Pneumothorax


PNEUMOTHORAX

Description:

The presence of free air or gas in the pleural cavity.

Terminology related to Pneumothorax.

    Artificial pneumothorax.

  • Catamenial pneumothorax.

  • Extrapleural pneumothorax.

  • Iatrogenic pneumothorax.

  • Open pneumothorax.

  • Pneumothorax simplex.

  • Pressure pneumothorax.

  • Spontaneous pneumothorax.

  • Tension pneumothorax.

  • Therapeutic pneumothorax.

  • Traumatic pneumothorax.

Alternative Names: Air around the lung; Air outside the lung

Your lungs and chest wall are both elastic. As you inhale and exhale, your lungs recoil inward while your chest wall expands outward. The two opposing forces create a negative pressure in the space between your rib cage and lung. When air enters that space, either from inside or outside your lungs, the pressure it exerts can cause all or part of the affected lung to collapse.

A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between your lungs and chest wall, creating pressure against the lung. Depending on the cause of the pneumothorax, your lung may only partially collapse, or it may collapse completely.

Other things can cause pneumothorax. Air can enter the mediastinum (the space in the center of the chest between the lungs), especially during an asthmatic attack, and then rupture into the pleural space, causing a pneumothorax. When a lung biopsy specimen is taken at the time of bronchoscopy or during thoracentesis (removal of fluid from the pleural space), the pleura lining the lung may be penetrated, causing a leak of air which may then cause a pneumothorax.

The major types of pneumothorax are:

    Open pneumothorax results when a penetrating chest wound enables air to rush in and cause the lungs to collapse.

  • Closed pneumothorax results when the chest wall is punctured or air leaks from a ruptured bronchus (or a perforated esophagus) and eventually ruptures into the pleural space.

  • Spontaneous pneumothorax occurs in a previously healthy individual with no prior trauma. This is thought to be due to rupture of a bleb (a blister containing air) on the surface of the lung. This spontaneous pneumothorax is most frequent in people under the age of 40.

  • Pulmonary barotrauma occurs when a patient whose lung function is being maintained mechanically may have air forced into the lungs, which may rupture the pleural space.

Symptoms:

Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is sharp and may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue are other symptoms of pneumothorax. The skin may develop a bluish color (termed cyanosis) due to decreases in blood oxygen levels.

Causes and Risk factors:

Sometimes pneumothorax occurs for no known reason. In such a case, the process is called spontaneous pneumothorax. This condition occurs most commonly among tall, thin men between the ages of twenty and forty. People with lung disorders are also subject to spontaneous pneumothorax. Emphysema (see emphysema entry), cystic fibrosis (see cystic fibrosis entry), and tuberculosis (see tuberculosis entry) are examples of such lung disorders.

Pneumothorax can also occur as the result of an accident or injury to the chest cavity. This type of pneumothorax is called traumatic pneumothorax. Certain kinds of medical procedures can cause traumatic pneumothorax. An example is the procedure known as thoracentesis. In thoracentesis, a large needle is inserted into the chest wall to remove fluids. Sometimes air accidentally enters the chest during this procedure. If so, traumatic pneumothorax can result.

The most serious type of pneumothorax is tension pneumothorax. Tension pneumothorax can be caused by injuries, such as a fractured rib, or by lung disease, such as asthma (see asthma entry), chronic bronchitis (see bronchitis entry), or emphysema. In this form of pneumothorax, a large amount of air gets into the chest cavity and cannot escape. It can cause the lung to collapse quickly. It can also push on the heart and its blood vessels. Without immediate treatment, tension pneumothorax can result in death.

Risk factors for pneumothorax include:

    Your Sex: In general, men are far more likely to have a pneumothorax than women are, though women can develop a rare form of pneumothorax (catamenial pneumothorax) related to the menstrual cycle.

  • Smoking: This is the leading risk factor for primary spontaneous pneumothorax. The risk increases with the length of time and the number of cigarettes smoked.

  • Age: Primary spontaneous pneumothorax is most likely to occur in people between 20 and 40 years old, especially if the person is very tall and underweight.

  • Lung disease: Having another lung disease, especially emphysema, makes a collapsed lung more likely.

  • A history of pneumothorax: If you've had one pneumothorax, you're at increased risk of another, usually within one to two years of the first episode. This may occur in the same lung or the opposite lung.

Diagnosis:

The diagnosis of pneumothorax is established from the patients' history, physical examination and, where possible, by radiological investigations. Adult respiratory distress syndrome, pneumonia, and trauma are important predictors of pneumothorax, as are various practical procedures including mechanical ventilation, central line insertion, and surgical procedures in the thorax, head, and neck and abdomen. Examination should include an inspection of the ventilator observations and chest drainage systems as well as the patient's cardiovascular and respiratory systems.

A pneumothorax is generally diagnosed using a chest X-ray. Other tests are sometimes performed, including:

    Computerized tomography (CT) scan: CT is an X-ray technique that produces more-detailed images than conventional X-rays do. This may be done if your doctor suspects a pneumothorax after an abdominal or chest procedure. A CT scan can help determine whether an underlying disease may have caused your lung to collapse — something that may not show up on a regular X-ray.

  • Blood tests: These may be used to measure the level of oxygen in your arterial blood.

  • Radiological diagnosis is normally confined to plain frontal radiographs in the critically ill patient, although lateral images and computed tomography are also important. Situations are described where an abnormal lucency or an apparent lung edge may be confused with a pneumothorax. These may arise from outside the thoracic cavity or from lung abnormalities or abdominal viscera inside the chest.

Treatment:

The goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to re-expand, and to prevent recurrences. The best method for achieving this depends on the severity of the lung collapse and sometimes on your overall health:

    Observation: If your lung is less than 20 percent collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the air is completely absorbed and your lung has re-expanded. Because it may take weeks for a pneumothorax to heal on its own, however, a needle or chest tube may be used to remove the air, even when the pneumothorax is small and nonthreatening.

  • Needle or chest tube insertion: When your lung has collapsed more than 20 percent, your doctor is likely to remove the air by inserting a needle or hollow tube (chest tube) into the space between your lungs and your chest wall. Chest tubes are often attached to a suction device that continuously removes air from the chest cavity and may be left in place for several hours to several days.

  • Other pneumothorax treatments: If you have had more than one pneumothorax, you may have treatments to prevent further recurrences.

A common surgical procedure is called video-assisted thoracoscopy, which uses small incisions and a tiny video camera to guide the surgery. In this procedure, two or three tubes are placed between your ribs while you're under general anesthesia. Through one of the tubes, the surgeon can observe with a fiberscope, while through the other tube, the surgeon attempts to close the air leak with surgical instruments. Rarely, when this doesn't work, a surgical procedure with an incision is necessary.

The chest tube remains in as long as necessary until the air in the pleural space is gone and doesn't recur when the chest tube is clamped and checked with an X-ray. Video-assisted thoracoscopy leads to less pain and a shorter recovery time than other types of surgery do because the chest cavity can be accessed without breaking any ribs.

Medicine and medications:

Medications commonly used to control pain and inflammation in adults with pneumothorax include:

Acetaminophen: Controls pain, but has no anti-inflammatory properties.

Nonsteroidal anti-inflammatory drugs:

  • Aspirin.

  • Ibuprofen.

  • Naproxen.

  • Ketoprofen.

Narcotic pain medications:

  • Require a doctor's prescription.

  • Generally reserved for moderate to severe pain or severe pain.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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