Pneumothorax

By:    Published: March 21, 2012

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A pneumothorax occurs when air seeps into the pleural cavity (the space between the lung and the wall of the chest cavity) of the chest and pushes on the lung, causing all or a portion of it to collapse. A pneumothorax may develop spontaneously, as a result of a trauma to the chest, or due to disease related abnormalities in the lung tissue. A small and uncomplicated pneumothorax can resolve on its own without any medical intervention. Whereas, a larger pneumothorax requires the insertion of a chest tube into the pleural cavity in order to drain the excess air.

Types Of Pneumothorax

There are four major types of pneumothorax. These include:

  • Primary spontaneous pneumothorax: occurs without an apparent underlying cause. It is most often attributed to the rupture of an air-filled sac in the lung. Smoking is associated with a higher incidence of spontaneous pneumothorax.
  • Secondary spontaneous pneumothorax: occurs as a result of an underlying lung disease.
  • Traumatic pneumothorax: occurs as a result of a traumatic injury to the chest.
  • Tension pneumothorax: is typified by the complete collapse of one or both lungs. This type of pneumothorax is associated with severe dysfunction of the cardiovascular system and can be fatal.

Symptoms

The symptoms of a pneumothorax may vary according to its size and its underlying cause. Symptoms of a pneumothorax may include:

  • Chest pain: Most often the chest pain will be sudden and sharp. It may also worsen when you cough or take a deep breath
  • Shortness of breath: This may be mild or severe, depending on how much of your lung is collapsed and whether you have an underlying lung disease
  • Tightness in the chest
  • Fatigue
  • Rapid heart rate
  • A bluish hue to the skin
  • Low blood pressure
  • A distended abdomen

Causes

A pneumothorax can occur spontaneously with no obvious cause, or it can be caused by:

  • Chest injury. This may occur as a result of a physical assault, a knife or gun- shot wound, or a car crash.
  • Certain medical interventions. The insertion of a chest tube, a lung biopsy, or even cardiopulmonary resuscitation (CPR) may result in a pneumothorax.
  • Underlying lung disease. This includes such lung diseases as emphysema, tuberculosis, pneumonia, cystic fibrosis, lung cancer, pulmonary fibrosis, and sarcoidosis.
  • Ruptured air blisters. Small air blisters or blebs can develop on the top of the lung. Although the cause of these blebs is unknown, they occur more often in tall and thin people. Activities such as scuba diving, flying or mountain climbing at high altitudes can cause these blebs to rupture.
  • Mechanical ventilation. A pneumothorax may also occur in people who need mechanical assistance to breathe. A ventilator can create an imbalance in air pressure within the chest causing the lung to collapse.

Diagnosis

A doctor will initially listen to your chest with a stethoscope for reduced or absent breath sounds. A doctor may also order additional tests including:

  • Chest X-ray: this can help to determine if there is air in the pleural cavity.
  • A computerized tomography (CT) scan: this can provide a more detailed image of the lung.

Treatment

The primary goal in treating a pneumothorax is to alleviate the pressure on the lung so that it may re-expand. Treatment of a pneumothorax may vary depending on the cause and severity of the collapsed lung. Treatment options may include:

  • Observation and Rest. A small and uncomplicated pneumothorax does not require any medical intervention.A doctor may monitor your condition with a series of chest X-rays. Additionally, bed rest is recommended in order to avoid any exertion that may aggravate the pneumothorax. In some cases oxygen may be provided to speed the absorption process.
  • Needle or chest tube insertion. A larger, more complicated pneumothorax may require a needle or chest tube to be used to remove the excess air. A hollow needle or tube is inserted between the ribs into the space around the lungs to drain the air and allow the lungs to re-expand. Chest tubes may be left in place for several hours to several days.
  • Surgery. A more severe pneumothorax may require surgical intervention. With the help of a small, fiber-optic camera, a surgeon can detect and repair any leaking air sacs on the lung. If a leak is not visible, the surgeon may use a chemical that is blown through a tube in order to irritate the tissues around the lung, causing them to stick together and seal any leaks.

Prevention

Up to 50 percent of patients who have a pneumothorax can experience a recurrence. Although there are no known ways to prevent a pneumothorax, you can lower your risk of developing one by:

  • Quit smoking
  • Being aware of the symptoms associated with pneumothorax if you have lung disease
  • Avoiding such activities as scuba diving if you have a history of pneumothorax

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