Pneumothorax | Health | Patient

What is a pneumothorax?

A pneumothorax describes the condition in which air has become trapped between a lung and the chest wall. The air usually gets there either from the lungs or from outside the body.

What are the symptoms of a pneumothorax?

• The typical symptom is a sharp, stabbing pain on one side of the chest, which suddenly develops.
• The pain is usually made worse by breathing in (inspiration).
• You may become breathless. As a rule, the larger the pneumothorax, the more breathless you become.
• You may have other symptoms if an injury or a lung disease is the cause – for example, cough or high temperature (fever).

A chest X-ray can confirm a pneumothorax. Other tests may be done if a lung disease is the suspected cause.

What are the causes of pneumothorax?

Primary spontaneous pneumothorax

This means that the pneumothorax develops for no apparent reason in an otherwise healthy person. This is the common type of pneumothorax. It is thought to be due to a tiny tear of an outer part of the lung – usually near the top of the lung. It is often not clear why this occurs. However, the tear often occurs at the site of a tiny bleb or bulla on the edge of a lung. A bleb or bulla is like a small balloon of tissue that may develop on the edge of a lung. A bulla is a large bleb. The wall of the bleb or bulla is not as strong as normal lung tissue and may tear. Air then escapes from the lung but gets trapped between the lung and the chest wall.

Most occur in healthy young adults who do not have any lung disease. It is more common in tall thin people.

About 2 in 10,000 young adults in the UK develop a spontaneous pneumothorax each year. Men are affected about three times more often than women and are affected at a younger age. Men are more likely to be affected around the age of 20 years and women in their early 30s.

It is 22 times more common in men who smoke than in men who don’t smoke and 9 times more common in women who smoke than in women who don’t smoke. Cigarette smoke seems to make the wall of any bleb even weaker and more likely to tear.

Up to 5 in 10 people who have a primary spontaneous pneumothorax have another one or more at some time in the future. If it does occur again it is usually on the same side and it usually occurs within three years of the first one.

Secondary spontaneous pneumothorax

This means that the pneumothorax develops as a complication (a secondary event) of an existing lung disease. This is more likely to occur if the lung disease weakens the edge of the lung in some way. This may then make the edge of the lung more liable to tear and allow air to escape from the lung. So, for example, a pneumothorax may develop as a complication of chronic obstructive pulmonary disease (COPD) – especially where lung bullae have developed in this disease. Other lung diseases that may be complicated by a pneumothorax include:

Other causes of pneumothorax

An injury to the chest can cause a pneumothorax – for example, a car crash or a stab wound to the chest. Surgical operations to the chest may cause a pneumothorax. A pneumothorax is also an uncommon complication of endometriosis.

What is the treatment for pneumothorax?

No treatment may be needed

You may not need any treatment if you have a small pneumothorax. The small tear that caused the leak usually heals within a few days (sometimes as little as 1-3 days), especially in cases of primary spontaneous pneumothorax. Air then stops leaking in and out of the lung. The trapped air of the pneumothorax is gradually absorbed into the body.

A doctor may advise an X-ray in 7-10 days to check that it has gone. You may need painkillers for a few days if the pain is bad.

Removing (aspirating) the trapped air is sometimes needed

This may be needed if there is a larger pneumothorax or if you have other lung or breathing problems. As a rule, a pneumothorax that makes you breathless is best removed. The common method of removing the air is to insert a very thin tube through the chest with the aid of a needle. (Some local anaesthetic is injected into the skin first to make the procedure painless.) A large syringe with a three-way tap is attached to the thin tube that is inserted through the chest. The syringe sucks out some air and the three-way tap is turned. The air in the syringe is then expelled into the atmosphere. This is repeated until most of the air of the pneumothorax is removed.

Sometimes a larger tube is inserted into the chest to remove a large pneumothorax. This is more commonly needed for cases of secondary spontaneous pneumothorax when there is underlying lung disease. Commonly, the tube is left there for a few days to allow the lung tissue that has torn to heal.

Tension pneumothorax

This is a rare complication. It causes shortness of breath that quickly becomes more and more severe. This occurs when the tear on the lung acts like a one-way valve. In effect, each breath in (inspiration) pumps more air out of the lung; however, the valve action stops air coming back into the lung to equal the air pressure. The volume and pressure of the pneumothorax increases. This puts pressure on the lungs and heart. Emergency treatment is needed to release the trapped air.

Note: it can be dangerous to fly if you have a pneumothorax. Do not fly until you have the ‘all clear’ from your doctor following a pneumothorax. Also, do not go to remote places where access to medical care is limited until you have the ‘all clear’ from a doctor.

Treating repeated episodes

Some people have repeated episodes of spontaneous pneumothorax. If this occurs, a procedure may be advised with the aim of preventing the condition from coming back. For example, an operation is an option if the part of the lung that tears and leaks air out is identified. It may be a small bleb on the lung surface, which can be removed. Another procedure that may be advised is for an irritant powder (usually a kind of talc powder) to be put on the lung surface. This causes inflammation which then makes the lung surface stick to the inside of the chest wall.

A lung specialist will be able to give the pros and cons of the different procedures. The procedure advised may depend on your general health and on whether you have an underlying lung disease.

If you are a smoker and have had a primary spontaneous pneumothorax, you can reduce your risk of it happening again by stopping smoking.

“Pneumothorax” a medical urgency that has to be treated

A pneumothorax (collapsed lung) occurs when air leaks into the space between the lung and chest wall. This air pushes on the outside of the lung and makes the lung collapse. Pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. Pneumothorax can attack anyone at anytime. However, high risk group to develop pneumothorax include the elderly who are heavy smokers, working people who expose to air pollution and adolescent group with precocious puberty. Pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures or damage from underlying lung disease. It might be silent without  manifestation of any sign. Typical symptoms are sudden chest pain and shortness of breath accompanied with dry cough. If left untreated, pneumothorax can be a life-threatening condition.

Get to know pneumothorax

A pneumothorax (collapsed lung) occurs when air leaks into the space between the lung and chest wall. This air pushes on the outside of the lung and makes the lung collapse. Pneumothorax causes leaking air to accumulate between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. Symptoms include chest pain, shortness of breath, rapid breathing and a racing heart, followed by shock. Pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. Since collapsed lung can put pressure on the heart, it is a fatal situation that has to be treated immediately upon diagnosis.

Warning signs of pneumothorax

A pneumothorax can be caused by lung diseases that damage lung tissue such as chronic obstructive pulmonary disease (COPD), cystic fibrosis and pneumonia. Chest injury including any blunt or penetrating injury to the chest can cause lung collapse. Some injuries may happen during physical assaults, car crashes or being stabbed in the chest, while others may inadvertently occur during medical procedures that involve the insertion of a needle into the chest. A severe type of pneumothorax can also occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely. Signs and symptoms of pneumothorax in different groups vary depending on age, individual health conditions and risk factors. 

• In young patients: Common signs and symptoms are sudden chest pain accompanied with dry cough without the presence of having previous common cold, runny nose or sore-throat.
• In elderly patients or heavy smokers: Typical symptom is shortness of breath, especially in patients diagnosed with  Chronic Obstructive Pulmonary Disease or COPD such as emphysema in which the air sacs in the lungs (alveoli) are damaged.

A sudden chest pain caused by pneumothorax differs from chest pain induced by cardiac diseases. The former produces a sudden sharp chest pain, in particular side of the lung followed by pains during breathing in while the latter causes  the feeling like pressure or squeezing in the chest. Complications caused by pneumothorax is fatal, therefore immediate treatment is required.

Types of pneumothorax

There are 2 common types of pneumothorax:

1. Primary Spontaneous Pneumothorax (PSP)
   Primary spontaneous pneumothorax (PSP) occurs in patients without underlying lung disease and in the absence of an inciting event. Air enters into the intrapleural space between the chest wall  without preceding trauma and underlying history of clinical lung disease. Patients are typically aged 18-30 years, tall and thin. Although the cause of primary spontaneous pneumothorax remains unknown, many patients whose condition is labeled as primary spontaneous pneumothorax have certain risk factors including genetic abnormalities and adolescent group with precocious puberty, affecting lung function. In addition, high risk group also includes women with endometriosis, a condition where the endometrium which is the inner uterine lining grows outside of the uterus in areas such as the ovary, pelvic area and intestine. Catamenial pneumothorax is a condition of air leaking into the pleural space occurring in conjunction with menstrual periods or during ovulation, believed to be caused primarily by endometriosis of the pleura (the membrane surrounding the lung or diaphragm). Treatment of catamenial pneumothorax mainly involves surgery and hormonal therapy.
2. Secondary Spontaneous Pneumothorax (SSP)
   Secondary spontaneous pneumothorax (SSP) occurs in patients with a wide variety of lung diseases such as chronic obstructive pulmonary disease (COPD), heavy smokers and the elderly aged over 60. These individuals have underlying pulmonary pathology that alters normal lung structure. Air enters the pleural space via distended, damaged or compromised alveoli, tiny air sacs in the lung. Compared to Primary Spontaneous Pneumothorax, the presentation of these patients may include more serious clinical symptoms and sequelae due to comorbid conditions, particularly in patients with damaged lung tissue or impaired lung function.

In Thailand, Secondary Spontaneous Pneumothorax is more common. Apart from heavy smoking, other possible risk factor might involve extreme air pollution which potentially increases risk of developing emphysema and other lung conditions. Especially in Bangkok and surrounding areas, a cloud of ultra-fine dust particles known as PM2.5 has recently returned. According to the Pollution Control Department (PCD), the concentration of PM2.5 pollutants should not exceed the PCD’s safe threshold of 50 µg/m³. If the number is greater than this threshold level, these fine particulate matters can substantially cause a wide range of health problems including respiratory disease and heart disease. For instance, a middle-aged patient who had run a marathon for 5 consecutive years developed pneumothorax. His imaging results reveal the blackened lungs even though he has never smoked. Normally it takes up to 10 years to manifest relevant signs and symptoms. However, in this case, it showed up extremely quick. In other case, young patient suddenly developed dry cough with severe chest pain during participating in a concert.  Diagnostic result indicates pneumothorax. Undiagnosed chronic emphysema was triggered by the loud noise in the concert. As a result, the alveoli became ruptured in the presence of sudden sharp pain in the chest.

Diagnosis of pneumothorax

Pneumothorax is generally diagnosed by using a chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax.

Treatment of pneumothorax

Most cases who have pneumothorax attacks seek medical attention in emergency department due to sudden chest pain and shortness of breath. Imaging results obtained from chest X-ray might indicate the air leakage in the space between the lung and chest wall while leakage of the lungs could not be revealed. The goal in treating a pneumothorax is to relieve the pressure on the lung, allowing it to re-expand. Depending on the cause of the pneumothorax, a second goal may be to prevent recurrences. The selected treatment for achieving these goals depend on the severity of the lung collapse and overall health conditions. The previous treatment guideline in the past mainly involved chest tube insertion to reduce pressure on the lung. The leakage could be healed and closed automatically within 3-7 days. Surgery is only indicated in case of recurrence. However, the recurrent rate is considerably high, up to 30% after the first attack.

Due to the advancements in cardiothoracic surgery, Video-Assisted Thoracic Surgery or VATS, a minimally invasive surgery has developed. This minimally invasive technique has been increasingly used due to its superiority including smaller incisions (similar size compared to incision needed for chest tube insertion), less pain and lower postoperative complications.

During VATS procedure, cardiothoracic surgeons make 2-3 small incisions (sized 2-3 cm. in diameter) in the side of the chest. Small surgical instruments are inserted to visualize and treat pneumothorax. Possibilities include sewing blisters closed, closing air leaks, or removing the collapsed portion of your lung, which is called a lobectomy. Instead of having a large cut required in the open surgery, VATS does not need breastbone to be divided. As a result, small incisions can significantly lead to less pain, enhanced cosmetic benefit and fewer post-operative complications as well as faster recovery time and shorter hospital.

To minimize chances of recurrence, pleurodesis might be performed. Pleurodesis is defined as a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae–membranes lining the and enveloping the lungs. This procedure is commonly recommended for individuals who have had repeated episodes of pneumothorax. During the procedure, surgeon irritates the pleural space so that air and fluid can no longer accumulate. Pleurodesis is performed to make the lungs’ membranes stick to the chest cavity. Once the pleura adheres to the chest wall, the pleural space no longer expands and this prevents formation of a future pneumothorax. There are different types of pleurodesis. Mechanical pleurodesis is performed manually by brushing the pleura to cause inflammation. Chemical pleurodesis is another form to deliver chemical irritants such as medical talc to the pleura through a chest tube. The irritation and inflammation cause the lung pleura and chest wall lining to stick together.

Different pleurodesis methods manifest different rates of pneumothorax recurrence. Chances of recurrence is up to 10-20% after chemical pleurodesis while only 1% of pneumothorax recurrence has been observed after mechanical pleurodesis. Therefore, mechanical pleurodesis is superior to other approaches since the recurrence rates are considerably low. Time consumption for operation is approximately an hour, allowing patients to have a shorter stay in the hospital, 2 days on average. Patients can return to their daily life and activities even quicker.

Taking good care after surgery

After surgery, it is highly recommended to: 

• Avoid heavy weight lifting. Lifting might cause healing problems to the surgical wound. Complete wound healing process takes approximately 1 week.
• For women with catamenial pneumothorax, hormonal therapy similar to post-menopause treatment  is required continuously 6-9 months.
• Lifestyle modification to strengthen lung function include smoke cessation and avoidance of exposure to air pollution such as PM 2.5. Open air activities should be avoided or limited. If necessary, duration of activities must be as short as possible and N95 masks must be worn at all times.

Pneumonia – NHS

Pneumonia is swelling (inflammation) of the tissue in one or both lungs. It’s usually caused by a bacterial infection. It can also be caused by a virus, such as coronavirus (COVID-19).

Symptoms of pneumonia

The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.

Common symptoms of pneumonia include:

• a cough – which may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm)
• difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting
• rapid heartbeat
• high temperature
• feeling generally unwell
• sweating and shivering
• loss of appetite
• chest pain – which gets worse when breathing or coughing

Less common symptoms include:

When to get medical help

If you have a high temperature, a new, continuous cough or a loss or change to your sense of smell, use the 111 online coronavirus service.

If you feel unwell and have any other symptoms of pneumonia, contact your GP or use the regular 111 online service.

Only call 111 if you cannot get help online or you need help for a child under 5.

Call 999 for an ambulance if you or someone you care for:

• are struggling to breathe
• are coughing up blood
• have blue lips or a blue face
• feel cold and sweaty, with pale or blotchy skin
• have a rash that does not fade when you roll a glass over it
• collapse or faint
• become confused or very drowsy
• have stopped peeing or are peeing much less than usual

Who’s affected

Pneumonia can affect people of any age, but it’s more common, and can be more serious, in certain groups of people, such as the very young or the elderly.

People in these groups are more likely to need hospital treatment if they develop pneumonia.

What causes pneumonia

Pneumonia is usually the result of a bacterial infection.

As well as bacterial pneumonia, other types include:

• viral pneumonia – caused by a virus, such as coronavirus
• aspiration pneumonia – caused by breathing in vomit, a foreign object, such as a peanut, or a harmful substance, such as smoke or a chemical
• fungal pneumonia – rare in the UK and more likely to affect people with a weakened immune system
• hospital-acquired pneumonia – pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive care on breathing machines are particularly at risk of developing ventilator-associated pneumonia

Risk groups

The following groups have an increased risk of developing pneumonia:

• babies and very young children
• elderly people
• people who smoke
• people with other health conditions, such as asthma, cystic fibrosis, or a heart, kidney or liver condition
• people with a weakened immune system – for example, as a result of a recent illness, such as flu, having HIV or AIDS, having chemotherapy, or taking medicine after an organ transplant

Diagnosing pneumonia

A doctor may be able to diagnose pneumonia by asking about your symptoms and examining your chest.

Further tests may be needed in some cases.

Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold, bronchitis and asthma.

To help make a diagnosis, a doctor may ask you:

• whether you feel breathless or you’re breathing faster than usual
• how long you have had your cough, and whether you’re coughing up mucus and what colour it is
• if the pain in your chest is worse when you breathe in or out

A doctor may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds.

They may also listen to your chest by tapping it. Lungs filled with fluid produce a different sound from normal healthy lungs.

If you have mild pneumonia, you probably will not need to have a chest X-ray or any other tests.

You may need a chest X-ray or other tests, such as a sputum (mucus) test or blood tests, if your symptoms have not improved within 48 hours of starting treatment.

Treating pneumonia

Mild pneumonia can usually be treated at home by:

• getting plenty of rest
• taking antibiotics if the pneumonia is likely to be caused by a bacterial infection
• drinking plenty of fluids

If you do not have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time.

For at-risk groups, pneumonia can be severe and may need to be treated in hospital.

This is because it can lead to serious complications, which in some cases can be fatal, depending on a person’s health and age.

Complications of pneumonia

Complications of pneumonia are more common in young children, the elderly and those with pre-existing health conditions, such as diabetes.

Possible complications of pneumonia include:

• pleurisy – where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure
• a lung abscess – a rare complication that’s mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse
• blood poisoning (sepsis) – also a rare but serious complication

You’ll be admitted to hospital for treatment if you develop one of these complications.

Preventing pneumonia

Although most cases of pneumonia are bacterial and are not passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading.

For example, you should:

• cover your mouth and nose with a handkerchief or tissue when you cough or sneeze
• throw away used tissues immediately – germs can live for several hours after they leave your nose or mouth
• wash your hands regularly to avoid transferring germs to other people or objects

A healthy lifestyle can also help prevent pneumonia. For example, you should stop smoking as it damages your lungs and increases the chance of infection.

Excessive and prolonged alcohol misuse also weakens your lungs’ natural defences against infections, making you more vulnerable to pneumonia.

People at high risk of pneumonia should be offered the pneumococcal vaccine and flu vaccine.

Watch a video to find out more about pneumonia on the Health and Care Video Library.

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Page last reviewed: 30 June 2019
Next review due: 30 June 2022

When My Left Lung Collapsed – Joe Antognini

Sunday, February 10, 2019 began as a wonderful day. I showered in the morning
and I distinctly remember feeling well rested and all around quite good. But as
I was drying off I felt a sharp pain in my upper back like I had pulled a muscle
or pinched a nerve.

I started to suspect that something was amiss as my wife and I walked to mass
that morning. Our church is down a pretty steep hill from our apartment, so
getting there is normally easy, but I was needing to walk pretty slowly. By
coincidence my wife had gone to the gym for the first time after a break, so her
legs were pretty sore and we both sort of hobbled to mass together. On the way
back up the hill I was able to (slowly) make it back to the apartment, but I had
to stop to catch my breath, which I never had to do.

Over the course of the day I found that I had trouble taking deep breaths. I
was reading the Decameron at the time, so to test myself I would try reading a
passage to my wife, but I usually wasn’t able to make it through an entire
sentence. I didn’t really feel like moving very much, but apart from that and
the fact that I couldn’t take a full breath, I felt fine. Nevertheless, that
evening I made a doctor’s appointment. Fortunately there was an opening early
the next morning. If you have symptoms where you’re having trouble breathing
and can’t take a full breath, don’t do what I did! Go straight to the emergency
room! Immediately! Like right now!

By nighttime I was starting to feel pretty crappy. It was too painful to lay on
my back or my left side, so I went to sleep laying on my right side. But after
a while that started to become painful, too, so I moved to the couch and slept
for a while sitting up. I ended up alternating between sleeping for a bit
sitting up and going back to bed to lay on my right side.

The doctor’s office

The following morning I felt completely miserable. I somehow managed to take a
shower (my last for more than a week as it would turn out), but it was too
painful to bend over so I had a hard time drying my legs. With some careful
gymnastics I managed to put on my pants, but I couldn’t put my shoes on so I
left home in my slippers instead. I booked a Lyft and took a slow,
uncomfortable journey through the heavy San Francisco Monday morning traffic to
the hospital.

When I arrived the nurse took my vitals and then the doctor came to see me. I
told her, a few words at a time, that I was having trouble taking deep breaths
and had a lot of pain when I bent over or lay on my back or left side. She
said, “Yes, it does sound like you’re having trouble breathing!” She listened
to my lungs and said that there was definitely an issue with my left lung and
there was possibly some fluid in it. She sent me to get an X-ray and told me
that she was going to call the emergency doctor in the meantime.

I hobbled on over to the floor with the radiology department to get my X-ray,
and after about twenty minutes or so hobbled on back to the original room. (I
was actually carrying my laptop bag with me at the time because I was under some
delusion, maybe born out of hopefulness that my condition wasn’t actually all
that serious, that I was going to go in to work after my appointment.) After a
few minutes my doctor came back and said, “So… we’re going to call 911.” She
told me that my left lung had collapsed, and then a few minutes later introduced
me to the emergency doctor and two SFFD paramedics who were going to take me by
ambulance to the emergency room at a hospital across town. The paramedics had
brought a gurney with them, but I told them I felt well enough to walk down to
the ambulance (after all, I had just walked to get my X-ray!), but they told me
that under no circumstances was I going to walk myself. I told them that under
no circumstances was I going to lay down in the gurney because it would be
incredibly painful, but fortunately they could transform it into an upright
seated position and they wheeled me out into the ambulance that way.

The first X-ray after my lung collapsed. I’ve kept the original on
the left and for those not familiar with interpreting chest X-rays (as I once
was) I’ve drawn a crude outline of my lungs on the copy on the
right.

The ambulance ride itself was fairly uneventful. I had never been in an
ambulance before so I made some small talk with the paramedics in the back with
me, and tried to ignore my heart rate approaching 130 bpm. Although my
condition was serious, it evidently wasn’t serious enough to warrant turning on
the sirens. Growing up my mother had always told me that I was lucky to have
ropey veins because it would make it easier to get an IV inserted. But this was
the one time my mom was mistaken because it took the paramedics about five tries
before they could get the line in a vein. Maybe it’s harder to do in a moving
vehicle! But the paramedics were correct in saying that I was going to become a
pincushion for the foreseeable future.

So what exactly is a collapsed lung?

Before getting into more details about my experience I should go into a little
more detail about what exactly a collapsed lung is. I didn’t get all this
information until a few days later, but I got some of it in the emergency room
so now is as good a time as any for a short primer on the condition.

The technical term for what happened to me is that I had a “spontaneous
pneumothorax.” A pneumothorax is simply a medical condition where there is air
in the chest cavity and outside the lung. A spontaneous pneumothorax is a
pneumothorax that happens, well, spontaneously, with no obvious reason as to
what caused it. By contrast a pneumothorax in general can be caused by lots of
things that you would think would definitely give you a pneumothorax. Getting
stabbed in the chest for instance.

Spontaneous pneumothorax cases broadly tend to fall into two groups. The first
group consists of people with certain genetic disorders which predispose them to
spontaneous pneumothorax. The most common of these is Marfan’s Syndrome, which
manifests itself in unusually elastic tissue. This elasticity seems to
predispose the lung tissue to rupture and produce a pneumothorax. The other
group consists of everyone else — people who are otherwise normal and healthy,
but end up with a collapsed lung anyway. Of this group, the largest demographic
is thin, tall males between the ages of twenty and forty. (In my particular
case, while I’m of average height at best, I do meet the other criteria.) From
what I can tell it doesn’t seem to be well known what predisposes this
demographic to be susceptible to spontaneous pneumothorax. One can speculate
that being tall and thin tends to stretch out the lung tissue more, maybe making
it thinner and more likely to rupture, but I don’t think there’s any concrete
evidence to support that speculation.

So how does the spontaneous pneumothorax actually happen? The lung can
sometimes have little blister-like bubbles on them called blebs. Based on
autopsies, blebs seem to be somewhat common and tend to form towards the top of
the lung. In rare cases (like mine), the bleb can pop, and then air leaks from
the lung into the chest cavity. Once air starts to leak into the chest cavity,
there’s no longer a pressure differential between the lung and the rest of the
chest. This means that when the diaphragm contracts, the chest cavity will
expand as normal, but this expansion will just suck air through the rupture and
into the chest cavity; the lung won’t inflate (or at least it won’t inflate as
much as it otherwise would). This might not necessarily be a serious problem.
Sometimes a bleb can pop and there can be a partial collapse that eventually
resolves itself. If the rupture is small, it can heal before too much air leaks
out and the remaining air on the wrong side of the rupture can slowly permeate
back into the lung over the course of several weeks.

But generally a pneumothorax is very dangerous. I was lucky because only a single lung
collapsed, so I could still breathe, albeit shallowly. But if one lung
completely collapses, it’s only a matter of time before it causes the other lung
to collapse as well. Once both lungs collapse you can’t breathe at all and will
quickly die if left untreated. Another danger is that the collapsed lung can
impinge upon the heart or aorta and lead to cardiac arrest. So if you have
trouble breathing, really, get treated right away!

Fortunately the immediate treatment for a pneumothorax is simple — a doctor or
nurse will insert a tube into your chest, attach it to a suction pump, and pump
the air out of your chest cavity. With the suction in your chest cavity, the
pressure differential between the lung and the chest cavity is restored, your
lung will expand when your diaphragm contracts, and you can breathe normally
again. In many cases this is all that is required. If the suction is kept on
for a while to ensure the lung stays expanded, the lung will often heal itself
and stay inflated once the chest tube is removed (at least for a while).

In the emergency room

The ambulance had phoned ahead to the emergency room, so as soon as I arrived at
the hospital I changed into a hospital gown, was transferred to a bed (which
thankfully also could be adjusted into an almost-sitting position), and was
given an oxygen mask.

Just after getting my (first) chest tube in the emergency room and on
a wee bit of morphine.

While I was in the ambulance I had texted my wife that I was on my way to the
emergency room. She was working at Google at the time and fortunately was able
to take advantage of their emergency ride program to get a ride from Mountain
View to San Francisco. In the meantime she had texted my parents that I was in
the emergency room and they arrived about fifteen minutes after I did, and my wife
arrived about thirty minutes after that.

Not too long after my wife had arrived they started to go ahead with inserting
the chest tube. One of the nurses kindly shaved the hair off the left side of
my chest and then inserted the tube somewhere midway up the left side of my
chest. A lot of people complain about the pain of getting a chest tube
inserted, but I don’t remember feeling this one at all. That changed, however,
when they turned on the suction. With the suction on, my lung started to
reinflate, and it was…let’s say uncomfortable. Although the point of the
chest tube is to get your lung inflated so you can breathe again, when they
turned the suction I had an overwhelming sensation of being unable to breathe at
all. Even when the nurses put the suction on the lowest setting, I felt like a
fish pulled out of water. It was so uncomfortable (even if not exactly
painful), that they stopped three times so I could catch my breath as my lung
expanded.

Surgery

Once a chest tube is in and the lung is reinflated, the usual treatment for a
spontaneous pneumothorax is to just wait a while to see if the lung can heal
Itself. So, I was wheeled to a hospital room, and every now and again a nurse
would disconnect my chest tube from suction, and then they’d wait a few hours
and take a chest X-ray to see if my lung was staying up on its own. They did
this for three days, but every time I was taken off suction my lung collapsed
again. This was probably partly due to the fact that by the time I got
treatment my lung had collapsed 100%. If I had gone to the emergency room
immediately after the start of the pneumothorax the chest tube may have been
enough.

In some ways the fact that my lung kept collapsing may have been a blessing,
because it meant that I was eligible for a pleurodesis. While it’s nice if your
lung heals itself, if you’ve had a spontaneous pneumothorax, the odds that the
lung will collapse again are about 80%. A pleurodesis, however, provides a more
permanent solution.

That said, the pleurodesis is not a fun surgery. As my surgeon diplomatically
put it, “It is a procedure that is not without pain.” The pleurodesis is
typically preceded by a “blebectomy”, where the surgeon removes the portion of
the lung with the ruptured bleb (and possibly other blebs in the area). The
lung is then stapled shut with a titanium surgical staple. After that the
pleurodesis begins. The lung is first stripped of a thin lining of outer
tissue, called the pleura. Then the lung is scarred by scrubbing it with what
is essentially steel wool (this is called mechanical pleurodesis). Finally the
surgeon uses a chemical to further scar the lung (this is known as chemical
pleurodesis). In my case the surgeon used doxycycline as the scarring agent,
although this varies. (From what I understand talc is most commonly used and is
more potent than doxycycline. As I explain later this has advantages and
disadvantages. Sometimes surgeons will also just do a mechanical pleurodesis or
a chemical pleurodesis alone.) The steel wool and doxycycline all cause the
lung to scar. The idea behind this procedure is that this scar tissue will then
grow between the lung and the chest wall. This way if (or, more probably, when)
another bleb ruptures, the scar tissue can keep the rest of the lung up.

In the past this procedure was a little more gruesome because the surgeon would
have to pry apart two ribs to get to the lung. Thankfully these days the
surgery is much less invasive; in my case I had five small incisions, three
midway down my left side, one just under my armpit, and one on my back, each one
about three-quarters of an inch long. The surgeon then sticks a robotic snake
through these incisions to perform the surgery. (In the lingo this is called
VATS — video-assisted thorascopic surgery.)

Nevertheless, thoracic surgery of any kind is no joke. The body keeps a lot of
its important parts there, so while there are risks associated with any surgery,
there are more risks associated with thoracic surgery than usual.

The downsides of pleurodesis

For an otherwise healthy adult, a pleurodesis is a relatively safe procedure.
In the words of my surgeon, “there are no home runs, but on a scale of 1 to 10,
a pleurodesis is a 1.” Given that there is a 20% chance that an individual who
has had a spontaneous pneumothorax on one lung will have a spontaneous
pneumothorax on the other, why don’t the doctors just perform a pleurodesis on
both lungs while they’re at it?

The first reason is that although the surgery is relatively safe, it’s still
extremely painful. After the surgery I wasn’t able to sleep on my left side for
about three months, and I still have pain today if I sleep on that side for too
long. Being able to lie down on my right side made my recovery much easier.

The other reason is that if you need to have lung surgery later in life (say,
you develop lung cancer), the pleurodesis makes those future surgeries much more
dangerous. The scar tissue that is keeping the lung up makes it very difficult
for the surgeon to isolate the part of the lung they want to operate on and so
any surgery becomes a much more delicate procedure.

A digression in support of opioids

One of the things that happens to you when you have a spontaneous pneumothorax
is that you take a lot of opioids. Over the course of my recovery I became
quite familiar with the different kinds and their effects: morphine, Oxycontin,
Norco, Diluadid, fentanyl, Percocet. I had them all.

The surprising thing to me about the opioids was that they didn’t actually
noticeably reduce my pain. I suppose the surgery was so painful that I would
have had to have been drugged out of my mind to completely eliminate the pain.
Nevertheless, opioids were a critical part of my recovery because even though I
was still in a lot of pain, they actually doubled the volume of air I was able
to breathe.

This turns out to be crucial for the recovery process. The idea of the
pleurodesis is that the surgeon thoroughly aggravates the lung and then scar
tissue grows between the lung and the chest wall to hold the lung up the next
time a collapse happens. But in order to get the scar tissue to grow to the
chest wall the lung needs to be pressed right up against the chest wall. This
means that taking in deep breaths is imperative. But as you might imagine,
having your lung scrubbed with steel wool and scarred with doxycycline does not
exactly make it easy to breathe deep. Nevertheless, after the surgery I was
instructed to do breathing exercises every six minutes.

To help you out with this, the hospital will give you a little plastic device to
keep called an incentive spirometer. The incentive spirometer is a graduated
cylinder with a floating disk and a tube attached. By breathing into it you can
measure how much air you can inhale. I noticed that before receiving a dose of
opioids, I would only be able to breathe about 750 mL of air, But after my next
dose kicked in I would be breathing 1500 mL. After the does had worn off four
hours later I would be back to breathing 750 mL. For context, an average adult
male can breathe around 4000 mL. (I never had need to use a spirometer before
my pneumothorax, so I unfortunately don’t know what my personal baseline was
before my lung collapsed.)

Breathing with my trusty spirometer.

Without opioids I would not have been able to breathe as deeply as I needed to
to successfully recover from the surgery. Even still, I wouldn’t be able to
breathe very deeply in the last hour before the next four hour dose. Sometimes
the hospital would give me Tylenol to help tide me over between doses, but I
never noticed the Tylenol making any difference.

There is another class of medications that would have been extremely effective
at relieving my pain: NSAIDs like Ibuprofen, Advil, and Motrin. As the full
name implies NSAIDs (nonsteroidal anti-inflammatory drugs) are good at reducing
inflammation. Unfortunately that is counter-productive in this case. In a
pleurodesis we want inflammation! Inflaming the tissue is the whole point so
that we can grow lots of scar tissue! So NSAIDs are great at relieving the pain
from a pleurodesis, but defeat the entire purpose of the operation and for that
reason you’re not allowed to have them for several weeks after this surgery.

Of the opioids I was given Norco was by far the best. Percocet was not too bad,
but not as effective for me as Norco was. The worst was Diluadid, which I was
given once and made me nauseous to the point of vomiting.

After surgery

Going into surgery I had one tube sticking out of my chest, but when I woke up
I discovered I now had two. This second tube was a little grosser than the
first because it was a drainage tube. Instead of sticking out of the front of
my chest, it was sticking out from my left side. It was about two feet long and
had a little bulb at the end to collect blood and other fluids.

As before, the first tube was providing suction to keep my lung up while the
scar tissue began to form. This tube passed through a little box with some sort
of a water lock in it. Since blood would make its way through the first tube,
the box would collect the excess fluid so it didn’t get sucked into the
hospital’s network of pneumatic tubes. Additionally the water lock would bubble
when air was being sucked out of my chest. After the surgery, the hope was that
the suction box would stop bubbling because the ruptured bleb would have been
removed and the hole in my lung would have been stapled up. Sadly, one day
later as I was laying the hospital bed down to go to sleep I heard the bubbling
start again. I didn’t realize it at the time, but it is apparently fairly
common for the leak to continue a little while after the surgery since it takes
a day or two for the stapled seam to heal and become airtight. Fortunately, by
morning the bubbling had stopped. One of the residents took me off of suction
and we waited a few hours, took an X-ray, and verified that the lung was staying
up.

(Incidentally I had a lot of chest X-rays over my week in the hospital,
probably somewhere around 20. I quickly learned that I have “long lungs” and a
normal X-ray wouldn’t catch the bottoms of my lungs. If I forgot to tell the
technician they’d have to redo the X-ray. One of the technicians joked that by
the time they were done with me I would glow in the dark. Fortunately the
radiation dosage from a chest X-ray is low enough that it takes on the order of
25,000 chest X-rays before you have a measurably increased chance of cancer.
By comparison, it only takes 25 CAT scans.)

Well, maybe not quite that long….

At this point I could be discharged from the hospital and go home. Before I
could go they had to remove the chest tube that had been providing suction. One
of the residents told me to take a deep breath, hunker down, and hum as loudly
as I could and then he yanked it out. (This was essentially performing a
Valsalva maneuver.) Once it was out I was sent on my way, although I still had
the drainage tube sticking out of my side. That was to be removed a week later.

The logo on the X-ray machine looked suspiciously similar to
Deepmind’s….

Recovery

The week that I had my drainage tube in was quite painful. I didn’t know it at
the time, but the tube wraps through the chest cavity and is perhaps a foot and
a half long. The tube rubs against parts of the body that normally do not have
plastic tubes rubbing against them, so it creates pain, but the brain doesn’t
know how to correctly interpret the pain. This produces a sensation of upper
back pain in very specific spots, known as “referred pain”. During this time it
was too painful to lie down so my wife and I created an enormous mound of
pillows on the bed so I could sleep sitting up.

A ridiculous pile of pillows so that I could sleep sitting up.

A week later I went back to the hospital to have the drainage tube removed. As
with the other chest tube, I had to take a deep breath in and hunker down while
the resident yanked the tube out of me. The drainage tube was longer than the
original chest tube and I think some scar tissue had started to grow around it,
so removing it was easily the worst pain in the entire ordeal.

Once all the tubes were out of my body I felt much better. I still couldn’t lie
down, but I at least didn’t have terrible back pain anymore. My tube was
removed on a Friday so I went back to work on the following Monday. I was out
for a total of two weeks, one in the hospital, and one recovering at home. I
was instructed not to carry anything heavier than five pounds for the six weeks
after my surgery.

The recovery process was slow. It took about two months before I could sleep
lying down and about five months before I could lie down on my left side. The
recovery period also came with a tremendous number of strange, new sensations
which I will catalog in some detail here for the benefit of anyone reading this
who has recently undergone a pleurodesis and is wondering if what they’re
feeling is normal.

The oddest sensation is what is called “pleural friction rub.” It was most
prominent when I would lie down and it sort of felt like a tugging in my chest
cavity as I breathed. Imagine the feeling of stepping on freshly fallen snow,
but that feeling is inside your body as you breathe. Pleural friction rub
occurs because the lung tissue is inflamed and has lost the natural lubrication
that allows it slide along the chest wall. Consequently, when you breathe, the
lung tissue catches as it slides along. Pleural friction rub is temporary,
however, and it went away for me after about three months.

Miraculously, I think I went more than six weeks without sneezing. Had I
sneezed I think my lung would have collapsed all over again! (Well, it
probably wouldn’t have, but I wasn’t taking any chances!) I became really
quite good at catching myself before I went into a sneeze and suppressing it.
Even a very small cough felt like I was blowing out a rib. But you can’t go
forever without sneezing, so for anyone who is currently recovering from a
pleurodesis, a trick I learned was to tightly clutch the area with the incision
before coughing or sneezing. That dramatically reduces the pain.

The recovery was also accompanied by a lot of chest pain. Pleurodesis can do a
lot of nerve damage within the chest. The nerve roots will grow back to some
extent, but they do so slowly and painfully, so for many months after surgery I
felt throbbing pains in various parts of my chest. Numbness is also a common
outcome and parts of my left side and chest are now numb, although the affected
areas have slowly shrunk over time. I also frequently experience muscle spasms
in my chest which I assume is also due to the nerve damage.

The final, strange sensation that I’ll document here is a sort of pressure on
the side of my trachea for two weeks about six months after the surgery. It
almost felt as though my trachea had been slightly displaced to one side. A
tracheal deviation can actually occur during a spontaneous pneumothorax (when I
first went to the doctor for my pneumothorax she checked to make sure my trachea
was still centered), but once the underlying pneumothorax has been cured, the
deviation should go away. (The trachea actually isn’t connected to anything in
the throat but just sort of floats in place on top of the lungs.) I was also
told that the intubation during surgery is pretty severe and can cause throat
irritation, but that it should go away after a few weeks. So I’m still not
exactly sure what caused this sensation, but other people who have experienced a
spontaneous pneumothorax have told me that they have felt the same thing. I
wonder if maybe there can occasionally be a small leak that shifts the lungs
just enough to put a little pressure on one side of the trachea. But that is
just speculation.

Gradually life has gotten more or less back to normal. Today I can easily
breathe over 3000 mL on my spirometer (twice as much as I was breathing after
surgery with pain medication, and four times more without), and I wrote much of
this post on an airplane somewhere over the middle of Greenland, flying back to
San Francisco from England. One of the more delicate questions in recovering
from a spontaneous pneumothorax is when you can fly again. Even in a
pressurized cabin, the air pressure during a flight is much lower than normal
atmospheric pressure (perhaps 75% or so), and the change happens quickly — all
recipes for a recurrence. In the past doctors were fairly conservative and
recommended waiting six months to a year before flying again. But my doctor
told me that these days after a pleurodesis the chance of having a recurrence
during an airplane flight is minimal. I don’t think he gave me a fixed time
when it would be safe, but after three months flying would likely
be fine. In my case, my first flight was nine months after the pneumothorax,
and I only felt a little chest tightness on the first flight (which may have
been imagined).

The view of San Francisco on my first flight after the pneumothorax.

Although flying is generally okay, scuba diving is permanently out if you have
had a spontaneous pneumothorax. Scuba diving subjects the body to high enough
pressures to risk rupturing another bleb. And if your lung collapses under
water, Boyle’s law guarantees that surfacing is not going to make things any
better.

I still have trouble sleeping for an extended period of time on my left side,
and the chest numbness, pain, and spasms are still present, though reduced. In
principle I should be able to do any physical activity that I could do before,
with the exception of scuba diving and skydiving (too big a pressure change). I
do, however, have the feeling that if I were to do a heavy deadlift I might
cause another bleb to pop or rip some scar tissue, or something. But I do know
that other people who have had a spontaneous pneumothorax have been able to
weightlift.

So, for anyone reading this who is currently recovering from a pleurodesis, know
that, despite my complaining, you will get better and life will go back to
normal! Or 98% normal, anyway. And while there is still a 20% chance that this
will happen all over again on my right lung, having gone through it once I think
the second time will be easier now that I know what’s coming. But here’s to
hoping it won’t come at all!

Standing next to a section of William Herschel’s forty-foot
telescope at Greenwich Observatory eight months after the spontaneous
pneumothorax, and in much less pain than the earlier photographs!

Collapsed Lung or Pneumothorax – Symptoms, Causes & Treatment

A collapsed lung is also known as a pneumothorax. It occurs when there is a build-up of air in the space between the lungs and the rib cage. Here we explain the symptoms, causes, and treatment for a collapsed lung.

Symptoms

• Collapsed lung symptoms include sharp chest pain, which is worse when breathing deeply.
• The patient will feel tightness in the chest and shortness of breath.
• A dry cough may be experienced.
• In more severe cases rapid heart rate, fatigue and a bluish tint to the skin and lips may be seen.
• The severity of symptoms depends on how much air has entered the pleural space (between the ribs and lungs).
• In the most severe case, known as a tension pneumothorax, the air which has entered cannot escape at all. This results in symptoms getting rapidly worse.
• If you suspect a Collapsed lung, seek medical attention immediately.

What is a Collapsed lung?

A pneumothorax or collapsed lung occurs when there is a build-up of air in the space between the lungs and the rib cage. This space is known as the pleural space. As a result, pressure on the lung is increased, therefore, it cannot expand as much as it usually can.

A collapsed lung will usually only occur on one side at a time. There are two types:

Traumatic Pneumothorax

• As the name suggests, occurs as a result of a traumatic injury, allowing air from outside the body into this space.
• This may occur with injuries such as broken ribs or gunshot or stab wounds.
• It may also happen as a complication following chest surgery.

Spontaneous Pneumothorax

• Occurs for no apparent reason.
• What happens is that an air sack on the surface of the lungs called a Bulla, bursts.
• The bulla may burst during heavy exercise or certain activities including scuba diving, flying or hiking at altitude.
• Respiratory diseases such as Asthma and COPD or chronic obstructive pulmonary disease also increase the risk.

Treatment

• Following a lung X-ray to confirm the diagnosis, the appropriate treatment is undertaken, depending on the severity of the condition.
• Minor cases usually heal on their own in a few days.
• The gap through which the air entered the space heals and the body absorbs the excess air. Extra Oxygen may be needed.
• More major injuries require a chest drain to be inserted into the pleural space. This allows the air to disband.
• The drain may be kept in place for anything from a couple of days to a few weeks, depending on the healing time for the injury.
• In repeated cases, a procedure known as pleurodesis may be performed. This uses a special chemical to stick the two layers of lung lining together, so air cannot get in between them.

Related articles

• Chest pain in athletes can be from a number of causes. Thankfully, cardiac chest pain in athletes is rare. A range of conditions causes pain…

• Acute chest pain is sudden onset and includes cardiac chest pain, heart attack, a torn muscle or bruised rib. Most chest pain in sport, however,…

• A Costochondral separation, sometimes known as a rib separation, usually occurs after a direct impact to the chest. One or more ribs become separated from…

• Referred chest pain is pain originates from an injury elsewhere, but is felt in the chest. The root cause of the problem may be in…

• A side stitch can usually be felt to one side of the abdomen, more often the right side, around the area of the lower ribs.…

Collapsed lung (pneumothorax) | Multimedia Encyclopedia | Health Information

Air around the lung; Air outside the lung; Pneumothorax dropped lung; Spontaneous pneumothorax

A collapsed lung occurs when air escapes from the lung. The air then fills the space outside of the lung, between the lung and chest wall. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath.

The medical name of this condition is pneumothorax.

Causes

Collapsed lung can be caused by an injury to the lung. Injuries can include a gunshot or knife wound to the chest, rib fracture, or certain medical procedures.

In some cases, a collapsed lung is caused by air blisters (blebs) that break open, sending air into the space around the lung. This can result from air pressure changes such as when scuba diving or traveling to a high altitude.

Tall, thin people and smokers are more at risk for a collapsed lung.

Lung diseases can also increase the chance of getting a collapsed lung. These include:

In some cases, a collapsed lung occurs without any cause. This is called a spontaneous collapsed lung.

Symptoms

Common symptoms of a collapsed lung include:

A larger pneumothorax causes more severe symptoms, including:

Exams and Tests

The health care provider will listen to your breathing with a stethoscope. If you have a collapsed lung, there are decreased breath sounds or no breath sounds on the affected side. You may also have low blood pressure.

Tests that may be ordered include:

Treatment

A small pneumothorax may go away on its own over time. You may only need oxygen treatment and rest.

The provider may use a needle to allow the air to escape from around the lung so it can expand more fully. You may be allowed to go home if you live near the hospital.

If you have a large pneumothorax, a
chest tube
will be placed between the ribs into the space around the lungs to help drain the air and allow the lung to re-expand. The chest tube may be left in place for several days and you may need to stay in the hospital. If a small chest tube or flutter valve is used, you may be able to go home. You will need to return to the hospital to have the tube or valve removed.

Some people with a collapsed lung need extra oxygen.

Lung surgery
may be needed to treat collapsed lung or to prevent future episodes. The area where the leak occurred may be repaired. Sometimes, a special chemical is placed into the area of the collapsed lung. This chemical causes a scar to form. This procedure is called pleurodesis.

Outlook (Prognosis)

If you have a collapsed lung, you are more likely to have another one in the future if you:

• Are tall and thin
• Continue to smoke
• Have had two collapsed lungs in the past

How well you do after having a collapsed lung depends on what caused it.

Possible Complications

• Another collapsed lung in the future
• Shock
  , if there are serious injuries or infection, severe inflammation, or fluid in the lung develops

When to Contact a Medical Professional

Call your provider if you have symptoms of a collapsed lung, especially if you have had one before.

Prevention

There is no known way to prevent a collapsed lung. Following standard procedure can reduce the risk of a pneumothorax when scuba diving. You can decrease your risk by not smoking.

References

Byyny RL, Shockley LW. Scuba diving and dysbarism. In: Marx JA, Hockberger RS, Walls RM, et al, eds.
Rosen’s Emergency Medicine: Concepts and Clinical Practice
. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 143.

Eckstein M, Henderson SO. Thoracic trauma. In: Marx JA, Hockberger RS, Walls RM, eds.
Rosen’s Emergency Medicine: Concepts and Clinical Practice
. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 45.

Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds.
Murray and Nadel’s Textbook of Respiratory Medicine
. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 81.

Lung Cancer – Non-Small Cell: Symptoms and Signs

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with NSCLC may experience the following symptoms or signs. Sometimes people with NSCLC do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

• Fatigue

• Cough

• Shortness of breath

• Chest pain, if a tumor spreads to the lining of the lung or other parts of the body near the lungs

• Loss of appetite

• Coughing up phlegm or mucus

• Coughing up blood

• Unintentional weight loss

• Hoarseness

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

For people with NSCLC who have no symptoms, the cancer may be noticed on an imaging test – such as a chest x-ray or CT scan – performed for some other reason, such as checking for heart disease. Most people with NSCLC are diagnosed when the tumor grows, takes up space, or begins to cause problems with parts of the body near the lungs. A lung tumor may also make fluid that can build up in the lung or the space around the lung or push the air out of the lungs and cause the lung to collapse. This prevents oxygen from getting in the body and carbon dioxide from leaving the body by blocking the flow of air into the lungs, or by using up the space normally required for oxygen to come in and carbon dioxide to go out of the lung.

NSCLC can spread anywhere in the body through a process called metastasis. It most commonly spreads to the lymph nodes, other parts of the lungs, bones, brain, liver, and structures near the kidneys called the adrenal glands. Metastases from NSCLC can cause:

• More breathing difficulties

• Bone pain

• Abdominal or back pain

• Headache

• Weakness

• Seizures

• Speech difficulties

• Rarely, a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels.

Symptoms such as fatigue, feeling out-of-sorts or unwell, and loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell in a general way. Loss of appetite can cause weight loss and muscle loss. Fatigue and weakness can further worsen a person’s ability to breathe. Muscle loss also contributes to weakness and loss of mobility.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

90,000 Frequently Asked Questions

The outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has turned into a growing global pandemic. Coronavirus Disease 2019 (COVID-19) can manifest itself in a spectrum of illnesses ranging from mild illness to severe respiratory failure requiring hospitalization in an intensive care unit.

The virology and epidemiology problems of SARS-CoV-2 range from the appearance of the virus to its spread and manifestations of the disease.Currently, Russia is not the leader in terms of morbidity and mortality compared to other countries. In the United States, the scenario of a pandemic is characterized by a rapid rise in morbidity with a high mortality rate (4%). With the accumulation of scientific and clinical material, there will be fewer and fewer white spots on the COVID-19 map, we decided to post a brief, currently relevant information in response to frequently asked questions.

What are the clinical and diagnostic manifestations of COVID-19?

The incubation period for COVID-19 ranges from 5-6 days.The period from the first onset of COVID-19 symptoms to death ranges from 6 to 41 days, with a median of 14 days. This period depends on the age of the patient and the state of the patient’s immune system. The most common symptoms at the onset of COVID-19 are fever, cough and fatigue, less sputum overproduction, headache, hemoptysis, diarrhea, shortness of breath and lymphopenia. On a computed tomography of the chest, clinical signs of pneumonia are most often determined, in some cases there are multiple foci of the “frosted glass symptom” mainly in the subpleural regions of both lungs.Other manifestations include RNA anemia, acute respiratory distress syndrome, and acute heart damage.

Which pathological conditions aggravate the course of coronavirus infection with an increased risk of death?

Cytokine storm (a sharp increase in the levels of pro-inflammatory cytokines) is observed in the majority of patients with severe COVID-19 infection. This life-threatening phenomenon leads to the development of cardiovascular collapse, severe respiratory distress syndrome, and multiple organ failure in patients.

Comorbidity – It is necessary to take into account the presence of COPD, bronchial asthma, obesity, diabetes, immunosuppression of any genesis. Chronic kidney and / or liver disease, drug incompatibility and toxicity.

Pneumofibrosis – The prognosis of the course of convalescence of coronavirus pneumonia is complicated by the fact that the affected areas of the lungs are completely or partially replaced by fibrosis. Accordingly, patients with extensive lesions and consolidation of the lung tissue require dynamic observation.

What are the standards of care for pharmacological treatment of COVID-19 patients?

There is currently no generally accepted standard of care for the pharmacological treatment of COVID-19 patients. Urgent identification of potential treatment strategies is a priority. At the Moscow Department of Health, a temporary treatment and diagnostic algorithm has been developed , in therapeutic schemes of which “off-lable” drugs are used.The developed protocol is based on international experience, expert opinions (risk / benefit ratio). Clinic of the Moscow State Medical University IM Sechenov and GBUZ GKB No. 52 work according to these recommendations, while simultaneously conducting a constant analysis of clinical data in search of ways to optimize therapeutic approaches.

Treatment regimens for drug and apparatus treatment are determined depending on the clinical variant, severity, period of illness, sex and age, comorbid and premorbid background of the patient.In 20-30%, when carrying out PCR diagnostics for SARS-CoV-2, there may be false negative results. If CT shows signs of viral pneumonia, the patient should be treated with the COVID-19 protocol. Clinical management of hospitalized patients with COVID-19 includes supportive therapy: supplemental oxygen therapy aimed at maintaining SpO2, therapy with antimicrobial drugs, antiviral drugs, and intensive care (1).

What therapeutic approaches are used depending on the stage of development COVID -19 ?

Currently, there are two pathogenetic approaches in the treatment of COVID-19, which are designed for different stages of the development of the disease.Antiviral drugs are most effective in the earliest stages of infection, and immune modulatory therapy has the potential to treat acute respiratory distress syndrome associated with a hyperinflammatory response.

Antiviral medicines. Chloroquine phosphate is the only drug that has been clinically proven to be therapeutic. Medicines currently prescribed for the treatment of COVID-19 include oseltamivir, lopinavir / ritonavir, ribavirin, and chloroquine phosphate or hydroxychloroquine sulfate.All of these drugs are metabolized in the liver, most of the metabolites are found in urine due to renal excretion. Damage to the liver and kidneys can interfere with the elimination of drugs, which can increase the risk of toxicity or make it difficult to achieve a therapeutic dose. Accordingly, frequent and careful monitoring of liver and kidney function in patients with COVID-19 is necessary.

Modulation of the immune response. IL-6 is one of the main cytokines involved in the development of a cytokine storm in patients with COVID-19-associated diseases, therefore, the use of IL-6 inhibitors may be effective in acute respiratory distress syndrome.There are currently encouraging results on the use of two IL-6 inhibitors – Kevzar (Regeneron / Sanofi) and Actemra (Roche / Genentech).

What are the current trends in the search for methods of effective therapy for COVID-19?

Inhibitors of tyrosine kinases JAK1 and JAK2 – a block of the cytokine cascade.
Ruxolitinib is a low molecular weight kinase inhibitor that selectively blocks Janus kinases (JAK1 and JAK2), mediating signaling of a variety of cytokines and growth factors important for hematopoiesis and immune system functions.Approved by the European Commission for the treatment of adult patients with polycythemia vera and chronic idiopathic myelofibrosis. The effectiveness of this drug in treating the cytokine storm in COVID-19 is currently being studied.

Reconvalescent plasma. The method is based on the introduction of plasma from donors who have recovered from COVID-19 to seriously ill COVID-19. A peer-reviewed study showed the efficacy of convalescent plasma in 10 patients with severe COPD-19 and reported significant improvement in clinical symptoms within three days.In addition, in early March 2020, Takeda announced that it is investigating the TAK-888 molecule, which is an anti-SARSCoV-2 polyclonal antibody based on globulin (H-IG) obtained from people who recovered from COVID-19 for hyperimmune therapy.

Inhibition of viral docking:
neutralizing antibodies are designed to protect healthy cells from viral infection and are intended to be used as preventive therapy for patients and individuals at high risk or already suffering from COVID-19.

Vaccine prophylaxis. Safety, immunogenicity and durability are major challenges in the development of vaccines against COVID-19, which experts estimate will take 12 to 18 months. Immunity for infections caused by other members of the coronavirus family is not persistent and re-infection is possible. With regard to safety, the developers have expressed concerns based on preclinical studies associated with exacerbation of lung disease.

The text uses the authors’ own clinical experience and data from scientific publications.

1. Temporary guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 3 (03.03.2020)” (approved by the Ministry of Health of Russia, Ministry of Health)

2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-13.

3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet 2020; 395 (10223): 497-506.

4. Wang T, Zhang F, Wang X, Li X, Ling H, Lv D, Yin X, et al. Clin Pharm Ther. 2020 Mar 16. Predictive factors associated with glycaemic response to exenatide in Chinese patients with type 2 diabetes mellitus.

5. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020.

6. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected.https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. 2020. [Accessed] 10 March 2020.

7. Kaur S, Bansal Y, Kumar R, Bansal G. A panoramic review of IL-6: Structure, pathophysiological roles and inhibitors. Bioorg Med Chem. 2020; 28 (5): 115327.

Fibrobronchoscopy of the lungs what is this procedure, how is it done, preparation

Fibrobronchoscopy – what is it?

Fibrobronchoscopy is a procedure for examining the bronchi, trachea.A fiberoptic bronchoscope is inserted into their lumen.

The fiberoptic bronchoscope is a thin-type flexible probe, in which there is a fiber of the fiber-optic type. The device transmits on the screen a view of the internal organs being examined.

This type of research is needed for:

• Viewing the anatomical features of the tracheobronchial tree;
• Assessment of mucous membranes by condition;
• Biopsies of the desired organs;
• Obtaining information for histology and cytology;
• Bacteriological research;
• Removal of viscous phlegm;
• Medicine input;
• Other medical enterprises;
• Detection of bronchotracheal tumors;
• Confirmation of lung disease;
• Identification of the causes of coughing up blood.

The procedure cannot be done to the patient if:

• There is asthma of the bronchial type;
• Patient intolerant of topical pain relievers;
• Severe pulmonary insufficiency present;
• There is severe cardiovascular insufficiency;
• There are mental problems.

Before the fibrobronchoscopy is performed, an x-ray of the organs of the breast cell, an electrocardiogram and a computed tomography must be done.

Before the study, you do not need to eat food in the evening. You must bring a towel with you.

A fiberoptic bronchoscope is inserted through the patient’s nose. Local anesthesia is done with a 2% lidocaine solution of the reflex zones.

During the procedure, there should be no pain, there may be some discomfort and a reflex cough.

The procedure takes one hour.

The indication for fibrobronchoscopy is the treatment of a collapse of a mild segmental or lobar nature.Fibrobronchoscopy is done to patients with whom it is impossible to contact, patients who have chronic atelectasis of the lung tissue, and if respiratory therapy is ineffective.

Fibrobronchoscopy will show if there are foreign bodies, aspirated stomach contents, malignant neoplasm due to which the collapse occurred in the organs being checked.

If there are difficulties with the patency of the airways, then the fiberoptic bronchoscope is passed alongside or through the endotracheal tube.The cause of its obstruction may be over-inflation of the cuff or a dry-type secret. To examine the subcuff space, the endotracheal tube is pulled back a certain number of centimeters.

If a secret has accumulated in the trachea, the vocal cords are swollen or paralyzed, then complete tracheal obstruction is possible. This violation is detected by a fiberoptic bronchoscope.

Also, fiberoptic bronchoscopy helps with complex intubation.The fiberoptic bronchoscope occupies most of the endotracheal tube cross-section. The fiberoptic bronchoscope can be passed through an endotracheal tube with an internal diameter of at least eight millimeters. It is possible to insert a fiberoptic bronchoscope into the trachea nearby. If the patient is intubated, then he needs to carry out manual or mechanical ventilation with a breathing bag.

Coughing up blood can be caused by trauma to the mucous membrane of ETT or a catheter when removing secretions. If coughing up blood is strong, then fibrobonchoscopy is performed using a rigid bronchoscope in order to intensively remove blood and provide oxygen permeability.

If infiltration and other formations are found in the lungs, fibrobronchoscopy is also performed.

If a brush or conventional airway biopsy is needed, fiberoptic bronchoscopy is done to obtain samples. A bronchoscope is inserted into the distal bronchus, an isotonic solution is installed. Samples may contain Pneumocystis carinii, Mycobacterium tuberculosis and other harmful microorganisms.

If there is an infiltrate that interferes with breathing, a lung biopsy is done with fibrobronchoscopy.

During the procedure, especially with artificial ventilation of the lungs, there is a danger:

• Depressurization;
• Air leak around the fiberscope;
• Excessive suction;
• Exceeding the upper pressure limit;
• Hypoventilation;
• Barthotrauma;
• Bleeding;
• Fever.

To avoid these dangers, you need to constantly monitor oxygen, be ready to stop arrhythmias, high blood pressure (connection to a heart monitor), be ready to administer bronchodilators to the patient, and infuse platelets and plasma if the patient has coagulopathy.

Clinic Onco.Rehab recommends partners who will perform modern diagnostic procedures required for your examination and treatment.

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90,000 ᐈ Computed tomography in the diagnosis and treatment of pneumonia, including coronavirus infection SARS-CoV-2 (COVID-19) at the ICLINIC

magnetic resonance imaging center

In March 2020, the World Health Organization (WHO) declared the spread of a new coronavirus infection caused by the SARS-CoV-2 virus (COVID-19) a pandemic.

Coronaviruses

Coronaviruses (Coronaviridae) are a large family of RNA viruses that can cause various diseases in humans – from the mildest forms of acute respiratory viral infection (ARVI) to lung tissue damage with severe acute respiratory syndrome (SARS-SARS) due to the development viral pneumonia. Today, it is well known about the constant circulation in the population of a number of coronaviruses (HCoV-NL63, HCoV-HKU1, HCoV-229E, HCoV-OC43, etc.), causing the lungs, as a rule, damage to the upper respiratory tract.

The new coronavirus infection COVID-19 was attributed to the II group of pathogenicity, like some other varieties of this family of viruses, such as MERS (from the English Middle East Respiratory Syndrome) and SARS (from the English Severe Acute Respiratory Syndrome) – Severe Acute Respiratory Syndrome). These viruses are more pathogenic to humans and can cause severe respiratory and lung damage.

Diagnostics

The current diagnostic algorithms and protocols based on the recommendations of the WHO and the Ministry of Health of the Russian Federation regulate the confirmation of the COVID-19 disease based on the presence of clinical manifestations of acute respiratory infection, bronchitis, pneumonia in combination with data from an epidemiological history and positive test results for the presence of RNA virus by the polymerase chain reaction method ( PCR). It is PCR with reverse transcription that is the only specific method for diagnosing COVID-19.

A positive or negative PCR test for COVID-19 is the most important criterion for early diagnosis of the disease, disease control, the need for anti-epidemic measures, hospitalization or isolation, and the effectiveness of treatment. However, the test systems available today in the arsenal of specialists have different sensitivity and diagnostic stability, as well as a relatively long time to obtain a test result. This fact cannot but have its negative consequences.To minimize them in the complex of measures in the examination of patients, radiation methods of research are successfully used, such as ultrasound examination of the chest organs (TGC), X-ray of the OGK, computed tomography of the OGK.

Radiation methods of research

Ultrasound and X-ray examinations are additional and should be performed in cases when it is impossible to perform a computed tomography for the patient, as well as for monitoring previously identified pathological changes in the lungs and pleural cavities in patients who are in intensive care units in an extremely serious and critical condition if they cannot be transported.Early signs of viral damage to the lower respiratory tract and lungs are poorly expressed and nonspecific, therefore, computed tomography (CT) of the lungs is recommended for all patients with suspected pneumonia and is in this case the most sensitive method of radiation diagnostics. The specificity of the study is 25%, and the sensitivity is 97%. The tomograms show minimal changes, including those characteristic of other types of bacterial and viral pneumonia. CT will detect and show pneumonia even if the patient does not have clinical signs of the disease, and will allow the specialist to diagnose pneumonia.

The study should be performed strictly as directed by a physician. Lung damage in COVID-19 is manifested by acute interstitial pneumonia in the form of diffuse ground-glass changes, bilateral polysegmental compaction of the lung tissue with peripheral localization with a tendency to consolidation. The permeability of cell membranes increases, the transport of fluid with an increased protein content to the alveoli and pulmonary interstitium increases with the phenomenon of tissue edema and collapse of the alveoli.Gas exchange progressively decreases until the development of acute respiratory distress syndrome (ARDS).

Clinical manifestations of lung damage in COVID-19 90 230

Clinically, the progression of the severe course of the COVID-19 disease is manifested by the appearance and intensification of shortness of breath, a feeling of shortness of breath, and a feeling of tightness in the chest. General manifestations of intoxication of the body are increasing. Cough with phlegm increases, sometimes hemoptysis appears. On examination, the doctor reveals a dull sound over the lungs, fine bubbling moist crepitant rales.The described manifestations do not change the cough and change in the position of the patient’s body. The appearance and growth of signs of respiratory failure with a decrease in oxygen saturation is a criterion for hospitalization of a patient in the intensive care unit. The progression of the disease can be facilitated by the addition of a bacterial and fungal infection, sepsis.

The progression of the disease is characterized on CT by a rapid increase in density and an increase in the area of ​​pathological changes up to diffuse alveolar damage.This further emphasizes that computed tomography of the lungs and CT scan is very important for the early detection of suspicious and asymptomatic cases in the diagnosis of pneumonia.

Treatment

When providing medical care, it is necessary to constantly monitor the patient’s condition to detect the first signs of deterioration, such as progressive respiratory failure and sepsis. Patients should receive antibiotic and / or antiviral therapy, supportive and symptomatic therapy, as well as therapy for various comorbidities, conditions or complications present or emerging in patients, based on existing standards and clinical guidelines.

With a favorable course of pneumonia, there is a gradual resorption of infiltration, and interstitial fibrosis may form in the outcome. Early diagnosis of the disease and adequate treatment significantly improve the prognosis and reduce the risk of consequences and residual effects after pneumonia. Radiological methods, especially CT of the lungs, are widely used to monitor the condition of patients and the effectiveness of treatment.

The procedure for discharging patients from the medical facility

To discharge a patient with a confirmed diagnosis of COVID-19, it is necessary to obtain a negative PCR test result for the presence of SARS-CoV-2 RNA twice with an interval of at least 1 day in the absence of any clinical manifestations of the disease.

scientific consultant, MD, prof. N.I. Ananyeva
deputy. Director of Medical Affairs N.N. Bukhartsev
network of medical centers ICLINIC, St. Petersburg 2020

————————————————– ————————————————– —-

We wish you good health.

You can do a computed tomography of the lungs every day at the ICLINIC diagnostic center at:

St. Petersburg, st.Timurovskaya 17, building 3

Inquiries and registration by phone. (812) 207-77-77

Vladimir medicine is in collapse

Photo myokolitsa.rf

Contrary to the assertion of the administration of the Vladimir region that the situation with the coronavirus infection pandemic in the territory of the province is controlled, Vladimir medicine is already in collapse. Patients with even 50% lung lesions are no longer hospitalized, because there are no places (recall the refusal of the governor Sipyagin to build a new infectious diseases hospital in May this year), doctors are forced to leave patients in critical condition at home for the same reason, there are queues in polyclinics and crowds of sick and healthy people with suspected coronavirus infection are forced to come to clinics themselves, thus spreading this infection further.

Doctors and residents of the region talk about this.

Two BSP employees posted stories on their pages on the Vkontakte social network about the conditions in which they have to work today.

Ekaterina Ashaeva writes that what is happening reminds her of a horror movie:

“ Actually, it all reminds me of a horror movie. An epidemic is raging in the country. And it has been raging not for the first day, but still everyone is not ready, and this is a fact. Being on the shift day 21.On 10.2020, I had all the calls, namely viral pneumonia and coronavirus, with the exception of only three calls. Of course, a small miracle happened, and we finally began to take patients to CT (computed tomography) for the entire period of the epidemic, BUT imagine, we in PPE (those same white suits) go with a patient for CT and after performing with the patient waiting for the result in the ambulance. And now the result is ready, for example: lung damage corresponds to CT-2 of 50%, and then I call an ambulance, outline the situation and wait for a call back and tell me where to hospitalize.And they call me back and say: “There are no places anywhere, the patient needs to go home and call the local doctor tomorrow.” And then the patient’s PANIC begins. “No room for me ???? Even in the hallway ??? And what is my home ???? Tell me, won’t I die at home ???? What should I do next ???? Where should I call ??? Or maybe you ask ??? You yourself said 50 percent lung damage ???? ” And that’s all, a feeling of hopelessness. With one such patient, we still went to the hospital for coronavirus patients, and there we heard a lot of things in our address, and why did you come ?! There is only one place, without oxygen, but the patient needs attention, OXYGEN (and where would he be at the patient’s home?), Hospitalize wherever you want, we do not take him, then we took him, but said not to come again.And it was a small victory, I guess. What’s next? Many of my colleagues left patients at home during this shift, and we do not know their further fate. And this is not a war or pre-war preparation! ”

Vasilisa Konovalova talks about the everyday life of BSP paramedics who come to the call after 12 hours (!) And whom (attention!) Doctors force to leave critical patients at home:

“ How to look into the eyes of a patient who lies at home with pneumonia caused by Covid-19, his shortness of breath increases, he looks at you with hopeful eyes, and the senior shift doctor answers you on the speakerphone on the phone:“ Leave at home, nowhere No”?


How I, an ambulance paramedic, trained to save lives and provide assistance, can leave a patient at home, knowing that, most likely, soon his body will no longer compensate for 70% of lung damage, his saturation will drop, and he will not live without oxygen ?


We are mentally tired.And physically too. Calls turn into hellish waiting hours until they reach an agreement with the hospital (if at all). All these hours eventually turn into huge call delays (people wait 12, 15, 20 hours). And to someone we do not have time. And then on another call you listen from desperate relatives that we could save if we arrived on time. What do we say? Yes, they could. But they did not have time. And we, ordinary paramedics, are not to blame for how much the call costs. But we get it. And complaints come to us.And we are listening to this. And we are ashamed. And it should be a shame to those who ruined all medicine.


It is a shame to speak into the intercom “ambulance” when people are waiting for half a day.


We knew where we were going, yes.


But we could not even imagine that there would be no places in hospitals, that we, in spite of everyone, would hospitalize a patient who needs hospital treatment to nowhere. That we will beg for places for seriously ill patients, that we will fight with the “receivers” and doctors on duty.And they certainly did not suspect that our senior doctors would shout into our phone to leave the patient at home.


How? I will be the last one of the paramedics who could help him. I will be the “scapegoat” that the patient’s family will blame for everything. And you know what? They will be right.


I must do everything in my power to save a person’s life. Not for thanks, not for the salary, but simply because I am a medical worker, and I was taught this.


So that’s it. There are no places in hospitals, dear citizens. We fight every shift for everyone. And reading the answers of DZAVO about the heap of places for patients with covid, we find it funny. And at the same time I want to cry. ”

The situation is no better in polyclinics. Here is what one of the TV-MIG readers, Svetlana D-va, said:

– I am currently on sick leave at the 5th polyclinic. There are not enough therapists, the queues for a smear are prohibitive.It’s stuffy … germs walk around and nothing is ventilated. Two women from the regional health department came to me … they were told that we were sitting in line both sick and healthy for 4 hours! We looked and left. Mess and indifference.

This is already a response to the call of the head of the health department to complain if patients are forced to go to polyclinics. Complained. The result is zero. For whom are beautiful words and appeals spoken? For the media to create a happy picture?

It is difficult to imagine that the regional administration does not know about the real state of affairs, that the regional health care has already failed and cannot cope with the flow of patients, which means that it is necessary to reduce this flow at least for a short time.And this can be done in only one way – by stopping the activities of enterprises, schools, kindergartens. For a while. Just for a couple of weeks.