Pneumothorax
Pneumothorax
Definition
Pneumothorax is a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse.
Description
Normally, the pressure in the lungs is greater than the pressure in the pleural space surrounding the lungs. However, if air enters the pleural space, the pressure in the pleura then becomes greater than the pressure in the lungs, causing the lung to collapse partially or completely. Pneumothorax can be either spontaneous or due to trauma.
If a pneumothorax occurs suddenly or for no known reason, it is called a spontaneous pneumothorax. This condition most often strikes tall, thin men between the ages of 20 to 40. In addition, people with lung disorders, such as emphysema, cystic fibrosis, and tuberculosis, are at higher risk for spontaneous pneumothorax. Traumatic pneumothorax is the result of accident or injury due to medical procedures performed to the chest cavity, such as thoracentesis or mechanical ventilation. Tension pneumothorax is a serious and potentially life-threatening condition that may be caused by traumatic injury, chronic lung disease, or as a complication of a medical procedure. In this type of pneumothorax, air enters the chest cavity, but cannot escape. This greatly increased pressure in the pleural space causes the lung to collapse completely, compresses the heart, and pushes the heart and associated blood vessels toward the unaffected side.
Causes and symptoms
The symptoms of pneumothrax depend on how much air enters the chest, how much the lung collapses, and the extent of lung disease. Symptoms include the following, according to the cause of the pneumothorax:
- Spontaneous pneumothorax. Simple spontaneous pneumothorax is caused by a rupture of a small air sac or fluid-filled sac in the lung. It may be related to activity in otherwise healthy people or may occur during scuba diving or flying at high altitudes. Complicated spontaneous pneumothorax, also generally caused by rupture of a small sac in the lung, occurs in people with lung diseases. The symptoms of complicated spontaneous pneumothorax tend to be worse than those of simple pneumothorax, due to the underlying lung disease. Spontaneous pneumothorax is characterized by dull, sharp, or stabbing chest pain that begins suddenly and becomes worse with deep breathing or coughing. Other symptoms are shortness of breath, rapid breathing, abnormal breathing movement (that is, little chest wall movement when breathing), and cough.
- Tension pneumothorax. Following trauma, air may enter the chest cavity. A penetrating chest wound allows outside air to enter the chest, causing the lung to collapse. Certain medical procedures performed in the chest cavity, such as thoracentesis, also may cause a lung to collapse. Tension pneumothorax may be the immediate result of an injury; the delayed complication of a hidden injury, such as a fractured rib, that punctures the lung; or the result of lung damage from asthma, chronic bronchitis, or emphysema. Symptoms of tension pneumothorax tend to be severe with sudden onset. There is marked anxiety, distended neck veins, weak pulse, decreased breath sounds on the affected side, and a shift of the mediastinum to the opposite side.
Diagnosis
To diagnose pneumothorax, it is necessary for the health care provider to listen to the chest (auscultation) during a physical examination. By using a stethoscope, the physician may note that one part of the chest does not transmit the normal sounds of breathing. A chest x ray will show the air pocket and the collapsed lung. An electrocardiogram (ECG) will be performed to record the electrical impulses that control the heart's activity. Blood samples may be taken to check for the level of arterial blood gases.
Treatment
A small pneumothorax may resolve on its own, but most require medical treatment. The object of treatment is to remove air from the chest and allow the lung to re-expand. This is done by inserting a needle and syringe (if the pneumothorax is small) or chest tube through the chest wall. This allows the air to escape without allowing any air back in. The lung will then re-expand itself within a few days. Surgery may be needed for repeat occurrences.
Prognosis
Most people recover fully from spontaneous pneumothorax. Up to half of patients with spontaneous pneumothorax experience recurrence. Recovery from a collapsed lung generally takes one to two weeks. Tension pneumothorax can cause death rapidly due to inadequate heart output or insufficient blood oxygen (hypoxemia), and must be treated as a medical emergency.
Prevention
Preventive measures for a non-injury related pneumothorax include stopping smoking and seeking medical attention for respiratory problems. If the pneumothorax occurs in both lungs or more than once in the same lung, surgery may be needed to prevent it from occurring again.
KEY TERMS
Electrocardiagram— A test that provides a typical record of normal heart action.
Mediastinum— The space between the right and left lung.
Pleural— Pleural refers to the pleura or membrane that enfolds the lungs.
Thoracentesis— Also called a pleural fluid tap, this procedure involves aspiration of fluid from the pleural space using a long, thin needle inserted between the ribs.
Resources
ORGANIZATIONS
American Association for Respiratory Care. 11030 Ables Lane, Dallas, Texas 75229. (972) 243-2272. 〈http://www.aarc.org〉.
American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. 〈http://www.lungusa.org〉.
OTHER
"Spontaneous Pneumothorax." HealthAnswers.com. 〈http://www.healthanswers.com〉.
Pneumothorax
PNEUMOTHORAX
DEFINITION
Pneumothorax (pronounced noo-moh-thor-ax) is a condition in which air or some other gas collects in the chest or the pleural space. The pleural space is the space that surrounds the lungs. When a gas collects in the pleural space, it can cause part or all of a lung to collapse. For that reason, pneumothorax is also called collapsed lung.
DESCRIPTION
Normally, pressure inside the lungs is greater than pressure in the pleural space. This difference in pressure allows the lungs to stay filled with air. But air or some other gas can get into the pleural space. When it does so, the normal condition is reversed. Pressure in the pleural space becomes greater than pressure in the lungs. This extra pressure on the lungs can cause them to collapse partially or completely.
Pneumothorax: Words to Know
- Electrocardiogram (ECG):
- A test that measures the electrical function of the heart, indicating the presence of any heart problems.
- Pleural:
- Having to do with the membrane that surrounds the lungs.
- Thoracentesis:
- A procedure for removing fluids from the pleural space by inserting a long, thin needle between the ribs.
CAUSES
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 (pronounced thoruh-sen-tee-sis). 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.
SYMPTOMS
The symptoms of pneumothorax depend on a number of factors. These include the amount of air that enters the chest, the extent to which the lung collapses, and the presence of any kind of lung disease.
Spontaneous pneumothorax can be classified as simple or complex. Simple spontaneous pneumothorax usually occurs with people who are otherwise healthy. It is caused by certain types of activity, such as scuba diving or flying at high altitudes. Complex spontaneous pneumothorax occurs with people who have lung disease. The symptoms of complex spontaneous pneumothorax are more serious than those of simple spontaneous pneumothorax.
The most common symptom of spontaneous pneumothorax is a chest pain that can be dull, sharp, or stabbing. The pain starts suddenly and becomes worse with coughing or deep breathing. Other symptoms include shortness of breath, rapid breathing, and a cough.
Traumatic pneumothorax occurs as a result of medical procedures or of injuries. For example, a stab wound allows air to enter the chest cavity. The air may have no way of escaping from the chest. The wound can result in a collapsed lung. The symptoms of traumatic pneumothorax are similar to those of spontaneous pneumothorax, but they are more severe.
The symptoms of tension pneumothorax tend to be severe with sudden onset (beginning). They include anxiety, swollen neck veins, weak pulse, and decreased breathing sounds from the lung.
DIAGNOSIS
Pneumothorax is diagnosed by listening to the patient's chest. With a stethoscope, a doctor can tell whether the normal sounds of breathing can be heard in the chest. A chest X ray is often taken to follow up on an initial diagnosis. The chest X ray will show pockets of air and a collapsed lung. An electrocardiogram (ECG; pronounced ih-LEK-tro-KAR-dee-o-gram) can also be taken. The ECG will tell whether the heart is functioning normally. Finally, blood tests can be used to diagnose pneumothorax. They will show the level of gases dissolved in the blood.
TREATMENT
Simple pneumothorax usually gets better on its own, but more complex cases require medical treatment. The object of the treatment is to remove air from the chest or pleural cavity. When the air is gone, the lung can expand to its normal size.
Removal of air is done by inserting a needle into the chest wall. Air is removed through the needle and not allowed to get back in. The lung returns to its normal size on its own within a few days. A person who experiences pneumothorax more than once may require surgery.
PROGNOSIS
Most people recover fully from spontaneous pneumothorax. About half of these people experience spontaneous pneumothorax a second time. Recovery from a collapsed lung generally takes one to two weeks. The prognosis for tension pneumothorax is not as good. In this condition, the patient's heart may fail, causing death in a short period of time. Tension pneumothorax must be treated as a medical emergency.
PREVENTION
Preventative measures for noninjury related pneumothorax include not smoking and having respiratory problems treated whenever they occur. Sometimes pneumothorax occurs in both lungs, or in one lung more than once. In such cases, surgery may be needed to prevent it from occurring again.
FOR MORE INFORMATION
Organizations
American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. (972) 243–2272. http://www.aarc.org.
American lung Association. 1740 Broadway, New York, NY 10019. (800) LUNG–USA. http://www.lungusa.org.
Web sites
"Collapsed Lung: Non-Injury Related." InteliHealth. [Online] http://www.intelihealth.com (accessed on October 28, 1999).
"Pneumothorax." http://www.thriveonline.com/health/Library/sports/sport52.html (accessed on October 25, 1999).
"Spontaneous Pneumothorax." Healthanswers. [Online] http://www.healthanswers.com (accessed on October 28, 1999).