى سائل بسب الحركة

يعني تخليه بوضع ال fluid state هاي عادة لكن يبقى معرض لأن يصبح clot ويتجلط الدم فهنا صعب نسحبه بال Aspiration من نعالج

⭕ الدم الموجود بالبلورا راح يصير Irretative فيخدش البلورا وينتج high or rich fluid effusion وfibrin ويصير بيه depostion بالبلورا بعدين يصيرله maturation فيصير fibrous layer طبقة ليفية بداخل البلورا فيسوي adhesion بين الطبقتين

⭕ بما انه الدم وسط زين حتى تتكاثر بيه البكتريا راح يصير عدناpus وEympaema

40-year-old male presents with blunt chest trauma following a car accident. He complains of severe chest pain and difficulty breathing. On examination, he is tachypneic and hypotensive (BP: 90/60 mmHg). Chest auscultation reveals diminished breath sounds on the left side, and percussion is dull.

Question:

What are the likely clinical features you expect to find in this patient?

a) Hyperresonance to percussion

b) Increased breath sounds on the affected side

c) Dullness to percussion with diminished breath sounds

d) Abdominal tenderness

Answer: c

A 45-year-old male presents with haemothorax following a stab wound to the chest. His initial blood loss is 1200 mL. The patient is hypotensive and requires intervention.

Question:

What is the first step in managing this patient?

a) Immediate thoracotomy

b) Intravenous fluids and analgesia

c) Insertion of an intercostal tube (ICT)

d) Surgical chest closure

Answer: c

A 50-year-old male develops increasing shortness of breath after the insertion of an ICT. A chest X-ray shows persistent fluid accumulation despite drainage. He begins to show signs of infection.

Question:

What is the most appropriate next step?

a) Continue antibiotics and observe

b) Reassess the placement of the ICT

c) Thoracotomy to evacuate clots and manage infection

d) Start fibrinolytic therapy

Answer: c

Indecations

⭕ المحروس باقي الshock مجاب يستجيب لا للفلود التعويضي ولا للblood

⭕ إذا اول سحبة بالچيست تيوب طلعت أكثر من 1500cc لازم اسويله عملية

وكذلك إذا بخلال المراقبة والobservation يعني خلال 2-3hours يطلع حوالي 200-300 ml هنا هم گبل للعمليات

⭕ إذا جان بالدم clot بالبداية ننطي اشياء تذوب الclot فننطيه streptokinase و trypsin إذا ذابت خير ع خير واذا بقت clot هنا بوجهك للعمليات

⭕ إذا جانت اكو إصابات أخرى مثل الbronchous, major b. V و diaphragm أو liver&spleen.

⭕ إذا جان اكو دم بالpericardium أيضا (الدنيا محترگة) يعني صاير يمه cardic temponade وبوجهك للعمليات ترا فصلهم مليارين.

الاندكيشن مالت الثوراكس العملية

Which is a conservative treatment for chylothorax?

a) Thoracic duct ligation

b) Antibiotics

c) Parenteral nutrition

d) Thoracotomy

Answer: c

Conservative management includes reducing _______ production by eliminating oral intake

If conservative treatment fails, _______ is the surgical option..

chyle

thoracic duct ligation

True or False

Chylothorax fluid is usually sterile on culture

Thoracic duct ligation is the first-line treatment for chylothorax.

3. Chylothorax can lead to systemic protein loss

T,F,T

Name one conservative treatment for chylothorax.

Parenteral nutrition to reduce chyle production.

What is the first step in managing chylothorax conservatively?

a) Thoracotomy

b) Eliminating oral intake and starting parenteral nutrition

c) Pleurodesis

d) Chest tube insertion

B

Scenario 1:

A 60-year-old male underwent esophageal cancer surgery. Two days later, he develops dyspnea. Thoracentesis reveals milky white fluid with high triglycerides. The patient is hemodynamically stable.

Question:

What is the first-line treatment?

a) Chest tube placement with pleurodesis

b) Immediate thoracic duct ligation

c) Conservative management with parenteral nutrition

d) Intravenous antibiotics

A 50-year-old man presents with persistent chylothorax despite 10 days of conservative management, including parenteral nutrition. Repeat thoracentesis confirms high triglyceride levels in pleural fluid.

Question:

What is the next step in treatment?

a) Switch to a low-fat diet

b) Thoracic duct ligation

c) Intravenous diuretics

d) Bronchopleural fistula repair

Answer: b

. A 50-year-old male develops a milky pleural effusion following esophageal surgery. The fluid has a high triglyceride content. What is the most likely diagnosis?

a) Empyema

b) Chylothorax

c) Hemothorax

B

Q: What is the characteristic appearance of pleural fluid in chylothorax?

Milky white appearance due to the presence of high triglycerides.

How does conservative management for chylothorax work?

It involves restricting oral intake and starting parenteral nutrition to reduce chyle production.

Rib fractures are rare in children because:

a) They have fewer ribs.

b) Their ribs are malleable.

c) They have a lower risk of chest trauma.

d) Their lungs are smaller.

Answer: b

Which ribs are least likely to fracture due to protection by the clavicle?

a) 11th and 12th ribs

b) 1st and 2nd ribs

c) 5th and 6th ribs

d) Floating ribs

B

What is the most common complication of rib fractures in elderly patients?

a) Pneumothorax

b) Atelectasis and pneumonia

c) Haemothorax

d) Chest wall deformity

Answer: b

Rib fractures are common and potentially deadly in the _______ due to their rigid, non-malleable ribs.

2. _______ ribs (11th and 12th) rarely fracture because they are mobile and not attached to the sternum.

Hypoventilation from rib fracture pain can lead to _______ and _______.

elderly

Floating

atelectasis, pneumonia

True or False

Pneumothorax is a rare complication of rib fractures.

Direct trauma can cause inward displacement of fractured ribs, leading to visceral injury.

True

True

What is the progression of complications from rib fractures in the elderly?

Pain → hypoventilation → atelectasis → pneumonia.

An elderly patient presents with rib fractures after a fall. He develops fever and difficulty breathing after a few days. Chest X-ray shows consolidation in the lower lobe.

Question:

What is the most likely complication of rib fractures in this patient?

a) Pulmonary embolism

b) Pneumothorax

c) Pneumonia and atelectasis

d) Flail chest

Answer: c

Indirect trauma: by compression of the chest (burst fracture). The ribs usually break at the angles, and since the broken ends are driven outwards, visceral injury is uncommon(t,f)

T

A 60-year-old man presents with chest pain following a fall. He has multiple rib fractures and complains of increasing difficulty breathing. Physical examination reveals paradoxical chest wall movement, with the fractured segment moving inward during inspiration.

Question:

Which clinical finding is indicative of flail chest in this patient?

a) Crepitus over the rib fractures

b) Paradoxical chest wall movement

c) Hyperventilation

d) Hyperresonance on percussion

Answer:

B

A 30-year-old male with flail chest is experiencing severe respiratory distress. He is hypoxic and requires immediate intervention.

Question:

What is the most appropriate management for this patient?

a) Pain management with an intercostal nerve block and observation

b) Endotracheal intubation with mechanical ventilation

c) Non-invasive positive pressure ventilation

d) Intercostal chest tube placement

B

الFlail chest كلش مهم تعريفه

هو كسر ب 2 أو أكثر من أضلاع متتالية ركزوا لازم متتالية وكل ضلع من هالاضلاع المتتالية بيه كسرين أو ٣

-راح يعاني الشخص هنا من paradoxical respiration يعني من حركة صدره بالتنفس عكس الحركة الطبيعية (ينزل بالشهيق ويصعد بالزفير)

⭕ الstove نفسه بالضبط لكن هنا اكو خسفة تصير بال chest wall الأضلاع تنزل جوا للداخل.

شرح

⭕ ألم يتداخل وي التنفس

⭕ paradoxical respiration حركة عكسية للصدر وي التنفس عكس الطبيعي

⭕ الأضلاع تدخل ليجوا بالشهيق وبالزفير ترجع.

⭕ راح تقلل الvenus return وتقلل الtidle volume

⭕ راح المدستاينم يروح ويرجع وي التنفس

⭕ من تدخل الأضلاع أو ال flail segment جوا راح يأثر ع الlung. وما ينطيها مساحة للexpantion فراح الشخص يتنفس هواء deoxygenaged وينتهي الشخص بالRes. Failure.

fliat Chest

Flail chest is defined as:

a) Single rib fracture with lung laceration

b) Two or more consecutive ribs fractured in two or more places

c) Pneumothorax with rib fractures

d) Rib fractures involving the sternum

B

Paradoxical respiration in flail chest is characterized by:

a) Normal outward movement during inspiration

b) Inward movement of the flail segment during inspiration

c) Complete cessation of movement of the chest wall

d) Bilateral chest wall expansion

B

Which investigation is critical in diagnosing flail chest?

a) Chest X-ray

b) ECG

c) CT scan

d) Blood gas analysis

A

2. _______ respiration occurs when the flail segment moves inward during inspiration and outward during expiration.

Pain relief in flail chest is essential to avoid _______ and respiratory failure.

Paradoxical

hypoventilation

True or False

Flail chest can result from blunt chest trauma.

Pain management is not a priority in treating flail chest.

Surgical stabilization of the flail segment is rarely required.

True

False

.

What is paradoxical respiration in flail chest?

Inward movement of the flail segment during inspiration and outward during expiration.

: What is the primary investigation for flail chest?

Chest X-ray.

إذا اجاني للطوارئ هيج حالة شادوس؟

📌أبدي بال ABC

⭕ اول شي اثبت الFlial segment بمكانها من خلال انه اخلي ايدي ع صدر المريض واضغط ع الاقل انطي مجال لل lung الما متأذية حتى تتنفس واذا الإصابة بجهتين هم اطبق هالحركة هم ح انطي مجال للرئات المتأذية تعين نفسها

⭕ لازم أوقف الparadoxical movment

⭕ إذا كبير بالعمر والحالة sever لازم يخلوله intertracheal tube ونسوي ippB احنا ندفع هوا للرئة ونسحبه يعني

هاي الطريقة تسوي تثبيت داخلي لل flial seg. طبعا نخليه 10 ايام إذا ما فاد اسويله treachostomy لأن ال tube ممكن يسويلي. Laryngeal oedema ونفقد المريض

⭕ إذا اكو اندكيشن للثوراكواكتومي وهم عدنا flail هنا لازم اثبت ب steel wire

⭕ اهم شي pain control +O2 لأن الألم كلش قوي واختناق

⭕ ننطي ستيرويد وانتيبايوتك أيضا.

ع كلبه احفظي

إذا اجاني للطوارئ هيج حالة شادوس؟

📌أبدي بال ABC

⭕ اول شي اثبت الFlial segment بمكانها من خلال انه اخلي ايدي ع صدر المريض واضغط ع الاقل انطي مجال لل lung الما متأذية حتى تتنفس واذا الإصابة بجهتين هم اطبق هالحركة هم ح انطي مجال للرئات المتأذية تعين نفسها

⭕ لازم أوقف الparadoxical movment

⭕ إذا كبير بالعمر والحالة sever لازم يخلوله intertracheal tube ونسوي ippB احنا ندفع هوا للرئة ونسحبه يعني

هاي الطريقة تسوي تثبيت داخلي لل flial seg. طبعا نخليه 10 ايام إذا ما فاد اسويله treachostomy لأن ال tube ممكن يسويلي. Laryngeal oedema ونفقد المريض

⭕ إذا اكو اندكيشن للثوراكواكتومي وهم عدنا flail هنا لازم اثبت ب steel wire

⭕ اهم شي pain control +O2 لأن الألم كلش قوي واختناق

⭕ ننطي ستيرويد وانتيبايوتك أيضا.

Chest X-ray—to identify the fracture segment. _ Blood grouping. _ Arterial PO2 and PCO2

 Treatment:

 First Aid: Stabilize flail segment: by applying pressure over it using hand or clothes (it is often lifesaving), it makes other lung function adequately.and this is the main treatment if flial segment is small.

 In patient with severe paradoxical respiration (especially in elderly), the best policy is to introduce an endotracheal tube and start intermittent positive pressure breathing (IPPB), which will lead to internal stabilization of the flial segment. If the period that required is more than 10 days, it is preferable to do a tracheostomy to avoid laryngeal stenosis due to prolonged endotracheal intubation.

 If there is an indication for thoracotomy, the fractured ribs may be secured by stainless steel wires or by nails. This will accelerate the patient's recovery.

 Pain relief (by strong i.v. analgesic or intercostal nerve block) is essential  Other supportive measures (O2, antibiotics, bronchodilators, judicious i.v.fluid and steroid

What is the primary mechanism of cardiac tamponade?

a) Blood in the peritoneal cavity

b) Hemorrhage into the pericardial sac, impairing ventricular filling

c) Pneumothorax causing lung collapse

d) Fluid in the pleural cavity

: b

Which of the following is part of Beck's triad?

a) Hypotension, diminished breath sounds, and chest pain

b) Distended neck veins, muffled heart sounds, and hypotension

c) Hyperventilation, chest pain, and distended neck veins

d) Cyanosis, hypoventilation, and muffled heart sounds

Answer: b

Which investigation is most effective in diagnosing cardiac tamponade?

a) ECG

b) Chest X-ray

c) FAST ultrasound

d) CT scan

Answer: c

2. _______ triad includes distended neck veins, muffled heart sounds, and hypotension

3. The primary diagnostic tool for cardiac tamponade is _______.

Beck’s

FAST ultrasound

True or False

Pulsus paradoxus is a rise in systolic blood pressure during inspiration.

Cardiac tamponade can result from blunt or penetrating chest trauma.

Emergency thoracotomy is rarely required in cardiac tamponade.

F,T,F

Q: What is the first step in managing cardiac tamponade?

Oxygen, IV access, cardiac monitoring, and consider pericardiocentesis.

What type of trauma commonly causes pulmonary contusion?

a) Penetrating chest trauma

b) Blunt chest trauma

c) Crush injuries

d) Iatrogenic injury

: b

Pulmonary contusion is characterized by:

a) Rib fractures

b) Air-fluid levels on X-ray

c) Capillary disruption and fluffy infiltrates on X-ray

d) Mediastinal widening

Answer: c

What is the usual duration of mechanical ventilation required in significant pulmonary contusion?

a) 1-2 days

b) 2-3 days

c) 5-7 days

d) >10 days

Answer: b

The hallmark of pulmonary contusion on X-ray is a _______ infiltrate appearing 24-48 hours after injury.

pulmonary contusion may require mechanical _______ for 48-72 hours.

fluffy

ventilation

True or False

Pulmonary injuries often heal spontaneously without surgical intervention.

Pulmonary contusion is caused by penetrating trauma in most cases.

A pulmonary contusion appears immediately on chest X-ray after trauma.

T ,f,f

Which hemidiaphragm is more prone to rupture?

a) Right

b) Left

c) Both equally

d) None

Answer: b

Traumatic aortic rupture is often caused by:

a) Penetrating trauma

b) Deceleration injuries

c) Blunt abdominal trauma

d) Crush injuries

Answer: b

What is the cardinal sign of traumatic aortic rupture on chest X-ray?

a) Pneumothorax

b) Mediastinal widening

c) Air-fluid level

d) Rib fractures

Answer: b

1. Diaphragm rupture is most commonly caused by _______ trauma or crush injuries.

Traumatic aortic rupture often results in a localized _______ aneurysm.

penetrating

false

Interstitial emphysema is caused by:

a) Air entering the pleural cavity

b) Air spreading into the mediastinum and subcutaneous tissues

c) Hemothorax

d) Blunt trauma

Answer: b

What is a common sign of interstitial emphysema?

a) Subcutaneous swelling

b) Air-fluid level on X-ray

c) Lung collapse

d) Rib fractures

Answer: a

Treatment of interstitial emphysema typically involves:

a) Emergency thoracotomy

b) Observation and stopping the air leak

c) Mechanical ventilation

d) Antibiotics

Answer: b

Interstitial emphysema is caused by disruption of the _______ tract or esophagus.

Air spreads into the _______ and subcutaneous spaces during interstitial emphysema.

respiratory

air leak

The appearance of the patient can be distorted in interstitial emphysema.TorF

True

A 28-year-old male is brought to the ED following blunt chest trauma from a car accident. He is hypoxic (O2 sat: 88%) and tachypneic. Chest X-ray 24 hours later reveals patchy infiltrates.

Question:

What is the most likely diagnosis?

a) Pulmonary embolism

b) Pulmonary contusion

c) Acute respiratory distress syndrome

d) Hemothorax

B

A patient with a known pulmonary contusion from blunt trauma develops worsening hypoxia and CO2 retention despite oxygen therapy.

Question:

What is the best management approach?

a) Start mechanical ventilation with PEEP

b) Perform emergency thoracotomy

c) Insert an intercostal chest tube

d) Initiate bronchodilator therapy

Answer: a

A 40-year-old man presents with blunt trauma to the chest after a fall from height. Chest X-ray reveals widening of the mediastinum, and a CT aortogram confirms a localized aortic aneurysm.

Question:

What is the next best step?

a) Emergency thoracotomy

b) Conservative management with antihypertensives

c) Endovascular repair of the aorta

d) Observation with serial imaging

Answer: c

Scenario 2:

A patient presents with shortness of breath and subcutaneous crepitus after blunt chest trauma. Chest X-ray shows interstitial emphysema without pneumothorax.

Question:

What is the recommended treatment?

a) Immediate chest tube placement

b) Emergency thoracotomy

c) Supportive care with oxygen therapy

d) Surgical repair of the air leak

Answer: c

A 35-year-old male is involved in a high-speed car accident and has widening of the mediastinum on chest X-ray. What is the most likely diagnosis?

a) Pneumothorax

b) Traumatic aortic rupture

c) Pulmonary contusion

d) Hemothorax

B

A patient presents with subcutaneous crepitus after blunt chest trauma. A CT scan reveals air in the mediastinum and subcutaneous tissue. What is the most likely diagnosis?

a) Pneumothorax

b) Interstitial emphysema

c) Pulmonary contusion

d) Flail chest

B

What is the most common complication of diaphragm rupture following blunt trauma?

a) Pneumonia

b) Herniation of abdominal contents

c) Atelectasis

d) Hemothorax

B

Which of the following is the best incision for an emergency thoracotomy in a hemodynamically unstable trauma patient?

a) Posterolateral thoracotomy

b) Anterolateral thoracotomy

c) Median sternotomy

d) Midlateral thoracotomy

B

. A patient undergoing pulmonary resection requires access to the posterior mediastinum and lung. What is the preferred incision?

a) Anterolateral thoracotomy

b) Posterolateral thoracotomy

c) Median sternotomy

d) Midlateral thoracotomy

B

What is a major advantage of midlateral thoracotomy over other approaches?

a) Faster access to the chest

b) Less postoperative pain due to minimal muscle division

c) Better access to anterior mediastinal structures

d) Suitable for trauma and resuscitation

B

Q: For which surgical procedures is a posterolateral thoracotomy most commonly used?

A: Pulmonary resections, esophageal surgeries, and access to the posterior mediastinum.

1. In a patient with haemothorax, where should an intercostal tube be placed for optimal drainage?

a) 2nd intercostal space, midclavicular line

b) 4th intercostal space, midaxillary line

c) 5th intercostal space, midaxillary line

d) 6th intercostal space, midclavicular line

C

What is the primary complication of incorrect ICT placement?

a) Increased pleural effusion

b) Pneumothorax

c) Injury to the neurovascular bundle

d) Infection

Answer c

3. After ICT placement, the chest tube fails to drain and the patient’s condition worsens. What is the next best step?

a) Reassess tube placement with a chest X-ray

b) Perform thoracotomy immediately

c) Replace the chest tube without imaging

d) Start IV antibiotics

A

A 55-year-old male with a history of traumatic chest injury is brought to the emergency department. After evaluation, he is diagnosed with a hemothorax and severe rib fractures. The patient is in shock and requires rapid access to the chest for immediate drainage and repair.

Question:

What is the preferred incision for this patient in an emergency setting?

a) Median sternotomy

b) Posterolateral thoracotomy

c) Anterolateral thoracotomy

d) Midlateral thoracotomy

C

A 40-year-old woman is undergoing surgery for a lung resection due to a malignant tumor. The surgeon plans to access the posterior part of the lung and mediastinal structures for the procedure.

Question:

Which thoracotomy incision is most appropriate for this surgery?

a) Anterolateral thoracotomy

b) Posterolateral thoracotomy

c) Midlateral thoracotomy

d) Median sternotomy

B

A patient is undergoing a routine pulmonary procedure where minimal muscle division is needed for quick access. The goal is to avoid significant postoperative pain and allow for faster closure.

Question:

What type of thoracotomy incision should be used for this patient?

a) Anterolateral thoracotomy

b) Posterolateral thoracotomy

c) Midlateral thoracotomy

d) Median sternotomy

C

A 65-year-old male with a history of coronary artery disease presents with chest pain and a suspected anterior mediastinal mass. After imaging studies, it is confirmed that the mass is a benign tumor located in the anterior mediastinum.

Question:

What is the most appropriate incision for this procedure?

a) Anterolateral thoracotomy

b) Posterolateral thoracotomy

c) Midlateral thoracotomy

d) Median sternotomy

D

A 50-year-old male presents with a stab wound to the right chest. Examination reveals absent breath sounds on the right side and dull percussion. Chest X-ray confirms a haemothorax. An intercostal tube is placed in the 5th intercostal space, draining 1200 mL of blood.

Question:

What is the appropriate next step in management?

a) Continue monitoring the drainage and repeat chest X-ray

b) Perform thoracotomy immediately

c) Insert a second chest tube

d) Start systemic anticoagulation therapy

A

A 60-year-old male has an intercostal tube inserted for haemothorax. After 6 days, the chest X-ray shows complete lung expansion, and the tube has stopped draining.

Question:

What is the next step?

a) Remove the intercostal tube and seal the site

b) Leave the tube in place for another 2 days

c) Repeat thoracentesis to confirm no residual fluid

d) Administer fibrinolytic agents through the tube

Answer: a

A patient with an intercostal tube in the 6th intercostal space for empyema develops fever, purulent drainage, and pain at the tube site. On examination, there is erythema and swelling around the tube insertion point.

Question:

What is the most appropriate next step?

a) Remove the tube immediately and administer antibiotics

b) Replace the tube and start systemic antibiotics

c) Perform surgical debridement of the site

d) Continue observation and local wound care

B

The intercostal tube is placed above the rib to avoid injury to the _______.

For pneumothorax, the intercostal tube is inserted in the _______ intercostal space, midclavicular line.

The underwater seal in intercostal drainage prevents _______ of air or fluid into the pleural cavity.

4. A painful intercostal tube may indicate it is abutting the _______ or mediastinum.

neurovascular bundle

2nd or 3rd

backflow

lung

True or False

Intercostal tubes are removed when the pleural cavity contents are expelled, and lung expansion is confirmed by chest X-ray.

The "safe triangle" for ICT placement minimizes the risk of injuring major organs and vessels.

3. ICT placement is never indicated for haemothorax.

Displacement of the intercostal tube can lead to inadequate drainage and recurrent pleural fluid accumulation.

T,t,f,t

Intercostal space draing indicates

Pneumothorax  Haemothorax  Haemopneumothorax  Empyema  After thoracotom

If there is bronchopleural fistula, ICT should be placed for a longer time, until the fistula heals.(t,f)

T

chest tube removal:

Usually for pneumothorax, ICT is kept for …….days. For haemothorax and pyothorax it is kept for ……. days or until it stops draining and lung expansion is confirmed by repeat chest X-ray.i

2-3

4-6