Pneumothorax

2021-07-22 12:50 PM

Pneumothorax can be caused by trauma to the chest, certain medical procedures involving the lungs, lung disease, or it can happen for no apparent reason.

Define

Pneumothorax occurs when air leaks into the space between the lungs and ribcage, creating pressure on the lungs. Depending on the cause of the pneumothorax, the lung may only partially collapse, or it may collapse completely.

Pneumothorax can be caused by trauma to the chest, certain medical procedures involving the lungs, lung disease, or it can happen for no apparent reason.

Small, uncomplicated pneumothorax can quickly heal on their own, but when the pneumothorax is larger, excess air is usually removed by inserting a tube or needle between the ribs and slowly removing the air for a few days.

Pneumothorax: Collapsed lung and Pleural layer

Symptoms

Signs and symptoms of pneumothorax typically include:

Sudden sharp chest pain on the top side of the affected lung - pain does not occur in the center of the chest.

Shortness of breath, which can be more or less severe, depending on how much the lung is collapsed.

Chest tightness.

Fast heartbeat.

If only a small amount of air enters the space between the lungs and chest (pleural space), there may be few signs or symptoms. However, even a slightly collapsed lung can cause chest pain and shortness of breath, some slowly improving over a few hours to a day or so, even with no reduction in the size of the collapsed lung.

See your doctor right away if you have sudden chest pain and shortness of breath. Many other problems with pneumothorax can cause these symptoms, and most require an accurate diagnosis and prompt treatment. If chest pain is severe or breathing becomes increasingly difficult, get emergency care right away.

Symptoms, causes, treatment of Pneumothorax

Causes

The lungs and thorax are elastic. During inhalation and exhalation, air enters the lungs while the chest expands outward. The two opposing forces create a negative pressure in the space between the ribs and the lungs. As air enters, either from inside or outside the lung, the resulting pressure can cause all or part of the lung to be affected leading to collapse.

There are several types of pneumothorax, defined by what causes them:

Spontaneous small pneumothorax

Spontaneous pneumothorax is thought to develop when a small air bubble at the top of the lung ruptures. It is due to weak lung tissue and can rupture from changes in air pressure while scuba diving, flying, climbing, or according to some reports - listening to extremely loud music. In addition, spontaneous pneumothorax can occur during marijuana smoking, after deep inhalation, followed by slow exhalation with partial lip closure. But most commonly, breaks for no apparent reason.

Genetic factors may play a role in spontaneous pneumothorax because this condition can happen in families. Spontaneous pneumothorax is usually mild because the pressure from the collapsed parts of the lung increases year on year.

Secondary pneumothorax

Develops in people who already have lung disorders, especially emphysema, which gradually damages the lungs. Other conditions that can lead to secondary pneumothorax include tuberculosis, pneumonia, cystic fibrosis, and lung cancer. In these cases, pneumothorax occurs because of diseased lung tissue adjacent to the pleural space.

Secondary pneumothorax can be more severe and even life-threatening because diseased tissue can open a wider hole, allowing more air into the pleural space than a minor rupture. In addition, people with lung disease have reduced lung reserve, which further reduces lung function. Secondary pneumothorax almost always requires a chest tube for treatment.

Pneumothorax after trauma

Any wound or trauma to the chest can cause atelectasis. Knife wounds and gunshot wounds, a blow to the chest can cause a pneumothorax. Accidental injury can occur during certain medical procedures, such as chest tube placement, cardiopulmonary resuscitation (CPR), and lung or liver biopsies.

Tension pneumothorax

The most severe type of pneumothorax occurs when the pressure in the pleural cavity is greater than atmospheric pressure, either because air is trapped in the pleural space or because air enters from a positive pressure of mechanical ventilation. The force of ventilation can cause complete atelectasis. It can also push towards the normal side. Tension pneumothorax comes on suddenly, progresses rapidly, and is fatal if not treated quickly.

Risk factors

Risk factors for pneumothorax include:

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

Smoke. This is the leading risk factor for spontaneous pneumothorax. The risk increased with the length of smoking and the number of cigarettes smoked.

Age. Spontaneous pneumothorax can occur in people between the ages of 20 and 40, especially if the person is very tall and underweight.

Lung disease. People having lung disease, especially emphysema are more likely to have atelectasis.

History of pneumothorax. If you've had one pneumothorax, there's an increased risk of another, usually within the first 1-2 years.

Complications

Complications that can result from spontaneous or post-traumatic pneumothorax include

Occur again periodically. Nearly half of people who have had a pneumothorax have a recurrence, usually within the first three years.

Air is constantly leaking. Although a drain is inserted to draw air out, sometimes air can continue to leak if the opening positions in the lung do not close. After a few days to a week or more, surgical closure of the air leak may be necessary.

Complications of tension pneumothorax are more serious and include

Low blood oxygen levels (hypoxia). Because the cause of a pneumothorax causes tension or collapse and can compress the lungs, less air is present in the spectrum and less oxygen enters the bloodstream. As a result, blood oxygen is lower than normal blood oxygen. Lack of oxygen can disrupt the body's basic functioning, and in severe cases can be life-threatening.

Heart compression. If continued, the increasing pressure can push on the heart and blood vessels, compressing both the healthy lungs and the heart. Tension pneumothorax can affect the return of blood to the heart and lead to a sudden loss of cardiac function. Cardiac tamponade is fatal if not treated immediately.

Respiratory failure. This happens when the level of oxygen in the blood falls too low, and the level of carbon dioxide becomes too high. Severely low blood oxygen can lead to arrhythmias and unconsciousness, and high carbon dioxide levels cause confusion, drowsiness, and coma. Ultimately, respiratory failure can be fatal.

Shock. This critical condition occurs when blood pressure drops very low and the vital organs of the body are deprived of oxygen and nutrients. Shock is a major medical emergency and requires immediate care.

Tests and diagnostics

Pneumothorax is usually diagnosed by X-ray. Other tests are sometimes taken, including:

Computed tomography (CT scan). CT is an X-ray technique that produces more detailed images than conventional X-rays. 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 be causing the atelectasis - something that may not show up on a regular X-ray.

Blood tests. Can be used to measure the level of oxygen in arterial blood.

Treatments and drugs

The goals in treating pneumothorax are to relieve pressure on the lung, allowing it to re-expand, and prevent a recurrence. The best method to achieve this depends on the severity of the atelectasis and sometimes on overall health:

Observe. If the lung collapse is less than 20 percent, the doctor may simply monitor the condition with a series of chest X-rays until the air is completely absorbed and the lung has re-expanded. Because it can take weeks for a pneumothorax to heal on its own, however, a chest syringe can be used to remove air, even if the pneumothorax is small and not threatening.

Needle tube or chest tube. When the lung has collapsed more than 20 percent, the doctor can remove the air by inserting a needle, hollow tube into the space between the lung and the ribcage. The needle tube is usually attached to a continuous suction device to remove air from the chest cavity and can be left in place for several hours to several days.

Pneumothorax treatments: Removing the air by a needle tube

Figure: Removing the air by a needle tube

Other treatments for pneumothorax. If there has been more than one pneumothorax, other treatments may be available to prevent a recurrence.

The common surgical procedure is called laparoscopic surgery, which uses a small incision and a small video camera to guide the surgery. In this section, two or three tubes are placed between the ribs during general anesthesia. Through one of the tubes, the surgeon can observe with the fiberscope, through the other tubes, the surgeon tries to close the air fistula. Rarely does this fail, surgery with an incision is necessary.

The ducts are still needed until the air in the pleural space has disappeared and has not recurred when the chest catheters are clamped and examined with radiographs. Laparoscopic surgery is less painful and has a shorter recovery time than open thoracotomy.

Prevention

Although it is often not possible to prevent a pneumothorax, stopping smoking is an important way to reduce the risk of the first pneumothorax and avoid a recurrence.

Related articles:

Pneumothorax 

“Pneumothorax” is the medical term for a collapsed lung.

A pneumothorax is generally diagnosed using a chest X-ray.

Pneumothorax is classified as spontaneous, iatrogenic, and traumatic.