What are the main causes of pneumothorax. How can you recognize the symptoms of a collapsed lung. What treatments are available for pneumothorax. Why is a tension pneumothorax considered life-threatening. How does smoking increase the risk of spontaneous pneumothorax.

Understanding Pneumothorax: The Collapsed Lung Phenomenon

Pneumothorax, commonly referred to as a collapsed lung, is a serious medical condition that occurs when air enters the space between the chest wall and the lung, known as the pleural space. This intrusion of air causes the lung to collapse inward, potentially leading to severe pain and breathing difficulties. In some cases, pneumothorax can be life-threatening, particularly if it develops into a tension pneumothorax.

The severity of pneumothorax can vary widely, from a small, partial collapse that resolves on its own to a complete lung collapse requiring immediate medical intervention. Understanding the causes, symptoms, and treatment options for pneumothorax is crucial for early detection and proper management of this condition.

Types of Pneumothorax: Primary, Secondary, and Traumatic

Pneumothorax is categorized into three main types based on its underlying cause:

1. Primary Spontaneous Pneumothorax (PSP)

PSP occurs in individuals with no known history of lung disease. While the exact cause remains unknown, certain risk factors have been identified:

• Tobacco and cannabis smoking
• Tall, thin body type
• Age group of 15-34 years
• Family history of pneumothorax

Are smokers at higher risk of developing PSP? Indeed, research published in the BMJ reveals that men who smoke tobacco are 22 times more likely to develop PSP compared to nonsmokers. For women smokers, the risk is nine times higher than their nonsmoking counterparts.

2. Secondary Spontaneous Pneumothorax (SSP)

SSP is associated with various underlying lung diseases and disorders. It typically presents with more severe symptoms and carries a higher mortality risk compared to PSP. Some conditions that increase the risk of SSP include:

• Chronic Obstructive Pulmonary Disease (COPD)
• Cystic fibrosis
• Severe asthma
• Lung infections (e.g., tuberculosis, certain pneumonias)
• Sarcoidosis
• Thoracic endometriosis
• Pulmonary fibrosis
• Lung cancer and sarcomas

Additionally, certain connective tissue disorders may contribute to the development of SSP:

• Rheumatoid arthritis
• Polymyositis and dermatomyositis
• Ankylosing spondylitis
• Systemic sclerosis
• Ehlers-Danlos syndrome
• Marfan’s syndrome

3. Traumatic Pneumothorax

Traumatic pneumothorax results from an impact or injury to the chest wall and pleural space. Common causes include:

• Rib fractures
• Sports injuries
• Car accidents
• Puncture or stab wounds
• Blast trauma from explosions

Can traumatic pneumothorax occur without visible chest wounds? Yes, it’s possible for traumatic pneumothorax to develop even in the absence of noticeable external injuries, particularly in cases of blast trauma.

The Dangers of Tension Pneumothorax

Any type of pneumothorax has the potential to progress into a tension pneumothorax, a life-threatening condition that requires immediate medical attention. Tension pneumothorax occurs when a one-way valve-like leak develops in the pleural space, allowing air to enter but not escape during exhalation. This leads to a rapid buildup of pressure within the pleural cavity, which can severely compromise lung function and cardiovascular stability.

Why is tension pneumothorax considered a medical emergency? The increasing pressure in the pleural space not only collapses the affected lung but also pushes against the heart and other vital structures in the chest. This can lead to a dramatic decrease in blood return to the heart, reduced cardiac output, and potentially fatal cardiovascular collapse if not treated promptly.

Recognizing the Symptoms of Pneumothorax

The symptoms of pneumothorax can vary in severity and may be easily confused with other respiratory or cardiac conditions. Common signs and symptoms include:

• Sudden onset of shortness of breath
• Sharp, stabbing chest pain, often worse on one side
• Increased pain during inhalation
• Sensation of chest pressure
• Rapid heartbeat
• Rapid, shallow breathing
• Cyanosis (bluish discoloration of the skin or lips)
• Confusion or dizziness
• In severe cases, loss of consciousness or coma

Is it possible to have pneumothorax without noticeable symptoms? Yes, some cases of pneumothorax may present with minimal or no symptoms, especially if the collapse is small. These cases are typically discovered incidentally through chest X-rays or other imaging studies performed for unrelated reasons.

Risk Factors and Special Considerations

While anyone can potentially develop pneumothorax, certain factors increase the risk:

Smoking and Pneumothorax

Smoking is the most significant modifiable risk factor for primary spontaneous pneumothorax. The harmful effects of tobacco smoke on lung tissue increase the likelihood of air leaks and subsequent lung collapse. How does smoking increase the risk of spontaneous pneumothorax? Tobacco smoke damages the small airways and alveoli in the lungs, making them more susceptible to rupture and allowing air to escape into the pleural space.

Gender and Age Considerations

Primary spontaneous pneumothorax is more common in men than women, with a peak incidence between the ages of 15 and 34. This gender disparity may be partly attributed to differences in smoking habits and body habitus between men and women.

Genetic Factors

A family history of pneumothorax increases an individual’s risk of developing the condition. Certain genetic disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, are associated with a higher incidence of pneumothorax.

Occupational and Recreational Risks

Certain activities and professions may increase the risk of traumatic pneumothorax:

• Scuba diving: Changes in pressure underwater can lead to lung barotrauma and pneumothorax
• Aviation: Rapid changes in air pressure during flight can potentially trigger pneumothorax in susceptible individuals
• Contact sports: Activities with a high risk of chest trauma, such as football or martial arts, may increase the likelihood of traumatic pneumothorax

Diagnostic Approaches for Pneumothorax

Accurate diagnosis of pneumothorax is crucial for appropriate management. Healthcare providers employ various diagnostic tools and techniques to confirm the presence and extent of a lung collapse:

Physical Examination

A thorough physical examination may reveal signs suggestive of pneumothorax, such as:

• Decreased breath sounds on the affected side
• Hyperresonance to percussion over the collapsed lung
• Decreased chest wall movement on the affected side
• Tracheal deviation away from the affected side (in cases of tension pneumothorax)

Imaging Studies

Imaging plays a crucial role in confirming the diagnosis and assessing the severity of pneumothorax:

• Chest X-ray: The primary imaging modality for diagnosing pneumothorax, typically showing a visible line representing the edge of the collapsed lung
• CT scan: Provides more detailed images and can detect small pneumothoraces that may be missed on conventional X-rays
• Ultrasound: Increasingly used in emergency settings for rapid diagnosis of pneumothorax

Can a small pneumothorax be missed on a standard chest X-ray? Yes, small pneumothoraces may sometimes be overlooked on routine chest X-rays, especially if the collapse is minimal or located in areas difficult to visualize on a single view. In such cases, additional imaging techniques or follow-up studies may be necessary to confirm the diagnosis.

Treatment Options for Pneumothorax

The management of pneumothorax depends on its size, cause, and the patient’s overall clinical condition. Treatment options range from conservative approaches to invasive interventions:

Observation and Oxygen Therapy

For small, asymptomatic pneumothoraces, especially in cases of primary spontaneous pneumothorax, a watchful waiting approach may be appropriate. Supplemental oxygen can be administered to help accelerate the reabsorption of air from the pleural space.

Needle Aspiration

In some cases, a thin needle may be inserted into the chest to remove the trapped air, allowing the lung to re-expand. This procedure is typically considered for small to moderate-sized pneumothoraces.

Chest Tube Insertion

For larger pneumothoraces or those causing significant symptoms, a chest tube may be inserted between the ribs to continuously drain air from the pleural space. This allows the lung to re-expand and helps prevent recurrence.

Surgery

Surgical intervention may be necessary for recurrent pneumothorax or cases that don’t respond to less invasive treatments. Common surgical approaches include:

• Video-assisted thoracoscopic surgery (VATS): A minimally invasive technique to repair lung blebs or bullae and perform pleurodesis
• Thoracotomy: An open surgical procedure for more complex cases or when VATS is not feasible
• Pleurodesis: A procedure to create adhesions between the lung and chest wall, reducing the risk of recurrence

What factors determine the choice of treatment for pneumothorax? The decision on treatment approach depends on several factors, including the size and cause of the pneumothorax, the patient’s symptoms and overall health status, and the risk of recurrence. Healthcare providers carefully consider these factors to develop an individualized treatment plan for each patient.

Prevention and Long-Term Management

While not all cases of pneumothorax can be prevented, certain measures can help reduce the risk of occurrence or recurrence:

Smoking Cessation

Quitting smoking is the most effective way to reduce the risk of primary spontaneous pneumothorax. Smoking cessation also improves overall lung health and reduces the risk of other respiratory complications.

Management of Underlying Lung Conditions

For individuals with secondary spontaneous pneumothorax, proper management of the underlying lung disease is crucial. This may include:

• Adherence to prescribed medications
• Regular follow-up with healthcare providers
• Participation in pulmonary rehabilitation programs
• Avoiding respiratory irritants and pollutants

Lifestyle Modifications

Certain lifestyle changes may help reduce the risk of pneumothorax recurrence:

• Avoiding rapid changes in atmospheric pressure (e.g., scuba diving, unpressurized air travel)
• Using appropriate protective gear during contact sports or activities with a risk of chest trauma
• Maintaining a healthy body weight and overall fitness level

Follow-up Care

Regular follow-up with healthcare providers is essential for individuals who have experienced pneumothorax, particularly those at risk of recurrence. This may include:

• Periodic chest X-rays or other imaging studies
• Pulmonary function tests to monitor lung health
• Discussion of preventive measures and lifestyle modifications
• Consideration of prophylactic interventions in high-risk cases

How often should patients with a history of pneumothorax undergo follow-up evaluations? The frequency of follow-up visits depends on individual factors such as the cause of pneumothorax, risk of recurrence, and overall health status. Generally, patients may be seen every 3-6 months initially, with the interval gradually increasing if they remain stable. However, any new or worsening symptoms should prompt immediate medical attention.

Emerging Research and Future Directions

The field of pneumothorax management continues to evolve, with ongoing research aimed at improving diagnosis, treatment, and prevention strategies:

Genetic Studies

Researchers are investigating genetic factors that may predispose individuals to spontaneous pneumothorax. Identifying specific genetic markers could help in early risk assessment and targeted prevention strategies.

Advanced Imaging Techniques

Development of more sensitive and specific imaging modalities may improve the detection of small pneumothoraces and guide treatment decisions. This includes the refinement of ultrasound techniques for rapid, bedside diagnosis in emergency settings.

Minimally Invasive Interventions

Ongoing research focuses on developing less invasive treatment options for pneumothorax, such as:

• Endobronchial valves: One-way valves placed in the airways to help seal air leaks
• Bioabsorbable materials: Substances that can be used to seal small air leaks without the need for surgery
• Targeted pleurodesis techniques: Methods to create localized adhesions in the pleural space with minimal systemic effects

Personalized Medicine Approaches

As our understanding of the underlying mechanisms of pneumothorax improves, there is growing interest in developing personalized treatment strategies based on individual patient characteristics, genetic profiles, and risk factors.

What potential advancements in pneumothorax management can we expect in the near future? While it’s difficult to predict specific breakthroughs, ongoing research suggests that we may see improvements in early detection methods, more targeted and less invasive treatment options, and better strategies for preventing recurrence. These advancements could significantly improve outcomes for patients with pneumothorax and reduce the associated morbidity and mortality.

In conclusion, pneumothorax remains a significant medical challenge, requiring prompt recognition and appropriate management to prevent potentially life-threatening complications. By understanding the causes, risk factors, and treatment options for this condition, both healthcare providers and patients can work together to optimize outcomes and improve quality of life for those affected by collapsed lung.

Pneumothorax (collapsed lung): Causes, symptoms, and treatment

Pneumothorax, commonly called a collapsed lung, can be painful and in certain situations, may be life-threatening.

In a healthy body, the lungs are touching the walls of the chest. A pneumothorax occurs when air gets into the space between the chest wall and the lung, called the pleural space.

The pressure of this air causes the lung to collapse on itself. The lung may fully collapse, but most often only a part of it collapses. This collapse can also put pressure on the heart, causing further symptoms.

A few different things can cause pneumothorax, and symptoms can vary widely. Doctors can help to diagnose and treat pneumothorax.

The causes of pneumothorax are categorized as either primary spontaneous, secondary spontaneous, or traumatic.

Primary spontaneous

Share on PinterestIf air gets in between the lung and the chest wall, it can cause the lung to collapse in on itself. Image credit: decade3d/ istock

A primary spontaneous pneumothorax (PSP) occurs when the person has no known history of lung disease. The direct cause of PSP is unknown.

At-risk groups for primary spontaneous pneumothorax include:

• tobacco or cannabis smokers
• tall men
• people ages 15-34
• people with a family history of pneumothoraces

The most important risk factor associated with PSP is smoking tobacco. A review in the medical journal BMJ noted that men who smoke tobacco are 22 times more likely to develop PSP than nonsmokers. Women who smoke tobacco are nine times more likely than nonsmokers to develop PSP.

If treated promptly, PSP is usually not fatal.

Secondary spontaneous

Secondary spontaneous pneumothorax (SSP) can be caused by a variety of lung diseases and disorders.

SSP carries more serious symptoms than PSP, and it is more likely to cause death.

Lung diseases that may increase the risk of developing pneumothorax include:

• chronic obstructive pulmonary disease (COPD)
• cystic fibrosis
• severe asthma
• lung infections, such as tuberculosis and certain forms of pneumonia
• sarcoidosis
• thoracic endometriosis
• pulmonary fibrosis
• lung cancer and sarcomas involving the lungs

Certain connective tissue disorders may also cause SSP. These disorders include:

• rheumatoid arthritis
• polymyositis and dermatomyositis
• ankylosing spondylitis
• systemic sclerosis
• Ehlers-Danlos syndrome
• Marfan’s syndrome

Under certain conditions, children are also at risk for SSP. Causes of SSP in children include:

• congenital malformations
• inhaling a foreign object
• measles
• echinococcosis

The risk may also be higher if a family member has previously experienced SSP.

Traumatic pneumothorax

A traumatic pneumothorax is the result of an impact or injury. Potential causes include blunt trauma or an injury that damages the chest wall and pleural space.

One of the most common ways this occurs is when someone fractures a rib. The sharp points of the broken bone can puncture the chest wall and damage lung tissue. Other causes include sports injuries, car accidents, and puncture or stab wounds.

A traumatic pneumothorax can occur even if there is no noticeable wound on the chest. This is common in people who have experienced a blast trauma from an explosion.

Scuba divers have to take precautions when underwater to prevent pneumothorax. When divers breathe from a compressed air tank, they experience different levels of pressure from the water and the air itself. The force of these different pressures can cause damage to the lungs, which may take the form of a pneumothorax.

Certain medical procedures may also lead to traumatic pneumothorax. Inserting a catheter into a vein in the chest or taking a sample of lung tissue may lead to a pneumothorax. Doctors will often monitor people after these procedures to catch any early signs that may need treatment.

Tension pneumothorax

Any of these types of pneumothorax can turn into a tension pneumothorax. This is caused by a leak in the pleural space that resembles a one-way valve.

As a person inhales, the air leaks into the pleural space and becomes trapped. It cannot be released during an exhale. This process leads to increased air pressure in the pleural space that is life-threatening and needs immediate treatment.

Symptoms of pneumothorax may hardly be noticeable at first and can be confused with other disorders.

The symptoms of pneumothorax can vary from mild to life-threatening and may include:

• shortness of breath
• chest pain, which may be more severe on one side of the chest
• sharp pain when inhaling
• pressure in the chest that gets worse over time
• blue discoloration of the skin or lips
• increased heart rate
• rapid breathing
• confusion or dizziness
• loss of consciousness or coma

Some cases of pneumothorax have almost no symptoms. These can only be diagnosed with an X-ray or another type of scan. Others require emergency medical attention. Anyone experiencing the symptoms above should contact their doctor or seek immediate medical help.

Diagnosing pneumothorax can be complicated due to the variety of symptoms and causes.

In non-emergency situations, doctors will first physically examine a person to look for signs of the disorder. They may tap on their chest to check for abnormal sounds or listen to their breathing through a stethoscope.

Doctors will also ask someone about their medical history and habits, such as smoking. They may also ask about any family history of lung disorders.

Imaging is an important part of most diagnoses. Doctors use X-rays to take images of the chest and look for signs of a collapsed lung. A technician takes the X-ray while the person inhales fully and holds their breath.

The size of the pneumothorax is usually measured as the space between the lung and chest wall. The size of the pneumothorax often determines how it is treated.

CT scans are used to get a better picture of the lung than an X-ray provides. Doctors often use CT scans in trauma situations when they need an accurate image of a puncture wound or other damage for treatment.

Ultrasound is used in some situations and can provide a quick way to view the size and severity of a pneumothorax. It may be more sensitive than X-rays for examining blunt trauma.

In cases of a severe tension pneumothorax, the evidence of the collapsed lung is often very obvious and requires immediate attention to prevent permanent damage or death.

Most forms of pneumothorax require medical attention. The extent of this medical attention can vary as much as the disorder itself.

The standard medical treatment usually involves inserting a small tube between the ribs or under the collarbone to release the gas that has built up. This will slowly decompress the lung.

Doctors may prescribe various drugs to numb pain, help remove toxins, or prevent infection in the body. Some people may need oxygen if their lung capacity is deficient.

Surgical treatment may be necessary in some cases, especially in individuals who have had repeated pneumothoraces.

People with SSP are more likely to need medical attention due to the serious nature of the lung diseases associated with the condition. Those with SSP may experience more severe symptoms and face a greater risk of serious complications and death.

Some very small pneumothoraces may heal without any treatment. Doctors may give their patients the option to allow the pneumothorax to heal under supervision without taking any medical or surgical action.

A person who experiences any signs or symptoms should report them to a doctor. They can decide whether medical intervention is necessary to reduce the risk of serious events.

Outlook

Pneumothorax can be difficult to diagnose and to treat. A person needs to work closely with their doctor to make sure the treatment is successful.

Pneumothoraces should not be taken lightly and may be life-threatening in certain situations.

Most cases can be treated with prompt medical intervention. Working with a doctor, as soon as symptoms are noticed, is the best way to ensure the pneumothorax heals correctly.

Pneumothorax in Dogs | VCA Animal Hospital

What is pneumothorax, and what are the different types?

The term pneumothorax refers to the abnormal accumulation of air outside the lungs, but inside the chest wall. The presence of air between the lungs and chest wall prevents the lungs from inflating normally, and can lead to lung collapse. There are several variations of pneumothorax, and it might be easiest to think about them separately.

What is traumatic pneumothorax?

In a traumatic pneumothorax, air accumulates between the lungs and chest wall following some type of trauma (such as being kicked by a horse). Traumatic pneumothorax can be divided into two categories: closed and open. A closed pneumothorax does not involve an ongoing or persistent hole in the chest wall, while an open pneumothorax involves communication between the chest cavity and the outside atmosphere. The air that is present in a closed pneumothorax can come from a hole in the chest wall that closes rapidly or from a hole in the lung that causes one-way air transfer from inside to outside the lung during inhalation. The air cannot then be exhaled and becomes trapped within the chest cavity.

“With a traumatic pneumothorax, there is typically evidence of recent trauma”

With a traumatic pneumothorax, there is typically evidence of a recent trauma. With obvious damage to the chest wall, it is straightforward to diagnose an open pneumothorax. These dogs present with rapid breathing, difficulty breathing, and they may be in respiratory distress. Dogs that are experiencing respiratory distress associated with pneumothorax will often stand with their elbows pushed away from their bodies in an attempt to increase their lung capacity. They may exhibit what is called “abdominal breathing” in which the origin of each breath seems to be the abdominal wall moving rather than the chest expanding. Pneumothorax patients may also have a higher-than-normal heart rate.

Trauma patients with pneumothorax may also have pale or bluish mucous membranes, they may be in shock, and they may have air trapped under the skin. This is called “subcutaneous emphysema” and it feels like “crackling” when they are petted over the affected areas.

The causes of traumatic pneumothorax can be quite varied and include:

• Blunt trauma (like being kicked by a horse)
• Chest injuries that penetrate into the chest cavity
• Surgical incision into the chest (this is, of course, planned and controlled trauma to the chest cavity)
• Perforation of the esophagus on its way to the stomach
• Trauma to the windpipe (trachea)
• Lung disease
• Foreign body migration (like a grass awn migrating through the tissues of the body)

What is Spontaneous pneumothorax?

In a spontaneous pneumothorax, air leaks from the lungs or the large air passages and accumulates in the chest space outside the lungs in the absence of any trauma. Because there are no defects, injuries or openings in the chest wall, any spontaneous pneumothorax would be considered closed. Spontaneous pneumothorax is more common in large, deep- chested dogs. The Siberian Husky may be unusually susceptible.

“The symptoms of spontaneous pneumothorax are the same as those of traumatic pneumothorax.”

Dogs that develop a spontaneous pneumothorax may or may not have previous signs of lung disease. The condition may have a slow, progressive onset, but what typically occurs is a sudden loss of the ability to compensate for the air that is outside the lungs and preventing the lungs from expanding properly for breathing. The symptoms of spontaneous pneumothorax are the same as those of traumatic pneumothorax. The causes, however, are quite different.

“The causes of spontaneous pneumothorax originate in the lungs themselves”

The causes of spontaneous pneumothorax originate in the lungs themselves. In the absence of underlying lung disease, this condition is called primary spontaneous pneumothorax. The most common cause is a condition in which the air spaces in the lungs become dilated, and the air can get in (on inhalation) but cannot get out (on exhalation). This is called “bullous emphysema”.

Secondary spontaneous pneumothorax is caused by underlying lung disease such as lung cancer, lung abscesses, heartworm disease, inflammatory airway disease, allergic bronchitis, tracheal rupture, foreign body migration, severe pneumonia, lung worms or flukes or lung nodules caused by fungal infection.

Tension pneumothorax

Tension pneumothorax most often occurs when patients are intubated (insertion of a breathing tube during general anesthesia or use of a ventilator). If the pressure of the ventilation is too great, the lung can rupture (burst). The resulting flap-like defect can act like a one-way valve, allowing air to accumulate outside of the lung and within the chest cavity.

It can also occur from blunt trauma, penetrating wounds, or during spontaneous negative-pressure inspiration.

How is pneumothorax treated?

Definitive treatment of pneumothorax depends upon the underlying cause, but there are commonalities across the spectrum of patients who develop this condition. Most dogs require hospitalization until the air accumulation within the chest cavity has stopped or has stabilized. If the dog presents in respiratory distress, then part of the treatment involves extracting the air from inside the chest cavity to allow the lungs to expand. Oxygen therapy is typically provided until the dog is stable.

“In traumatic pneumothorax… it is important that effective pain relief be provided”

In traumatic pneumothorax, or for dogs requiring surgery to resolve the underlying issue that led to the pneumothorax, it is important that effective pain relief be provided. A closed traumatic pneumothorax may not require any intervention beyond stabilization. If there is a significant defect in the chest wall, surgery will be required once the dog is stable and receiving adequate oxygen into the tissues. Removal of part or all of a lung may be necessary if there are localized lesions, masses, etc. Any traumatic lacerations of the lung may be sutured closed. A chest tube may be required to allow the removal of air that accumulates in the chest cavity. If a chest tube is placed, it is important that the dog not be allowed to dislodge it.

Most dogs require strict rest for at least a week (and often longer) following resolution of pneumothorax, in order to minimize the chance of recurrence.

What sorts of complications can arise from having a pneumothorax?

It is possible for pneumothorax to cause a fatal cardiovascular event from too low a level of oxygen in the blood. Another important potential complication of pneumothorax is recurrence. It is important to monitor the dog’s breathing rate, as an increased breathing rate may suggest a recurrence. Follow-up x-rays may be required, as may additional measurements of blood oxygen levels.

What is the expected recovery and long-term outlook after suffering a pneumothorax?

For traumatic pneumothorax, if the chest trauma is not too severe and if treatment goes according to plan, the expectation is for a full recovery. If the chest trauma is severe, it is possible for the dog to decline despite all interventions and emergency efforts. If there is bleeding into the lungs or bruising of the heart, these patients can deteriorate very quickly.

The recovery and long-term outlook for a dog with spontaneous pneumothorax is a bit more complicated because it depends on the underlying cause. A well-identified, single, localized lesion that can be removed surgically provides a better outlook than if the underlying cause cannot be identified or if there is disease throughout the lungs.

While pneumothorax is a very serious condition, it is important to note that with advances in diagnostic and treatment options, these dogs can often be treated with a successful outcome.

Spontaneous pneumothorax – causes, symptoms, diagnosis and treatment, prognosis

Spontaneous pneumothorax is a pathological condition characterized by a sudden violation of the integrity of the visceral pleura and the flow of air from the lung tissue into the pleural cavity. The development of spontaneous pneumothorax is accompanied by acute pain in the chest, shortness of breath, tachycardia, pallor of the skin, acrocyanosis, subcutaneous emphysema, and the patient’s desire to take a forced position. For the purpose of primary diagnosis of spontaneous pneumothorax, X-ray of the lungs and diagnostic pleural puncture are performed; to establish the causes of the disease, an in-depth examination (CT, MRI, thoracoscopy) is required. Treatment of spontaneous pneumothorax includes drainage of the pleural cavity with active or passive air evacuation, video-assisted thoracoscopic or open interventions (pleurodesis, removal of bullae, lung resection, pulmonectomy, etc. )

General information

In clinical pulmonology, spontaneous pneumothorax is defined as idiopathic, spontaneous pneumothorax not associated with trauma or iatrogenic medical and diagnostic interventions. Spontaneous pneumothorax develops statistically more often in men and prevails among people of working age (20-40 years), which determines not only the medical but also the social significance of the problem.

If in traumatic and iatrogenic pneumothorax a causal relationship between the disease and external influences (trauma of the chest, puncture of the pleural cavity, catheterization of the central veins, thoracocentesis, biopsy of the pleura, barotrauma, etc.) is clearly traced, then in the case of spontaneous pneumothorax such a conditionality absent. Therefore, the choice of adequate diagnostic and therapeutic tactics is the subject of increased attention of pulmonologists, thoracic surgeons, and phthisiatricians.

Spontaneous pneumothorax

Causes

Primary spontaneous pneumothorax develops in individuals without clinically diagnosed lung disease. However, when performing diagnostic videothoracoscopy or thoracotomy in this group of patients, subpleurally located emphysematous bullae are detected in 75-100% of cases. The relationship between the frequency of spontaneous pneumothorax and the constitutional type of patients was noted: the disease often occurs in thin, tall young people. Smoking increases the risk of developing spontaneous pneumothorax up to 20 times.

Secondary spontaneous pneumothorax can develop against a wide range of pathologies:

• lung diseases (COPD, cystic fibrosis, bronchial asthma)
• respiratory tract infections (pneumocystis pneumonia, abscess pneumonia, tuberculosis). In the case of a breakthrough into the pleural cavity of the lung abscess, pyopneumothorax develops.
• interstitial lung diseases (Beck’s sarcoidosis, pneumosclerosis, lymphangioleiomyomatosis, Wegener’s granulomatosis), systemic diseases (rheumatoid arthritis, scleroderma, Marfan’s syndrome, ankylosing spondylitis, dermatomyositis and polymyositis)
• malignant neoplasms (sarcomas, lung cancer).

Relatively rare forms of spontaneous pneumothorax include menstrual and neonatal pneumothorax. Menstrual pneumothorax is etiologically associated with breast endometriosis and develops in young women in the first two days from the onset of menstruation. The probability of recurrence of menstrual pneumothorax, even against the background of conservative therapy for endometriosis, is about 50%, therefore, immediately after diagnosis, pleurodesis can be performed in order to prevent repeated episodes of spontaneous pneumothorax.

Neonatal pneumothorax – spontaneous neonatal pneumothorax occurs in 1-2% of children, 2 times more often in boys. Pathology may be associated with lung expansion problems, respiratory distress syndrome, lung tissue rupture during mechanical ventilation, lung malformations (cysts, bullae).

Pathogenesis

The severity of structural changes depends on the time elapsed since the onset of spontaneous pneumothorax, the presence of initial pathological disorders in the lung and visceral pleura, the dynamics of the inflammatory process in the pleural cavity.

In spontaneous pneumothorax, there is an abnormal pulmonary-pleural communication that causes air to enter and accumulate in the pleural cavity; partial or complete collapse of the lung; displacement and flotation of the mediastinum.

Inflammatory reaction develops in the pleural cavity 4-6 hours after an episode of spontaneous pneumothorax. It is characterized by hyperemia, injection of pleural vessels, and the formation of a small amount of serous exudate. Within 2-5 days, the swelling of the pleura increases, especially in the areas of its contact with the infiltrated air, the amount of effusion increases, fibrin falls out on the surface of the pleura.

The progression of the inflammatory process is accompanied by the growth of granulations, fibrous transformation of the precipitated fibrin. The collapsed lung is fixed in a contracted state and becomes unable to straighten. In the case of hemothorax or infection, pleural empyema develops over time; possible formation of a bronchopleural fistula that supports the course of chronic pleural empyema.

Classification

According to the etiological principle, primary and secondary spontaneous pneumothorax are distinguished. Primary spontaneous pneumothorax is said to be in the absence of data for a clinically significant pulmonary pathology. The occurrence of secondary spontaneous pneumothorax occurs against the background of concomitant pulmonary diseases.

Depending on the degree of collapse of the lung, there are:

• partial (small, medium). With a small spontaneous pneumothorax, the lung collapses by 1/3 of the original volume, with an average – by 1/2.
• total . With total pneumothorax, the lung collapses by more than half.

According to the degree of compensation of respiratory and hemodynamic disorders accompanying spontaneous pneumothorax, three phases of pathological changes were defined: the phase of stable compensation, the phase of unstable compensation and the phase of decompensation (insufficient compensation).

• The phase of persistent compensation is observed in spontaneous pneumothorax of small and medium volume; it is characterized by the absence of signs of respiratory and cardiovascular insufficiency, VC and MVL are reduced to 75% of the norm.
• The phase of unstable compensation corresponds to the collapse of the lung by more than 1/2 of the volume, the development of tachycardia and shortness of breath during exercise, a significant decrease in external respiration.
• The decompensation phase is manifested by dyspnea at rest, severe tachycardia, microcirculatory disturbances, hypoxemia, and a decrease in respiratory function by 2/3 or more from normal values.

Symptoms of spontaneous pneumothorax

According to the nature of clinical symptoms, a typical variant of spontaneous pneumothorax and a latent (erased) variant are distinguished. A typical clinic of spontaneous pneumothorax may be accompanied by moderate or violent manifestations.

In most cases, primary spontaneous pneumothorax develops suddenly, in the midst of full health. Already in the first minutes of the disease, acute stabbing or squeezing pains in the corresponding half of the chest, acute shortness of breath are noted. The severity of pain varies from mild to very severe. Increased pain occurs when trying to take a deep breath, coughing. Pain extends to the neck, shoulder, arm, abdomen or lower back.

Within 24 hours, the pain syndrome decreases or completely disappears, even if spontaneous pneumothorax does not resolve. Feelings of respiratory discomfort and lack of air occur only during physical exertion.

In violent clinical manifestations of spontaneous pneumothorax, the pain attack and shortness of breath are extremely pronounced. There may be short-term fainting, pallor of the skin, acrocyanosis, tachycardia, a sense of fear and anxiety. Patients spare themselves: limit movements, take a half-sitting position or lying on a sore side. Often develops and progressively increases subcutaneous emphysema, crepitus in the neck, upper limbs, torso. In patients with secondary spontaneous pneumothorax, due to the limited reserves of the cardiovascular system, the disease is more severe.

Complications

Complicated variants of the course of spontaneous pneumothorax include the development of tension pneumothorax, hemothorax, reactive pleurisy, simultaneous bilateral collapse of the lungs. The accumulation and prolonged presence of infected sputum in a collapsed lung leads to the development of secondary bronchiectasis, repeated episodes of aspiration pneumonia in a healthy lung, and abscesses. Complications of spontaneous pneumothorax develop in 4-5% of cases, but they can pose a threat to the life of patients.

Diagnostics

Examination of the chest reveals smoothness of the intercostal space, restriction of respiratory excursion on the side of spontaneous pneumothorax, subcutaneous emphysema, swelling and dilatation of the neck veins. On the side of the collapsed lung, there is a weakening of voice trembling, tympanitis on percussion, and on auscultation, the absence or sharp weakening of respiratory sounds. Paramount importance in the diagnosis is given to:

• Radiation methods. Chest x-ray and fluoroscopy assess the amount of air in the pleural cavity and the degree of collapse of the lung, depending on the extent of spontaneous pneumothorax. Control x-ray studies are carried out after any medical manipulations (puncture or drainage of the pleural cavity) and allow us to evaluate their effectiveness. Subsequently, using high-resolution CT or MRI of the lungs, the cause of spontaneous pneumothorax is established.
• Therapeutic and diagnostic thoracoscopy. A highly informative method used in the diagnosis of spontaneous pneumothorax is thoracoscopy. In the course of the study, it is possible to identify subpleural bullae, tumor or tuberculous changes on the pleura, and to biopsy the material for morphological examination.

Spontaneous pneumothorax of a latent or erased course must be differentiated from a giant bronchopulmonary cyst and diaphragmatic hernia. In the latter case, differential diagnosis is assisted by radiography of the esophagus.

KT OGK. Spontaneous small pneumothorax due to bulla rupture.

Treatment of spontaneous pneumothorax

Medical standards require the early evacuation of air accumulated in the pleural cavity and the achievement of lung expansion. The generally accepted standard is the transition from diagnostic to therapeutic tactics. Thus, obtaining air during thoracocentesis is an indication for drainage of the pleural cavity. Pleural drainage is installed in the II intercostal space along the midclavicular line, after which it is connected to active aspiration.

Improved bronchial patency and evacuation of viscous sputum facilitate the task of expanding the lung. For this purpose, therapeutic bronchoscopy (bronchoalveolar lavage, tracheal aspiration), inhalations with mucolytics and bronchodilators, breathing exercises, oxygen therapy are performed.

If there is no expansion of the lung within 4-5 days, they proceed to surgical tactics. It may consist in thoracoscopic diathermocoagulation of bulls and adhesions, the elimination of bronchopleural fistulas, the implementation of chemical pleurodesis. With recurrent spontaneous pneumothorax, depending on its causes and also the condition of the lung tissue, an atypical marginal lung resection, lobectomy, or even pneumonectomy may be indicated.

Prognosis

Primary spontaneous pneumothorax has a favorable prognosis. It is usually possible to achieve expansion of the lung by minimally invasive methods. With secondary spontaneous pneumothorax, relapses of the disease develop in 20-50% of patients, which dictates the need to eliminate the root cause and choose a more active treatment strategy. Patients who have had a spontaneous pneumothorax should be under the supervision of a thoracic surgeon or pulmonologist.

Pneumothorax (collapse of the lung)

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Diseases

Pneumothorax (collapse of the lung) – a pathological life-threatening condition in which air accumulates where it should not normally be – in the pleural cavity. This is accompanied by a collapse of the lung tissue, the dome of the diaphragm and a violation of the normal activity of the cardiovascular and respiratory systems, increasing pressure in the pleural cavity. Complete collapse of lung tissue causes collapse. The state of pneumothorax can develop against the background of maintaining the tightness of the chest, when excess gas enters the lung through existing pleural defects. And it can be open when there are injuries to the sternum, depressurization of the lung has occurred and gas comes from outside. Pathology can develop suddenly as an independent disease, it can be a complication of pulmonary pathology, or it can be created artificially by doctors to achieve certain goals.
If this condition has not developed as a result of purposeful actions of doctors, the person needs urgent medical care.

REASONS

The main reasons include mechanical damage to the chest, which can occur as a result of trauma, penetrating wounds, unsuccessful medical manipulations, artificial creation of a pneumothorax state by doctors.
Another group of causes include ruptures in emphysema, breakthroughs of abscesses.
In infants, pneumothorax can develop as a result of prolonged crying, existing lung pathologies, cyst rupture, lung abscess.

RISK FACTORS

Tuberculosis and tumor neoplasms are provoking factors. Bad habits – smoking. Weakness of the pleura due to heredity. Situations accompanied by a sharp drop in pressure: diving, air travel, deep diving. The presence of pathological lung diseases: sarcoidosis, lung cancer, sarcoma, bronchial asthma, pulmonary obstruction, scleroderma, Marfan’s syndrome).

SYMPTOMS

A person suddenly develops shortness of breath, as well as pain when inhaling, possibly radiating to the shoulder. Pain ranges from mild to unbearable. Attacks of dry unproductive cough begin. Increased heart rate, feeling of fear, lowering blood pressure. In the case of an existing injury to the sternum, foamy blood comes out of the wound. The skin turns blue, fainting may develop. During exhalation, air begins to be released into the subcutaneous tissue, which leads to the formation of swelling, crunching when pressed on them.

DIAGNOSIS

Diagnosis of pneumothorax is based on its clinical manifestations: chest pain, shortness of breath and dry cough. On examination, the doctor may detect a “lag” of half of the chest during breathing. A follow-up x-ray is usually sufficient to confirm the diagnosis. Computed tomography is used to clarify the cause of this condition.

TREATMENT

Urgent actions in this condition include stopping the supply of oxygen to the pleural cavity. If it is an open wound, it must be bandaged to stop the bleeding. As a rule, the condition is accompanied by severe pain, which can sometimes be stopped only with narcotic drugs. The patient must be provided with oxygen, as well as relieve coughing fits. If necessary, and the rapid deterioration of a person’s condition, a doctor or paramedic makes a pleural puncture. Removal of excess air is the main measure in the treatment of pneumothorax. In order to prevent recurrence of the condition, conditions are sometimes deliberately created for the adhesive process by pleurodesis using various sclerosing drugs.

PREVENTION

There are no specific methods for the prevention of this disease. However, there are a number of recommendations, the observance of which allows you to minimize the risk. You should stop smoking, treat lung diseases in a timely manner, move a lot and walk in the fresh air, and do breathing exercises.

COMPLICATIONS

Uncomplicated forms of the disease, as a rule, have a good prognosis for a cure. But there is no guarantee that a relapse will not occur. In any case, the sooner a person was taken to the hospital and professional medical care was provided to him, the greater his chances of survival and recovery. Complications of pneumothorax will be pleurisy, purulent pleurisy, internal bleeding, subcutaneous emphysema. In severe cases, the condition of pneumothorax can be fatal.

Which doctor should I contact for pneumothorax (lung collapse)?

Specialists

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Petrechko Irina Viktorovna

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Kassner Lilia Nikolaevna

Experience 42 years

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Novikov Maxim Sergeevich

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Smirnova (Soboleva) Olga Vladimirovna

Experience 32 years

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Golovina Natalya Alexandrovna

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Koshkina Marina Yurievna

Experience 30 years

+7 (3022) 28-41-79
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Victoria Alexandrovna Savchenkova

Experience 18 years

Candidate of Medical Sciences

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