• Pneumothorax

    Definition

    Pneumothorax is a condition in which air collects in the space between the lungs and the chest wall. This air pocket puts pressure on the lung and can collapse a portion of the lung.

    Causes

    The chest cavity is normally a sealed chamber. Air can leak into the chamber through damaged lung tissue, the chest wall, or the diaphragm (a muscle that separates the abdominal and chest cavity). The air can eventually become large enough to collapse a section of lung.
    Pneumothorax may be named according to its cause or how it acts, for example:
    • Primary spontaneous pneumothorax—No known cause, but genetics and small lung abnormalities may play a role.
    • Secondary spontaneous pneumothorax—Caused by air leaks from damaged lung tissue. Tissue is often weakened from lung disease, injury, or mechanical ventilation.
    • Tension pneumothorax—Caused by trauma to the lungs and/or chest cavity (ribs and muscles). This is the most serious type because the collapse is more rapid and involves a larger amount of lung. It may affect the heart's ability to pump blood.
    • Catamenial pneumothorax (women only)—caused by small holes in the diaphragm muscle. Occurs within 72 hours of start or end of menstrual cycle and most often associated with endometriosis.
    Rib Fractures With Pneumothorax
    BN00065
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Primary spontaneous pneumothorax is more common in tall, thin young men, generally from teenagers up to the age of 30. Factors that may increase your chance of primary spontaneous pneumothorax may include:
    • Smoking
    • Scuba diving and high-altitude flying
    • Poor nutrition resulting from anorexia nervosa
    Weakened lung tissue increases your risk of secondary spontaneous pneumothorax. Conditions that can cause weak lung tissue include:
    Factors that may increase your chance of tension pneumothorax include:
    • Penetrating or blunt force trauma to the chest
    • Having a medical or surgical procedure
    • Mechanical ventilation

    Symptoms

    Pneumothorax may not cause symptoms if it is small. Symptoms include:
    • Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
    • Acute shortness of breath
    • Cough
    • Tightness in the chest
    • Rapid heartbeat
    • Bluish color of the skin due to a lack of oxygen
    • Flaring of the nostrils
    • Feelings of anxiety, stress, and tension
    Those with lung disease should be aware of the symptoms associated with pneumothorax. Get help as soon as symptoms arise.

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may be able to hear reduced or absent breath sounds on the affected side. The level of oxygen in your blood may be monitored with pulse oximetry.
    Images of your chest cavity, including your heart and lungs, will need to be taken.
    • This is usually done with Chest x-ray
    • CT scan may be needed if pneumothorax still suspected and x-ray is normal or further details are needed.
    • Ultrasound may be used if you can't be moved

    Treatment

    A small pneumothorax may resolve on its own or with oxygen therapy and observation. A larger pneumothorax and tension pneumothorax always requires treatment. Treatment focuses on providing oxygen and removing the air from the space so the lung can again expand to its full capacity.
    Treatment may also be needed for health conditions that are causing the pneumothorax.

    Oxygen

    Oxygen is given for support, but may increase rate of resolution. It is given for any pneumothorax needed a procedure.

    Removing Air

    A needle may be inserted into the affected area. The excess air can be pulled out of the chest cavity through the needle. This will be done urgently for a tension pneumothorax.
    Sometimes a chest tube will be placed in the chest. This tube will allow air to drain until it can be confirmed that the lung has fully expanded. It usually needed for large or symptomatic pneumothorax before or after needle aspiration.
    The tube may be needed for several days for full expansion to occur.

    Sclerosing agent

    An agent is put into the space between the chest and lung so they will stick together.
    This may be needed if healing is not complete with other treatments and surgery is not wanted.

    Surgery

    Surgery may be necessary for persistent air leaks or to prevent recurrence of some pneumothorax. Surgery may include:
    • Removal of weak spots in the lungs that are allowing air to leak out of the lungs
    • Closing the space between the lung and chest wall—called pleural abrasion or pleurodesis
    • Removing part or all of the lining that adheres to the chest wall—pleurectomy
    • Removing any lung lesions
    Follow-up is an important part of any pneumothorax treatment plan. More than half of people with a pneumothorax have a recurrence.
    Follow-up is an important part of any pneumothorax treatment plan. More than half of people with a pneumothorax have a recurrence.

    Prevention

    Prevention will depend on the cause. If you smoke, talk with your doctor about how you can quit.
    Other steps to help reduce your risk include:
    • Wear a seatbelt when in a motor vehicle to help prevent accident-related chest trauma.
    • Stop smoking.
    • If you have a history of pneumothorax, it is often recommended that you avoid scuba diving.

    RESOURCES

    American College of Chest Physicians http://www.chestnet.org

    American Thoracic Society http://thoracic.org

    CANADIAN RESOURCES

    The Canadian Lung Association http://www.lung.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Catamenial pnuemothorax. National Organization for Rare Disorders website. Available at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1227/printFullReport. Updated February 14 2012. Accessed August 24, 2017.

    Pneumothorax. Merck Manual website, Professional Version. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax. Updated September 2014. Accessed August 24, 2017.

    Pneumothorax - emergency management. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T913035/Pneumothorax-emergency-management. Accessed August 24, 2017.

    Spontaneous pneumothorax in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T306335/Spontaneous-pneumothorax-in-children. Updated January 11, 2016. Accessed August 24, 2017.

    Spontaneous pneumothorax in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114714/Spontaneous-pneumothorax-in-adults. Updated June 19, 2017. Accessed August 24, 2017.

    Tension pneumothorax. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115634/Tension-pneumothorax. Updated January 151, 201t. Accessed August 24, 2017.

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