Pneumothorax – StatPearls – NCBI Bookshelf

Continuing Education Activity

A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. Pneumothoraces can be even further classified as simple, tension, or open. A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax. An open pneumothorax also is known as a “sucking” chest wound. This activity examines when this condition should be considered in differential diagnosis and how to evaluate it properly. This activity highlights the role of the interprofessional team in caring for patients with this condition.

Objectives:

• Recall the presence of a pneumothorax.

• Describe the pathophysiology of a tension pneumothorax.

• Summarize the treatment options for pneumothorax.

• Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by pneumothorax.

Access free multiple choice questions on this topic.

Introduction

A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. The air accumulation can apply pressure on the lung and make it collapse. The degree of collapse determines the clinical presentation of pneumothorax. Air can enter the pleural space by two mechanisms, either by trauma causing a communication through the chest wall or from the lung by rupture of visceral pleura. There are two types of pneumothorax: traumatic and atraumatic. The two subtypes of atraumatic pneumothorax are primary and secondary. A primary spontaneous pneumothorax (PSP) occurs automatically without a known eliciting event, while a secondary spontaneous pneumothorax (SSP) occurs subsequent to an underlying pulmonary disease. A traumatic pneumothorax can be the result of blunt or penetrating trauma. Pneumothoraces can be even further classified as simple, tension, or open. A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax. Open pneumothorax is an open wound in the chest wall through which air moves in and out.[1][2][3][4]

Etiology

Risk factors for primary spontaneous pneumothorax

Diseases associated with secondary spontaneous  pneumothorax

• COPD

• Asthma 

• HIV with pneumocystis pneumonia

• Necrotizing pneumonia 

• Tuberculosis 

• Sarcoidosis

• Cystic fibrosis 

• Bronchogenic carcinoma 

• Idiopathic pulmonary fibrosis 

• Severe ARDS

• Langerhans cell histiocytosis

• Lymphangioleiomyomatosis

• Collagen vascular disease

• Inhalational drug use like cocaine or marijuana

• Thoracic endometriosis 

Causes of iatrogenic pneumothorax

• Pleural biopsy

• Transbronchial lung biopsy

• Transthoracic pulmonary nodule biopsy

• Central venous catheter insertion

• Tracheostomy

• Intercostal nerve block

• Positive pressure ventilation

Causes of traumatic pneumothorax

Causes of tension pneumothorax

• Penetrating or blunt trauma

• Barotrauma due to positive pressure ventilation

• Percutaneous tracheostomy

• Conversion of spontaneous pneumothorax to tension

• Open pneumothorax when occlusive dressing work as one way valve

Causes of pneumomediastinum

Epidemiology

Primary spontaneous pneumothorax mostly occurs in 20-30 years of age. The incidence of PSP in the United States is 7 per 100,000 men and 1 per 100,000 women per year[5]. The majority of recurrence occurs within the first year, and incidence ranges widely from 25% to 50%. The recurrence rate is highest over the first 30 days. 

Secondary spontaneous pneumothorax is more seen in old age patients 60-65 years. The incidence of SSP is 6.3 and 2 cases for men and women per 100,000 patients, respectively. The male to female ratio is 3:1. COPD has an incidence of 26 pneumothoraces per 100,000 patients.[6] The risk of spontaneous pneumothorax in heavy smokers is 102 times higher than non-smokers.

The leading cause of iatrogenic pneumothorax is transthoracic needle aspiration (usually for biopsies), and the second leading cause is central venous catheterization. These occur more frequently than spontaneous pneumothorax, and their number is increasing as intensive care modalities are advancing. The incidence of iatrogenic pneumothorax is 5 per 10,000 admissions in the hospital.

The incidence of tension pneumothorax is difficult to determine as one-third of cases in trauma centers have decompressive needle thoracostomies before reaching the hospital, and not all of these had tension pneumothorax.

Pneumomediastinum has an incidence of 1 case per 10,000 admissions in the hospital.

Pathophysiology

The pressure gradient inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is negative when compared to atmospheric pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between parietal and visceral pleurae. Lungs have a tendency to collapse due to elastic recoil. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit equilibrium is achieved, or the rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. An increase in central venous pressure can result in distended neck veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia.

Spontaneous pneumothorax in the majority of patients occurs due to the rupture of bullae or blebs. Primary spontaneous pneumothorax is defined as occurring in patients without underlying lung disease but these patients had asymptomatic bullae or blebs on thoracotomy. Primary spontaneous pneumothorax occurs in tall and thin young people due to increased shear forces or more negative pressure at the apex of the lung. Lung inflammation and oxidative stress are essential to the pathogenesis of primary spontaneous pneumothorax. Current smokers have increased inflammatory cells in small airways and are at increased risk of pneumothorax.

Secondary spontaneous pneumothorax occurs in the presence of underlying lung disease, primarily chronic obstructive pulmonary disease; others may include tuberculosis, sarcoidosis, cystic fibrosis, malignancy, idiopathic pulmonary fibrosis, and pneumocystis jiroveci pneumonia.

Iatrogenic pneumothorax occurs due to a complication of a medical or surgical procedure. Thoracentesis is the most common cause.

Traumatic pneumothoraces can result from blunt or penetrating trauma, these often create a one-way valve in the pleural space (letting the airflow in but not to flow out) and hence hemodynamic compromise. Tension pneumothorax most commonly occurs in ICU settings, in positive pressure ventilated patients.

History and Physical

In primary spontaneous pneumothorax, the patient is minimally symptomatic as otherwise healthy individuals tolerate physiologic consequences well. The most common symptoms are chest pain and shortness of breath. The chest pain is pleuritic, sharp, severe, and radiates to the ipsilateral shoulder. In SSP, dyspnea is more severe because of decreased underlying lung reserve. 

The history of pneumothorax in the past is important as recurrence is seen in 15-40% cases. Recurrence on the contralateral side can also occur.

On examination, the following findings are noted

• Respiratory discomfort

• Increased respiratory rate

• Asymmetrical lung expansion

• Decreased tactile fremitus 

• Hyperresonant percussion note

• Decreased intensity of breath sounds or absent breath sounds

In tension pneumothorax following additional findings are seen

Some traumatic pneumothoraces are associated with subcutaneous emphysema. Pneumothorax may be difficult to diagnose from a physical exam, especially in a noisy trauma bay. However, it is essential to make the diagnosis of tension pneumothorax on a physical exam.

Evaluation

Chest radiography, ultrasonography, or CT can be used for diagnosis, although diagnosis from a chest x-ray is more common. Radiographic findings of 2.5 cm air space are equivalent to a 30% pneumothorax. Occult pneumothoraces may be diagnosed by CT but are usually clinically insignificant. The extended focused abdominal sonography for trauma (E-FAST) exam has been a more recent diagnostic tool for pneumothorax. The diagnosis of ultrasound is usually made by the absence of lung sliding, the absence of a comet-tails artifact, and the presence of a lung point. Unfortunately, this diagnostic method is very operator dependent and sensitivity, and specificity can vary. In skilled hands, ultrasonography has up to a 94% sensitivity and 100% specificity (better than chest x-ray). If a patient is hemodynamically unstable with suspected tension pneumothorax, intervention is not withheld to await imaging. Needle decompression can be performed if the patient is hemodynamically unstable with a convincing history and physical exam, indicating tension pneumothorax.[7][8][9][10][11]

Treatment / Management

Management depends on the clinical scenario.

For patients who have associated symptoms and are showing signs of instability, needle decompression is the treatment of a pneumothorax. This usually is performed with a 14- to 16-gauge and 4.5 cm in length angiocatheter, just superior to the rib in the second intercostal space in the midclavicular line. After needle decompression or for stable pneumothoraces, the treatment is the insertion of a thoracostomy tube. This usually is placed above the rib in the fifth intercostal space anterior to the midaxillary line. The size of the thoracostomy tube usually ranges depending on the patient’s height and weight and whether there is an associated hemothorax.

Open “sucking” chest wounds are treated initially with a three-sided occlusive dressing. Further treatment may require tube thoracostomy and/or chest wall defect repair.

An asymptomatic small primary spontaneous pneumothorax (depth less than 2cm) patient is usually discharged with follow up in outpatient after 2-4 weeks. If the patient is symptomatic or depth/size is more than 2cm needle aspiration is done, after aspiration, if the patient improves and residual depth is less than 2cm then the patient is discharged otherwise tube thoracostomy is done.

In secondary spontaneous pneumothorax, if size/depth of pneumothorax is less than 1cm and no dyspnea then the patient is admitted, high flow oxygen is given and observation is done for 24 hours. If size/ depth is between 1-2cm, needle aspiration is done, then the residual size of pneumothorax is seen, if the depth after the needle aspiration is less than 1cm management is done with oxygen inhalation and observation and in case of more than 2cm, tube thoracostomy is done. In case of depth more than 2cm or breathlessness, tube thoracostomy is done.

Air can reabsorb from the pleural space at a rate of 1.5%/day. Using supplemental oxygen can increase this reabsorption rate. By increasing the fraction of inspired oxygen concentration, the nitrogen of atmospheric air is displaced changing the pressure gradient between the air in the pleural space and the capillaries. Pneumothorax on chest radiography approximately 25% or larger usually needs treatment with needle aspiration if symptomatic and if it fails then tube thoracostomy is done.

Indications for surgical intervention(VATS vs. thoracotomy)

• Continuous air leak for longer than seven days

• Bilateral pneumothoraces

• The first episode in high-risk profession patient, i.e., Divers, pilots

• Recurrent ipsilateral pneumothorax

• Contralateral pneumothorax

• Patients who have AIDS

Patients who undergo a video-assisted thoracic surgery (VATS) get pleurodesis to occlude pleural space. Mechanical pleurodesis with bleb/bullectomy decreases the recurrence rate of pneumothorax to <5%. Options for mechanical pleurodesis include stripping of the parietal pleura versus using an abrasive “scratchpad” or dry gauze. A chemical pleurodesis is an option in patients who may not tolerate mechanical pleurodesis. Options for chemical pleurodesis include talc, tetracycline, doxycycline, or minocycline, which are all irritants to the pleural lining.

Differential Diagnosis

Differential diagnoses of pneumothorax include:

Prognosis

PSP is usually benign and mostly resolves on its own without any major intervention. Recurrence can occur up to three years period. Recurrence rate in the following five years is 30% for PSP and 43% for SSP. The risk of recurrence increases with each subsequent pneumothorax; it is 30% with first, 40% after a send, and more than 50% after the third recurrence. PSP is not considered a major health threat, but deaths have been reported. SSPs are more lethal depending upon underlying lung disease and the size of the pneumothorax. Patients with COPD and HIV have high mortality after pneumothorax. The mortality of SSP is 10%. Mortality of tension pneumothorax is high if appropriate measures are not taken.

Complications

• Respiratory failure or arrest

• Cardiac arrest

• Pyopneumothorax

• Empyema

• Rexpansion pulmonary edema

• Pneumopericardium

• Pneumoperitoneum

• Pneumohemothorax

• Bronchopulmonary fistula

• Damage to the neurovascular bundle during tube thoracostomy

• Pain and skin infection at the site of tube thoracostomy

Deterrence and Patient Education

Patients with pneumothorax should be educated that they should not travel by air or to remote areas until after the complete resolution of pneumothorax. Patients with high-risk occupations like scuba divers and pilots should be advised that they should not dive or fly until definitive surgical management of their pneumothorax is done.

All patients are advised to stop smoking. They should be assessed for their will to quit smoking; they should be educated and provided pharmacotherapy if they decided to quit.

Pearls and Other Issues

Do not let a chest radiograph or CT scan delay treatment with needle decompression or thoracostomy tube if the patient is clinically unstable, i.e., tension pneumothorax.

Worsening subcutaneous emphysema can be associated with malposition of a chest tube and repositioning with a new chest tube is recommended. A chest tube should never be reinserted as this can increase the patient’s risk for empyema.

An untreated pneumothorax is a contraindication for flying or scuba diving. If air transport is required, then a thoracostomy tube should be placed before transport. 

If there is a persistent or recurrent pneumothorax despite treatment with thoracostomy tube, these patients need specialty consultations for a possible video-assisted thoracoscopic surgery (VATS) with or without pleurodesis or thoracotomy.

If the patient is discharged from the hospital after a resolved pneumothorax, recommendations should be made for no flying or scuba diving for a minimum of two weeks. Patients with a known history of spontaneous pneumothorax should not be medically cleared for occupations involving flying or scuba diving.

Enhancing Healthcare Team Outcomes

The management of a pneumothorax is often done by the emergency department physician. In some cases, the disorder may be managed by the ICU staff and the thoracic surgeon. The care of patients who have a chest tube is done by the nurse. All nurses who manage patients with a chest tube should know how a chest drain functions. Patients need to be examined every shift and the patency of the chest tube is important. Patients with small pneumothorax can be observed if they have no symptoms. If discharged the patient should be seen within 24 hours.

Figure

Portable Chest Radiograph Left Deep Sulcus Pneumothorax. Contributed by Scott Dulebohn, MD

Figure

Chest Radiograph Tension Pneumothorax. Contributed by Scott Dulebohn, MD

Figure

Ct rib fracture, CT Scan, pneumothorax, collapsed lung. Contributed by Steve Bhimji, MS, MD, PhD

Figure

upper lobe pneumothorax. Contributed by S bhimji MD

Figure

left sided tension pneumothorax. Contributed by Wikimedia User: Karthik Easvur, (CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/)

References

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Tejero Aranguren J, Ruiz Ferrón F, Colmenero Ruiz M. Endobronchial treatment of persistent pneumothorax in acute respiratory distress syndrome. Med Intensiva (Engl Ed). 2019 Nov;43(8):516. [PubMed: 30799041]

2.

Furuya T, Ii T, Yanada M, Toda S. Early chest tube removal after surgery for primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg. 2019 Sep;67(9):794-799. [PubMed: 30798488]

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Singh SK, Tiwari KK. Analysis of clinical and radiological features of tuberculosis associated pneumothorax. Indian J Tuberc. 2019 Jan;66(1):34-38. [PubMed: 30797280]

4.

Imperatori A, Fontana F, Dominioni L, Piacentino F, Macchi E, Castiglioni M, Desio M, Cattoni M, Nardecchia E, Rotolo N. Video-assisted thoracoscopic resection of lung nodules localized with a hydrogel plug. Interact Cardiovasc Thorac Surg. 2019 Jul 01;29(1):137-143. [PubMed: 30793736]

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Melton LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979 Dec;120(6):1379-82. [PubMed: 517861]

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Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Thorax. 2000 Aug;55(8):666-71. [PMC free article: PMC1745823] [PubMed: 10899243]

7.

Mandt MJ, Hayes K, Severyn F, Adelgais K. Appropriate Needle Length for Emergent Pediatric Needle Thoracostomy Utilizing Computed Tomography. Prehosp Emerg Care. 2019 Sep-Oct;23(5):663-671. [PubMed: 30624127]

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Williams K, Baumann L, Grabowski J, Lautz TB. Current Practice in the Management of Spontaneous Pneumothorax in Children. J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):551-556. [PubMed: 30592692]

9.

Schnell J, Beer M, Eggeling S, Gesierich W, Gottlieb J, Herth FJF, Hofmann HS, Jany B, Kreuter M, Ley-Zaporozhan J, Scheubel R, Walles T, Wiesemann S, Worth H, Stoelben E. Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline. Respiration. 2019;97(4):370-402. [PubMed: 30041191]

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Wong A, Galiabovitch E, Bhagwat K. Management of primary spontaneous pneumothorax: a review. ANZ J Surg. 2019 Apr;89(4):303-308. [PubMed: 29974615]

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Bertolaccini L, Congedo MT, Bertani A, Solli P, Nosotti M. A project to assess the quality of the published guidelines for managing primary spontaneous pneumothorax from the Italian Society of Thoracic Surgeons. Eur J Cardiothorac Surg. 2018 Nov 01;54(5):920-925. [PubMed: 29788194]

Pneumothorax (Collapsed Lung): Symptoms & Treatment

What Is Pneumothorax (Collapsed Lung)?

Pneumothorax is a partially or completely collapsed lung. Lung collapse occurs when air forces its way into the pleural cavity, a membranous layer between the lungs and the chest wall. The pleural cavity is inflated beyond its natural limits, putting pressure on the lung and other parts of the chest, including the heart. Causes are varied, but include traumatic injury and chronic lung disease. Pneumothorax is more common in men than women and is potentially fatal.

There are several types of pneumothorax, with differing degrees of severity. If you or a loved one is showing signs of pneumothorax or another form of lung trouble, the respiratory specialists at Baptist Health are available to help.

What Are Pneumothorax Symptoms?

Pneumothorax is marked by the following symptoms:

• Sudden chest pain, followed by a steady achiness
• Labored breathing
• Chest tightness
• Accelerated heart rate
• A cold sweat
• Turning blue in appearance (cyanosis).

These symptoms are common to all types of pneumothorax. Several are known to medical research:

• Primary spontaneous pneumothorax: This type of lung collapse occurs, often without warning, for no apparent reason. Some of the lung’s alveoli burst, releasing air into the pleural cavity. Individuals with this condition are usually otherwise healthy.
• Secondary spontaneous pneumothorax: Secondary lung collapse typically results from an underlying medical condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD).
• Catamenial pneumothorax: This unusual form of lung collapse occurs only in menstruating women. Endometrial tissue attaches to the chest cavity, where it forms cysts. These cysts release blood into the pleural cavity, increasing pressure on the lungs.
• Traumatic or injury-related pneumothorax: Traumatic injury can lead to lung collapse. Gunshots, knife wounds, or blunt-force traumas that compromise respiratory pathways permit air to enter the pleural cavity. 
• Tension pneumothorax: Tension pneumothorax is a potentially fatal form of lung collapse that is an unwanted side effect of mechanical ventilation. If air is prevented from escaping the pleural cavity by the ventilator, pressure on the lungs and heart can build to critical levels.

Pneumothorax is often recurrent. Persons that have experienced lung collapse may undergo a second episode within one to two years of the first.

What Causes Pneumothorax?

Lung collapse has multiple causes. Some primary contributors include:

• Chest injuries: Broken ribs, bullet or stab wounds, blunt-force trauma, and similar injuries can facilitate lung collapse.
• Lung diseases: Lung disorders are the source of secondary spontaneous pneumothorax. These include COPD, cystic fibrosis, asthma, tuberculosis, emphysema, lung cancer, and certain forms of pneumonia.
• Activities involving dramatic changes in air pressure: Flying, scuba diving, and mountain climbing are all activities which subject participants to significant changes in air pressure. These changes can lead to pneumothorax.
• Medical procedures: Procedures which risk lung punctures, such as biopsies or catheter insertions, have resulted in some cases of lung collapse.

Pneumothorax has a number of associated risk factors. These include family history, tobacco use, and body type. Tall, thin persons are most vulnerable to primary spontaneous pneumothorax.

How Is Pneumothorax Diagnosed?

To diagnose pneumothorax, your physician will document symptoms and conduct a physical exam. He or she will also arrange for:

• A chest X-ray: A chest X-ray will allow your physician to see the outline of your lungs. A collapsed lung will be evident from its shrunken or misshapen appearance in the X-ray.
• A CT scan: A CT scan is an X-ray series that provides a cross-sectional view of the lungs. This image will provide greater detail than that of a single X-ray. 
• An electrocardiogram or EKG: EKGs measure your heart’s electrical activity. Certain irregularities are indicative of medical issues involving the heart, including pressure from air buildup in the pleural cavity.
• An arterial-blood gas (ABG) or pulse oximetry test: An ABG test measures the amount of oxygen and carbon dioxide in the blood. Pulse oximetry is a similar metric. Low oxygen and high carbon dioxide levels are evidence of respiratory dysfunction in the lungs.

How Is Pneumothorax Treated?

Pneumothorax treatment will depend on the cause, severity, and extent of lung collapse. Treatment methods include:

• Observation: If damage is minimal, collapsed lungs sometimes re-inflate themselves. Your physician may take a wait-and-see approach, keeping you under observation in case there is a sudden worsening of symptoms.
• Oxygen: Supplemental oxygen is sometimes prescribed for patients with a partial lung collapse.
• Needle aspiration: A hollow needle is inserted in the pleural cavity, to remove air by suction.
• Chest-tube drainage: Chest-tube drainage is similar to needle aspiration. A small plastic tube is inserted in the chest to remove air. The collapsed lung re-inflates, when freed of pressure.
• Autologous blood patch: Some procedures are designed to close air leaks into the pleural cavity. One of these is the autologous blood patch, which deploys a blood sample from the arm to form a sealant on the leak, stopping the flow of air out of the lungs.
• Surgery: Surgical procedures include open-chest thoracotomy and video-assisted thoracoscopic surgery (VATS). The former utilizes a catheter to suction out air from the pleural cavity; the latter is a minimally invasive procedure using tiny cameras and surgical tools to repair air leaks into the pleural cavity.
• Pleurodesis: Pleurodesis is a major invasive technique for persons with recurrent cases of lung collapse. It involves the purposeful irritation of the pleural cavity, joining it to the chest wall, and eliminating the possibility that air can enter the membranous structures surrounding the lungs.

Recovery from pneumothorax can take time. While recuperating, remember to:

• Observe your symptoms
• Refrain from lifting sizable objects
• Resume your exercise and other physical routines gradually
• Avoid activities like flying that expose you to sudden changes in air pressure.

The outlook for persons with pneumothorax is generally favorable, if the condition is properly diagnosed and treated in a timely fashion. More serious forms of lung collapse, resulting from traumatic injury, present a greater challenge.

Can Pneumothorax be Prevented?

Pneumothorax isn’t preventable, especially from an unknown or spontaneous cause. It is, however, possible to reduce the risk of a recurrent condition. You should:

• Stop smoking and the use of any tobacco products
• Avoid activities that involve sudden changes in air pressure (e.g., diving or mountain climbing).
• Avoid air travel, unless cleared to fly by your physician
• Keep regular appointments with your healthcare providers, especially if you have a chronic respiratory disorder.

Learn More About Pneumothorax from Baptist Health

If you’re dealing with a respiratory ailment or condition, see your Baptist Health physician. He or she will be able to assess your condition and determine which medical treatments, if any, are most appropriate for you.

Tall, thin young man? You could suffer from a collapsed lung

Local health experts say they’re seeing a number of cases of young men suffering from a collapsed lung – something that can come as a shock to the men who are otherwise healthy.

Adam Brilz, 19, never thought his tall, lean build would land him in hospital but Brilz is among a group of men with a health condition called pneumothorax, where a collection of air in the chest can cause the lung to collapse.

“I noticed when I breathed all the way in, it was really hurting when I got to the top of my breath,” Brilz said.

Brilz was at work when he felt a sharp pain in his side.

“I had a really sharp pain in my right side and I said, ‘this doesn’t seem normal,”” he said.

“It was horridly sharp. It felt like a stabbing pain.”

Brilz went to the medicentre and was told to get an X-Ray, which then determined that his right lung had collapsed by 60 per cent.

“I was little panicked,” Brilz said.

“I’m a healthy kid. I didn’t really have any previous issues. It just happened.”
 

Growth spurts likely the cause

Experts at the Chest Medicine Clinic say they see three to five patients a week with pneumothorax. Of that number, about half are tall, thin, young men.

Nurse practitioner James Veenstra says the condition may be common in that demographic as a result of a growth spurt.

“The main theory is the lung is weakened in individuals who grow and grow in a significant way in terms of a growth spurt and that can cause weakening of the lung, which leads to what is called to a bleb or a cyst,” Veenstra explains.

“If you think of a cyst like bubble wrap, if one of those bubbles ruptures, air can escape from the lung and cause the lung to collapse.”

While pneumothorax is common in teens and those in their 20s, Veenstra says the condition is also common in those who smoke and can be caused by a chest injury or underlying lung disease.

“The most common is people who have spontaneous pneumothorax in a younger age group,” he said.

Treatment depends on how large the pneumothorax is and medical history of the patient.

Veenstra says Brilz’ case was severe.

Brilz required surgery to re-inflate the lung and a second surgery tor remove the ruptured air blisters called blebs to try to prevent future cases.

He spent nine days in hospital and was released with a fully-functioning lung and a slim chance that he’d suffer from a collapsed lung again.

“Now they said it’s like a less in one per cent chance that it’s going to happen again,” he said.

Now Brilz is telling friends who fall into that tall, thin category, to see a doctor if they feel chest pain or shortness of breath.

“I told all my tall, lanky friends, if you feel a sharp pain in your left or right side, go get that checked out immediately,” he said.

“I said make sure you go check that out because it’s pretty dangerous.”

With files from Carmen Leibel

Collapsed Lung (Pneumothorax) | Frankel Cardiovascular Center

Topic Overview

What is a pneumothorax?

A collapsed lung (pneumothorax) is a buildup of air in the space between the lung and the chest wall (pleural space). As the amount of air in this space increases, the pressure against the lung causes the lung to collapse. This prevents your lung from expanding properly when you try to breathe in, causing shortness of breath and chest pain.

A pneumothorax may become life-threatening if the pressure in your chest prevents the lungs from getting enough oxygen into the blood.

What causes a pneumothorax?

A pneumothorax is usually caused by an injury to the chest, such as a broken rib or puncture wound. It may also occur suddenly without an injury.

A pneumothorax can result from damage to the lungs caused by conditions such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. Spontaneous pneumothorax can also occur in people who don’t have lung disease. This happens when an air-filled blister (bleb) on the lung ruptures and releases air into the pleural space.

People who smoke cigarettes are much more likely to develop a pneumothorax than those who don’t. Also, the more you smoke, the greater your chances are of having a pneumothorax.

What are the symptoms?

Symptoms depend on the size of the pneumothorax. In minor cases, you may not realize you have a pneumothorax. In more severe cases, symptoms will develop rapidly and may lead to shock.

Symptoms may include:

• Shortness of breath (dyspnea), which may be mild to severe, depending on how much of the lung is collapsed.
• Sudden, severe, and sharp chest pain on the same side as the collapsed lung.

Symptoms may become worse with altitude changes (such as flying in an airplane or going underground or underwater).

How is a pneumothorax diagnosed?

A pneumothorax usually is diagnosed through a physical exam and a chest X-ray. Your doctor may also perform blood tests to measure the level of oxygen in your blood.

A computed tomography (CT) scan or ultrasound may be needed to diagnose the severity of your condition and help plan your treatment.

How is it treated?

A minor pneumothorax may only require observation by your doctor; in some cases, oxygen may be given (through a mask). More serious cases are treated by inserting a needle or a chest tube into the chest cavity. Both of these procedures relieve the pressure on the lung and allow it to re-expand.

Surgery may be needed if the original treatment does not work or if the pneumothorax returns.

What are the chances that a pneumothorax will return?

If you have had one pneumothorax, you have an increased risk for another. Nearly all recurrences happen within 2 years of the first pneumothorax. If you smoke, quitting smoking can reduce your risk of another pneumothorax.

Collapsed Lung | NorthShore

The lungs normally expand and contract with air much like a balloon. Sometimes a weakness develops in the lung and essentially pops or bursts, allowing air to escape into the chest between the lung and the rib cage. The pressure of this air on the lungs can cause a complete or partial collapsed lung, also known as a spontaneous pneumothorax.

This potentially life-threatening condition may develop for a variety of reasons. Primary collapsed lung often occurs in healthy young individuals (ages 20 to 40) without any obvious signs of lung disease. Sometimes these patients, though, have a strong family history of collapsed lung. Secondary pneumothorax tends to affect people with underlying health issues affecting the lungs such as chronic smoking, COPD or cystic fibrosis.

Symptoms and Diagnosis of Collapsed Lung

Trouble breathing and chest pain are two major signs you may have a collapsed lung. But since they are also symptoms of many other health conditions, you should seek immediate medical attention if these problems suddenly appear and/or worsen.

Your NorthShore thoracic surgeon may require you undergo several imaging tests to accurately diagnosis your condition, including:

• Chest X-ray
• CT Scan 
• Lung Sonography
• Thoracic Ultrasound

Surgical Treatment Options for Collapsed Lung

Depending on how much of your lung has collapsed, surgery may be needed to repair the air leak as a preventative measure against recurrence. At NorthShore, our specially trained thoracic surgeons use minimally invasive video assisted thoracoscopic surgery (VATS) to repair the weakened area of the lung and help the lung adhere to the chest wall. This advanced technique, called thoracoscopic pleurodesis, typically yields a more than 95 percent success rate in preventing another collapsed lung.

For More Information

To schedule an appointment with one of our thoracic surgeons, please call 847.570.2868.

Primary spontaneous pneumothorax (PSP) – European Lung Foundation

There are a number of ways to treat PSP, depending on your circumstances and where you live.

Observation

It is possible to live comfortably with air in your pleural cavity for a reasonable period of time. Therefore, you may not require any significant treatment immediately after your PSP. Once you are in the hospital, your healthcare professional will examine you and, if necessary, give you oxygen to help with your breathlessness, and treat your pain with medication.

It is likely that, once your symptoms pass, you will either be kept in the hospital for a short period of time so that your doctor can check you will be OK (observation), or you may be sent home and told to get in contact if you have further symptoms, such as chest pain and breathlessness. Your healthcare professional will follow-up with you in the next few days to check on your lung health, and may also offer you a new chest X-ray to ensure the PSP has reduced or resolved.

“I was sitting down when I felt chest pain and started to find breathing difficult. I had a chest X-ray which showed that I had had a PSP on my left lung. I was given oxygen for about 2 minutes and was treated for the pain, and was kept in the hospital for 4 or 5 hours for observations. I haven’t had any symptoms since.”

Linda, France, who had PSP when she was 24 years old.

Removing air from the cavity

If your healthcare professional deems you at particular risk of having your lung collapse again, or if they feel your PSP compromises your breathing, it is likely that they will suggest one of several procedures to release any air from the pleural cavity.

Needle aspiration

When you have needle aspiration, a thin tube is inserted into your chest after the area is numbed with local anaesthetic, and the air in your pleural cavity is drawn out through a syringe. The procedure can be done on an outpatient basis (you will not have to stay in hospital overnight) and takes around 30 minutes. Once the needle aspiration has been carried out, your healthcare professional will take a chest X-ray to check whether the procedure has been successful. If so, you should be able to go home and your healthcare professional will follow-up with you at an outpatient appointment.

“Needle aspiration wasn’t particularly difficult to undergo. The one thing that would have been helpful to know about is the feeling when your lung re-inflates – I started coughing uncontrollably which was quite alarming, but it only lasted for a few minutes.”

Maria, UK, who first had PSP in her early twenties, and has since had recurrent episodes before having an open thoracotomy.

Inserting a chest drain

A chest drain involves having a tube inserted into your chest to drain the air out of your pleural cavity. Your skin will be numbed with local anaesthetic and you will be given some further pain relief or medication to relax you – you can ask for this if it is not offered. It should usually be possible to use a thin tube.

After insertion, the tube is secured in place with a small stitch and attached either to a water-seal drain, or to a valve. Both allow air to leave but not enter back into the pleural cavity, and this allows your lung to re-expand.

It is possible to go home when you have a valve, but when you have a water-seal type chest drain you may need to stay in hospital overnight. It can sometimes take several days for the lung to fully re-expand. When the chest drain is removed, the stich used to secure the tube is used to close the tiny wound left.

Preventing your lung from collapsing again

Pleurodesis

Pleurodesis is a procedure that aims to stick the pleura together to prevent your lung from collapsing again. This can be done chemically or mechanically.

Chemical pleurodesis involves applying a chemical irritant (usually talc) to the pleural cavity via the chest drain, which causes the two layers of tissue to stick together.

There are also surgical approaches like pleurectomy or pleural abrasion (mechanical pleurodesis). A pleurectomy is a procedure during which the surgeon will strip the lining between the lung and the chest wall so that the lung sticks to the chest wall, preventing further lung collapse.

In pleural abrasion, the surgeon gently rubs the pleura with a piece of gauze. This roughens up the pleura so that when it heals, the lung will stick to the chest wall. This can either be done via thoracoscopy (a keyhole operation using a small camera) or by surgery

Video-assisted thoracic surgery

Video-assisted thoracic surgery (VATS) is a relatively non-invasive, keyhole operation performed under general anaesthesia. It involves a thin, tube-like instrument with a camera on the end (called a thoracoscope) being inserted into a small cut in your chest.

The procedure involves removal of bullae, followed by pleurodesis. VATS generally requires a short hospital stay and, as it is a keyhole surgery, should only result in minimal scarring to the skin.

Open thoracotomy

Open thoracotomy is now used much less commonly as a surgical treatment for PSP than VATS. It requires surgical opening of the chest wall, which is usually performed under the arm. Like VATS, open thoracotomy involves removal of bullae, followed by pleurodesis. In the long term, some people may have ongoing or occasional pain after a VATS or open thoracotomy operation.

Treatment of catamenial pneumothorax

Catamenial pneumothorax needs to be treated by a team of different healthcare professionals, including experts in lung health and experts in female reproductive health. Treatment may involve the surgery described above, hormonal treatment, or both.

Another possible COVID complication: ‘Punctured lung’

As many as 1 in 100 hospitalized COVID-19 patients may experience a pneumothorax, or punctured lung, according to a multicenter observational case series published yesterday in the European Respiratory Journal.

Pneumothorax usually occurs in very tall young men or older patients with serious underlying lung disease. But University of Cambridge researchers identified COVID-19 patients with neither of those traits who had a punctured lung or pneumomediastinum (air or gas leakage from a lung into the area between the lungs) from March to June at 16 UK hospitals.

“We started to see [COVID-19] patients affected by a punctured lung, even among those who were not put on a ventilator,” said Stefan Marciniak, MB BChir, PhD, from the University of Cambridge in a news release. “To see if this was a real association, I put a call out to respiratory colleagues across the UK via Twitter. The response was dramatic—this was clearly something that others in the field were seeing.”

Sixty of 71 COVID-19 patients included in the study had a punctured lung, including two with different episodes of pneumothorax, for a total of 62 punctures. Six of the 60 patients with pneumothorax also had pneumomediastinum, while 11 patients had only pneumomediastinum.

Age, acidosis, and survival

Nine patients with shortness of breath on arrival at the hospital were diagnosed on chest x-ray as having punctured lung, 5 of them hospital readmissions after COVID-19 treatment (4 patients) or becoming infected with coronavirus in the hospital (1). All patients in this group were older than 40 years, and only two had underlying lung disease.

Seven of the nine patients required a chest drain. Two (22%) died 7 and 10 days after pneumothorax, one not requiring a chest drain and one having had the drain removed after the pneumothorax healed. The remaining seven patients were released from the hospital after a median stay of 7 days.

Fourteen patients experienced pneumothorax during their hospitalization while breathing on their own on a general or respiratory ward; six of them were diagnosed by chance. Three patients were on noninvasive ventilation at diagnosis. Eleven patients needed chest drains, while one required surgical intervention. Three patients (21%) died, the rest were released from the hospital after a median stay of 35 days, and one was later readmitted because of pneumothorax of the other lung.

Thirty-eight patients had a total of 39 lung punctures while receiving invasive ventilation; 26 needed invasive ventilation only, while 12 needed oxygen added to their blood outside their body.

Of the 26 patients requiring only invasive ventilation, punctured lung was diagnosed by chance or because they needed more oxygen, revealing hypercapnia (excess carbon dioxide caused by breathing that is too shallow or slow) and acidosis, a buildup of acid caused by lung or kidney dysfunction. Seven patients were given a chest drain, and eight survived for at least 28 days.

There was no significant difference in 28-day survival after punctured lung or pneumomediastinum (63.1% vs 53%; P = 0.85) or between men and women (62.5% vs 68.4%, P = 0.62). However, men were three times more likely to have pneumothorax than women, which the authors said might be because men with COVID-19 appear predisposed to more severe disease. No patients required treatment for pneumomediastinum.

Patients 70 years and older had only a 41.7% survival rate, compared with 70.9% in younger patients (P = 0.02), and patients with acidosis had only a 35.1% chance of 28-day survival, versus 82.4% of their peers, regardless of age.

Serious but treatable condition

The authors noted that previous small retrospective studies suggested that punctured lungs might occur in 1% of hospitalized COVID-19 patients and those dying from their infections and 2% of those needing intensive care, while another study estimated rates of barotrauma (both pneumothorax and pneumomediastinum) at 15%.

A case report yesterday out of China highlights the importance of being on guard for spontaneous pneumothorax, or sudden collapsed lung, especially in COVID-19 patients who have prolonged severe lung damage.

Studies have also suggested that other coronaviruses may contribute to pneumothorax. In a 2004 study, SARS (severe acute respiratory syndrome) was also associated with spontaneous pneumothorax, occurring in 1.7% of hospitalized patients. Likewise, in a 2015 study, a punctured lung was considered a predictor of a poor prognosis in patients with MERS (Middle East respiratory syndrome).

The authors of the new study said that COVID-19 may cause cysts in the lungs that could lead to lung punctures. They advised doctors to consider the possibility of punctured lungs in COVID-19 patients, even in those who don’t fit the profile for it, as many study patients were diagnosed with this condition only by chance.

While an observational case series can’t prove that COVID-19 causes pneumothorax, the authors said that the number of affected patients in their study make it unlikely that all lung punctures were coincidental. They said that if there were no link between the two conditions, they would likely have observed only 18 cases of punctured lung in COVID-19 patients from Jan 22 to Jul 3.

While previous studies have suggested that pneumothorax is a predictor of poor outcomes, the authors noted that study patients had an overall 63.1% survival rate and that 52% were released from the hospital.

“These cases suggest that pneumothorax is a complication of COVID-19,” they wrote. “Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage active treatment to be continued where clinically possible.”

Co-author Anthony Martinelli, MB BChir, a respiratory physician at Broomfield Hospital, said in the news release, “Although a punctured lung is a very serious condition, COVID-19 patients younger than 70 tend to respond very well to treatment. Older patients or those with abnormally acidic blood are at greater risk of death and may therefore need more specialist care.”

90,000 disease, symptoms, treatment, causes, diagnosis

Pneumothorax is the presence of air in the pleural cavity between the chest wall and the lung due to injury to the chest wall or lung with damage to one of the branches of the bronchus. Pneumothorax can also occur spontaneously in people without chronic lung disease (“primary”) or in people with lung disease (“secondary”).

Symptoms of pneumothorax are determined by the size and rate of entry of air into the pleural cavity; in most cases it is chest pain and shortness of breath.If the flow of air into the pleural cavity has ceased, the pneumothorax is considered closed. With an open pneumothorax, air freely enters it and, when exhaled, moves in the opposite direction. With valvular pneumothorax, inhalation air enters the pleural cavity, but does not have an exit from it. With intense pain, acute vascular insufficiency can occur. The severity of shortness of breath and the severity of the patient’s condition depend on the type of pneumothorax (closed, open, valve) and the degree of lung collapse.The most severe is valvular pneumothorax, in which the patient is agitated, difficulty breathing, rapidly progressing shortness of breath and cyanosis, increasing weakness up to loss of consciousness.

With a slow flow of air into the pleural cavity, gradual collapse of the lung and a good initial state of the respiratory and cardiovascular systems, pain in the affected half of the chest is insignificant and quickly stops, sometimes there is moderate shortness of breath and tachycardia (subacute pneumothorax).A closed pneumothorax with a small gas bubble volume may be asymptomatic (latent pneumothorax).

If you suspect a pneumothorax, you should immediately call an ambulance or see a doctor.

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90,000 Pneumothorax is… What is Pneumothorax?

accumulation of air in the pleural cavity, depending on the type of communication of the pleural cavity containing water, with the external environment distinguish between closed, open and valve P. If the flow of air into the pleural cavity has stopped, P. is considered closed. When P. is open, air freely enters it, and when exhaled, it moves in the opposite direction. With valve P., the air on inhalation penetrates into the pleural cavity, but does not have an exit from it. P. can be one – and bilateral, depending on the degree of collapse of the lungs, complete and partial.According to etiology, spontaneous, traumatic (including operational) and artificial pneumothorax are distinguished.
Spontaneous pneumothorax develops spontaneously, it is not associated with damage to the parietal or visceral pleura as a result of trauma, educational or diagnostic manipulations, conditionally distinguish between primary and secondary spontaneous P. Primary (idiopathic) is called P., the cause of which could not be established; more often it is caused by the rupture of small subpleural air bubbles (bullae), which are formed when the intrauterine development of the lungs is impaired.Secondary spontaneous P. is a complication of various lung diseases. It can be caused by air cysts, bullous emphysema, destructive pulmonary tuberculosis, histiocytosis X, pneumoconiosis, occasionally fibrosing alveolitis, chronic obstructive pulmonary diseases (chronic bronchitis, bronchial asthma), abscess, gangrene, cancer, echinococcal cyst of the lung. A rupture of the pleura and extrapleural adhesions with a strong cough and forced breathing can also lead to secondary spontaneous P.Morphological changes in spontaneous P. are characterized by an inflammatory reaction of the pleura arising in 4-6 h after air enters the pleural cavity. In this case, there is a hyperemia of the pleura, the injection of its vessels, a small amount of serous exudate is formed after 2-5 days. on the thickened and edematous pleura, fibrin overlays appear, the amount of exudate increases. If spontaneous P. persists for more than 2-3 months. the so-called chronic P. with sclerosed and thickened pleura leaves (rigid P.) In the case of a breakthrough of purulent cavities and a pleural cavity or infection of a pleural effusion (pyopneumothorax), chronic pleural empyema often develops (see Pleurisy), often complicated by a bronchopleural fistula. Sometimes spontaneous P. is accompanied by intrapleural bleeding (hemopneumothorax).
Spontaneous P. usually occurs after physical or mental stress, cough, sudden movement, less often in a state of complete rest or during sleep. Most often it is observed in men with asthenic physique.As a rule, spontaneous P. develops acutely, suddenly there is a dagger or stabbing pain in the chest on the side of the lesion radiating to the shoulder blade or abdominal cavity, shortness of breath, sometimes dry cough. The patient takes a semi-sitting or sitting position. With intense pain, acute vascular insufficiency can occur. The severity of shortness of breath and the severity of the patient’s condition depend on the type of P. (closed, open, valve), the degree of collapse of the lung (partial, complete), the nature of the pathological process in the lungs, and also on the state of the function of the respiratory and cardiovascular systems.The valve P. proceeds most heavily, at which the patient’s excitement is noted. difficulty in breathing rapidly progressing shortness of breath and cyanosis, increasing weakness up to loss of consciousness, swelling of the veins of the neck and upper extremities, a slight increase in the volume of the affected half of the chest and expansion of its intercostal spaces can be observed.
With a slow flow of air into the pleural cavity, a gradual collapse of the lung and a good initial state of the respiratory and cardiovascular systems, pain in the affected half of the chest is insignificant and quickly stops, sometimes there is moderate shortness of breath and tachycardia (subacute P.). Closed P. with a small volume of a gas bubble may be asymptomatic (latent P.).
Palpation with spontaneous P. reveals the absence of voice tremor (Voice tremor), percussion – boxy or tympanic sound on P.’s side, a decrease in the size of relative and absolute cardiac dullness, and with valve P. – displacement of cardiac dullness to the healthy side, auscultatory – sharply weakened breathing (up to the complete absence of respiratory noises with valve P.) in the affected area. Physical changes in the initial stage of latent flowing P. may be absent.
Diagnosis is typically based on history and physical findings. The final diagnosis is made after X-ray examination – the only method for diagnosing latent P. To identify P. and clarify his character, X-ray (X-ray), tomography (Tomography) are used. Chest X-ray in direct projection gives an approximate idea of ​​the presence of P.and his character; it serves as the basis for choosing additional research methods.
The main X-ray sign of P. is a site of enlightenment, devoid of a pulmonary pattern, located along the periphery of the pulmonary field and separated from the collapsed lung by a clear border corresponding to the image of the visceral pleura ( rice . 1 ). X-ray examination can reveal the connection of the pleural cavity with the external environment. Open P. on inspiration is characterized by an increase in the gas bubble, further collapse of the lung, displacement of the mediastinal organs in the healthy direction, and the dome of the diaphragm downward.When P. is closed, the x-ray picture depends mainly on the amount of air accumulated in the pleural cavity and the intrapleural pressure associated with it. If the pressure is lower than atmospheric pressure, the amount of air in the pleural cavity is small and the lung is collapsed slightly; on inhalation it increases in volume, on exhalation it collapses. At a pressure higher than atmospheric pressure, the lung is sharply collapsed, its respiratory excursions are barely noticeable, the mediastinal organs are displaced to the healthy side, the diaphragm is downward.If the pressure in the pleural cavity is equal to atmospheric, the lung is partially collapsed, respiratory excursions are preserved, the mediastinum is slightly displaced.
At valve P., the collapsed lung does not change fresh sizes and configurations during breathing, the degree of lung collapse is maximum, the mediastinum is sharply shifted to the healthy side, and on exhalation moves somewhat towards the defeat. Prolonged injection of air into the pleural cavity with valve P. leads to the formation of a tense pneumothorax.In this case, a sharp displacement of the mediastinum in the opposite half of the chest, low location and flattening of the diaphragm is found, gas in the soft tissues of the chest wall is often determined. With total P., gas occupies the entire pleural cavity, the shadow of the mediastinum shifts to the healthy side, the dome of the diaphragm downwards ( rice . 2 ).
P.’s identification, small in volume, is facilitated by research in lateroposition. With a small amount of gas in the pleural cavity and the position of the patient on the healthy side, the so-called sinus symptom, described by V.A. Vasiliev, M. A. Kunin and E.I. Volodin (1956): on P.’s side, there is a deepening of the costo-phrenic sinus and a flattening of the contours of the lateral surface of the diaphragm. If, in addition to air, blood also enters the pleural cavity, a picture of hemopneumothorax appears with a horizontal border between the two media ( rice . 3 ).
The cause of spontaneous P. can be established using tomography (computed tomography is the most informative). The presence of annular shadows on the tomograms along the periphery of the collapsed lung indicates the presence of air cysts or bullae in it, often complicated by pneumothorax.The pleural puncture with manometry helps to clarify the type of spontaneous P. With closed spontaneous P., the indicators of intrapleural pressure are stable, slightly negative (from –3 to –1 cm of water . cm .) Or positive (from +2 to +4 cm of water . cm of water . cm of water .). With open spontaneous P., they are close to zero (from -1 to +1 cm of water . st. .), With valve P., they are positive with a tendency to increase. The fluid aspirated from the pleural cavity is sent to the laboratory for the study of microflora and cellular composition.If it is necessary to determine the localization and size of the pleural fistula, thoracoscopy is performed (see Pleura).
Differential diagnosis before X-ray examination is carried out with myocardial infarction, pleurisy, pneumonia, perforated gastric ulcer, myositis, intercostal neuralgia. Radiologically, it is sometimes difficult to distinguish spontaneous P. from a giant air cyst or a tuberculous cavity, less often from a diaphragmatic hernia.
Emergency care for spontaneous P. is required relatively rarely.Acute chest pain is relieved by the introduction of anesthetic (2-3 ml 1% solution of promedol or 1 ml 2% solution of omnopon subcutaneously, 1-2 ml 50% solution of analgin intramuscularly). With increasing shortness of breath and falling blood pressure (for example, with valve P., pneumothorax, accompanied by intrapleural bleeding), urgent pleural puncture and air aspiration are indicated. The needle is inserted in the second intercostal space along the midclavicular line, fixed to the skin with an adhesive plaster and left in the pleural cavity during transportation of the patient to the surgical department of the hospital.To reduce hypoxia, oxygen inhalation is prescribed.
In the hospital, after specifying the type of spontaneous P. (closed, open, valve), further treatment tactics are selected. At closed spontaneous P. with a lung collapse of a small degree are limited to symptomatic therapy and X-ray control in 3-4 days. Slow expansion of the collapsed lung is an indication for pleural puncture with air aspiration. If it is impossible to straighten the lung, the pleural cavity is punctured with a trocar and its contents are continuously aspirated through the drainage using a Lavrinovich aspiration apparatus, a single-use device for active drainage of wounds or an electric suction ( rice . 4 ) within 1-2 days; sometimes use valve drainage according to Bulau (see. Drainage). At valve or open P., drainage of the pleural cavity with a thin catheter with constant air aspiration is shown.
With small defects of the visceral pleura (with a diameter of up to 1.5 mm ), the pleural cavity can be successfully sealed using diathermic or laser coagulation, or gluing with fibrin glue. Large defects of the visceral pleura can close after the introduction of drainage with a rarefaction of 15-20 cm of water . st . within 2-5 days. Drainage from the pleural cavity is removed after 1-2 days. after complete expansion of the lung. To prevent recurrence of spontaneous P., talc or tetracycline powder is insufflated into the pleural cavity for the purpose of its obliteration (pleurodesis).
If the listed measures are not effective, an operation is indicated – thoracotomy with suturing of the lung defect, resection of a segment or lobe of the lung, pleurectomy with decortication of the lung (see Pleura). With complicated and recurrent P.operations are performed without prior drainage of the pleural cavity. In patients with widespread changes in the lungs and reduced functional breathing reserves, prolonged drainage of the pleural cavity in combination with endoscopic occlusion of the bronchopleural fistula with a foam sponge or collagen mass is shown.

The prognosis with timely diagnosis, absence of complications and rational treatment is favorable in most cases. The prognosis is serious with spontaneous P., complicated by pleural empyema.Fatal outcomes are observed in the case of untimely diagnosis of bilateral P. or with lung damage, which does not allow the use of modern methods of treatment.

Traumatic pneumothorax occurs more often as a result of an open penetrating wound of the chest or blunt trauma to the chest with a ruptured lung. It can also be caused by complications of various medical procedures (pleural puncture, broncho- and esophagoscopy with biopsy of pathologically altered tissue or removal of a foreign body.catheterization of the subclavian vein, etc.), operations accompanied by opening the chest (operating P.).

With traumatic P., the lung collapses (as with spontaneous P.): due to tissue damage in the pleural cavity, along with a small amount of serous exudate, blood appears, and if the thoracic duct is damaged, lymph appears. If P. does not dissolve for a long time, fibrin is deposited on the surface of the pleura, the serous-hemorrhagic fluid turns into purulent.
Clinical manifestations of traumatic P.the same as in spontaneous P. Open traumatic P. is accompanied by serious disturbances of the cardiovascular and respiratory systems, which is caused not only by the collapse of the lung, but also by flotation of the mediastinum on inhalation and exhalation. The patient’s condition is extremely serious, shortness of breath and cyanosis are expressed, the pulse is quickened. Blood pressure is reduced, the number of breaths is more than 40 in 1 min . From the wound of the chest on exhalation and when coughing, blood is released with air bubbles.
Closed traumatic P. arises with small sizes of the wound channel in the chest and lung and rapid obturation of it with blood clots.The severity of symptoms of respiratory failure varies depending on the degree of collapse of the lung. Valve traumatic P. is formed with a small defect of the chest wall half-covered with soft tissues or with a closed chest injury with damage to the lung. The increasing intrapleural pressure leads to displacement of the mediastinal organs and partial compression of the healthy lung. The clinical picture is characterized by sharply increasing suffocation, cyanosis, tachycardia. Sometimes with valve and open traumatic P.shock develops. Hemodynamic disorders in this case are aggravated by the displacement of the heart and large vessels of the mediastinum. In case of traumatic P., air penetration into the subcutaneous tissue of the chest, neck, face and abdomen is possible.
X-ray signs of traumatic P. are the same as in spontaneous: complete or partial collapse of the lung, the presence of air and fluid (blood, lymph) in the pleural cavity, with a significant accumulation of air – a sharp shift of the shadow of the mediastinum to the healthy side, air layers in the mediastinum and under skin of the chest wall and neck.The preservation of the visceral pleura and lung tissue is indicated by a change in the position and size of the collapsed lung during inhalation and exhalation. However, it is possible to finally judge the state of the lung tissue only after the complete expansion of the lung. If trachea, large bronchi or esophagus are suspected of trauma, tracheobronchoscopy and contrast x-ray examination of the esophagus are indicated.
Victims with suspected traumatic P. are urgently hospitalized in the surgical department of the hospital. To eliminate the clinical symptoms of P.at the prehospital stage, morphine and other analgesics, drugs that stimulate the respiratory and vasomotor centers (caffeine, cordiamine, sulfo-camfocaine) are administered. With an open traumatic P. with a gaping wound of the chest wall and a valve traumatic P., open outward (there is a defect in the chest wall), an airtight bandage is urgently applied using a sticky plaster or oilcloth strip. If the valve traumatic P. is open inwards (there is no defect in the chest wall), an urgent pleural puncture with a thick needle in the second intercostal space along the midclavicular line is necessary.The needle or a thin catheter passed through it is left in the pleural cavity during the entire period of transportation of the patient to the hospital.
In a hospital with a closed P. with an insignificant amount of air in the pleural cavity, they are limited to dynamic observation, with a collapse of the lung, a pleural puncture is performed for air aspiration. With open traumatic P. and valve traumatic P., open outwards, surgical treatment of a wound and sealing of the chest is carried out by layer-by-layer suturing and plastics by surrounding tissues.Expansion of the lung with an open and valve traumatic P. (including an open inward valve P.) is achieved by drainage of the pleural cavity. In the case of hemopneumothorax, one catheter is inserted into the upper chest to remove air, the other into the lower chest to aspirate blood. With intrapleural bleeding, injury to the trachea, large bronchus, esophagus, and an extensive lung defect, urgent thoracotomy is indicated. To prevent pleural empyema in traumatic P., antibiotics of a wide spectrum of action are prescribed.

When operating P. in the postoperative period, drainage of the pleural cavity is carried out in order to completely expand the collapsed lung.

Artificial pneumothorax – the introduction of air into the pleural cavity for therapeutic or diagnostic purposes. The widespread earlier introduction of air into the pleural cavity for collapsing the affected lung in destructive forms of pulmonary tuberculosis (collapse therapy) in the present. time is rarely used. Air is injected into the pleural cavity when performing thoracoscopy, in some cases – before X-ray examination of the chest organs for differential diagnosis of pulmonary and extrapulmonary pathological processes. Features of pneumothorax in children . In newborns (up to 1-2% of cases), spontaneous P. can develop during the first acts of respiration, when intrabronchial pressure rises due to uneven expansion of the lung tissue. In children in the first three years of life, it often complicates staphylococcal pneumonia. At an older age, spontaneous P. is more often associated with an increase in intrabronchial pressure with whooping cough, bronchial asthma, foreign body aspiration. The cause of spontaneous P. in childhood can also be a rupture of congenital air cysts.Traumatic P. in children occurs in the same cases as in adults, and also as a result of damage to the trachea during intubation or inadequate ventilation under anesthesia.
P.’s clinical manifestations in children are the same as in adults. The younger the child’s age, the heavier they are. In newborns with a slight collapse of the lung, P.’s clinical symptoms may be absent, sometimes there is a short-term cessation of breathing, with an extensive collapse of the lung, tachycardia, cyanosis and convulsions are observed. With an objective study, P.in a newborn, it can be suspected by a significant displacement of the apical impulse to the healthy side. A high-quality chest x-ray only confirms the diagnosis if the lung is extensively collapsed. An accurate diagnosis is established by transillumination of the chest with a high-intensity light flux.
Principles of P.’s treatment in children are the same as in adults. At spontaneous P. at newborns carry out symptomatic therapy; if P.’s clinical symptoms progress, constant drainage of the pleural cavity with air aspiration is shown.Indications for P.’s surgical treatment in children arise mainly with trauma of the bronchi, esophagus and malformations of the lungs.
Bibliography .: Diseases of the respiratory system, ed. N.R. Paleeva. t. 2, p. 399, M., 1989; Vishnevsky A.A. and Shreiber M.I. Military field surgery. M., 1975; Light R.U. Diseases of the pleura, trans. from English, p. 278, M., 1986; Lindenbraten L.D. and Naumov L.B. X-ray syndromes and diagnostics of lung diseases. M., 1972; Rozenshtraukh L.S., Rybakova N.I. and Winner M.G. X-ray diagnostics of respiratory diseases.M., 1987.
X-ray of the chest organs with right-sided pneumothorax: the right lung is collapsed (indicated by the arrow), the remaining part of the right half of the chest is occupied by enlightenment, devoid of pulmonary pattern “>

Fig. 1. X-ray of the chest organs with right-sided pneumothorax: the right lung is collapsed (indicated by the arrow), the remaining part of the right half of the chest is occupied by enlightenment, devoid of pulmonary pattern.

Drainage of the pleural cavity in spontaneous pneumothorax with a device for active drainage of wounds, single use “>

Fig.4b). Drainage of the pleural cavity in spontaneous pneumothorax with a single-use device for active drainage of wounds.

Fig. 2. X-ray of the chest organs with total (complete) left-sided pneumothorax: the transparency of the left half of the chest is increased, the pulmonary pattern is absent, the shadow of a completely collapsed lung is adjacent to the mediastinum (indicated by the arrow).

Fig. 3. X-ray of the chest with right-sided hemopneumothorax in a patient with lung cancer: the right lung is collapsed (indicated by an arrow), the remaining part of the right half of the chest cavity is occupied by a zone of enlightenment without a pulmonary pattern (air congestion) and shading with a horizontal upper border (blood).

Fig. 4c). Drainage of the pleural cavity in spontaneous pneumothorax with electric suction.

Fig. 4a). Drainage of the pleural cavity in spontaneous pneumothorax with the Lavrinovich aspiration apparatus – OP-1.

In an unhealthy body: named the top 5 consequences of COVID-19 | Articles

Scientists are paying more and more attention to the long-term consequences of COVID-19, which are recorded in every tenth patient. In particular, researchers from Yale University have found that a new infection can provoke chronic renal failure, and specialists from Wenzhou Medical University have found a tendency to a sharp decrease in vision in those who have been ill. Izvestia compiled the top 5 consequences of coronavirus infection based on a survey of experts and publications in scientific journals. The only way to avoid unpleasant consequences is to vaccinate , experts say.

Cardiovascular collapse

Coronavirus infection is associated not only with respiratory system disorders, but also with dysfunction of other organs and systems. The virus damages the endothelium (the lining that lines the inner surface of blood vessels). Impaired metabolism in the myocardium and oxygen supply to cardiomyocytes leads to the development of cardiomyopathy. Also, with coronavirus infection , complications such as heart rhythm disturbances and myocarditis are often encountered, one of the leading experts of Russia in the field of cardiology, Professor Mehman Mammadov, told Izvestia.

Photo: TASS / Artem Geodakyan

– In recent months there has been an increase in the number of patients with decompensated heart failure , especially among convalescents (people who have recovered.- “Izvestia”) elderly and senile age. The reason for this may be the consequences of pneumonia, pulmonary fibrosis, microthrombosis of the pulmonary arteries, – he said. – I also believe that there will be more patients with rhythm disturbances after suffering from viral myocarditis.

Therefore, patients with a tendency to cardiovascular diseases need to be vaccinated.

Kidney blow

Scientists at Yale University School of Medicine conducted a study involving 1.6 thous.patients with acute kidney injury. Experts monitored people who were diagnosed with pathology while in hospital with coronavirus, as well as those who were not infected with this infection. According to American scientists, 24-57% of hospitalizations with COVID-19 and from 61% to 78% of hospitalizations in intensive care units are accompanied by kidney damage . Doctors monitored the condition of the patients 21 days after discharge and found that those who had undergone coronavirus infection did not recover their original renal function.Moreover, they were more likely to require dialysis than non-COVID-19 patients with acute kidney inflammation. Those who had the infection also had a higher risk of developing chronic renal failure (CRF), the study said.

Photo: Izvestia / Dmitry Korotaev

According to Izvestia, associate professor of the Department of Internal, Occupational Diseases and Rheumatology, Nephrologist of the Clinic named after EAT. Tareev of the Sechenov University Nikolai Bulanov, kidney damage in coronavirus infection is one of the most frequent manifestations and complications among patients who underwent inpatient treatment.And research into the long-term effects of this kind in patients with coronavirus is especially valuable.

– In some patients (not in the majority, but their number is quite significant), complete recovery of renal function does not occur 90 120. This suggests that acute organ damage has actually led to irreversible damage: chronic renal failure, with which patients are likely to live.

According to the specialist, such people need the supervision of a nephrologist and additional measures to prevent the progression of this condition.

Injection of vision

Scientists from the Stem Cells and Retinal Regeneration Laboratory of the Eye Hospital of Wenzhou Medical University in China have published a review summarizing all the available materials on diseases of the visual system caused by coronavirus. The authors pointed out the key roles of two receptors through which SARS-CoV-2 can infect the eyes.

Photo: TASS / EPA

COVID -19 is capable of causing disturbances of the visual system , the head of the ophthalmology department of the Federal State Budgetary Institution NMITSO FMBA of Russia, a full member of the European Society of Cataract and Refractive Surgeons (ESCRS), a member of the Russian Society of Ophthalmologists Nika Takhchidi confirmed to Izvestia. Speech about lesions of the ocular surface (conjunctivitis), changes in the retina, inflammation and thrombosis of the vessels of the eyes.

– Coronavirus can affect the vessels of the eyes, causing microvascular damage to the retina. They are manifested as follows: inflammation of the type of vasculitis and a state of hypercoagulability (disseminated intravascular coagulation syndrome). Inflammation is most often manifested by opacities in the vitreous body, changes in the retina. Thrombosis of retinal veins and arteries is manifested by a decrease in vision, sometimes by a change in the field of view , the expert explained.

Tasteless and odorless

The olfactory system is a complex, well-coordinated system of receptor cells in the nasal mucosa, conductive nerve fibers and the olfactory center of the brain. In case of malfunction of any link, the process of smelling is disrupted. As a rule, a violation of the sense of smell in COVID occurs on the fourth to seventh day of illness, and in most patients, the sense of smell is restored within 14 days. However, there is evidence of a longer course of olfactory disorders.

Photo: Depositphotos

– The mechanism of development of anosmia in a new coronavirus infection differs from anosmia caused by an allergic reaction or the common cold and runny nose. Some scientists believe that the virus infects the olfactory nerve fibers that are located in the nasal cavity , – Maria Petina, deputy chief physician of the Medsi Clinical Diagnostic Center, explained to Izvestia.

According to research results, full recovery from coronavirus anosmia takes from three days to three months. Do not self-medicate in such cases, it is recommended to consult a specialist as soon as possible after the onset of symptoms. It is unacceptable to use traditional medicine, conduct olfactory tests with harsh odorous substances that can damage the nasal mucosa (for example, ammonia).

I got to the intestines

Patients who have undergone COVID most often experience symptoms of an increase in the number of enteritis, lesions of the gastrointestinal tract, diarrhea after each meal that is not associated with a dietary violation , Maria Petina emphasized.

Photo: pixabay.com

– As a result the patient loses weight, important trace elements, nutrients. His quality of life is seriously deteriorating. Sometimes even pseudoneuronal colitis is detected, when, with reduced immunity, pathogenic microflora begins to multiply. Experts believe that the reason for this is not only coronavirus infection, but also massive treatment with antiviral drugs, she said.

Experts emphasize that the only way to avoid all these consequences is vaccination.

(PDF) [Small tension pneumothoraxes according to roentgenogram]

1

Makhambetchin Murat Maksutovich

Key words: polytrauma, tension pneumothorax.

Small on the roentgenogram, but tense pneumothorax

Research Institute of Traumatology and Orthopedics, Astana, Kazakhstan.

Director, MD, Professor N. BatpenovD.

Introduction. Tension pneumothorax is a long-known pathology described in detail

. In the literature, diagrams and figures are widespread,

reflecting the mechanism of tension pneumothorax, as a rule, with

complete collapse of the lung [1,2,4,5]. At the same time, there are no other important signs of tension in the pneumothorax on similar diagrams

. According to

drawings and diagrams, it turns out that complete collapse of the lung is the main one,

is a necessary and sufficient sign of a tense pneumothorax.In the

literature, complete collapse of the lung appears not only in the diagrams, but also in the

description of radiographs and the clinic, which leads to a firm consolidation in

of the consciousness that complete collapse of the lung is a mandatory sign of

tension pneumothorax, regardless of whether it is open or closed.

An increase in the number of victims with polytrauma and, accordingly,

expansion of medical and diagnostic experience showed that

academic, stressful

pneumothorax corresponding to the established stereotype are much less common than other (non-academic,

atypical) forms of pneumothorax.Non-academic (atypical)

due to the fact that they cannot be attributed to typical unstressed

pneumothorax, in contrast to which they displace the mediastinum and

cause severe respiratory failure. And at the same time,

with them there is no complete collapse of the lungs, as it should be according to the literature with

tension pneumothorax.

Purpose of the study. Show the possibility of a clinically significant

tension in a pneumothorax with small volumes on a roentgenogram.

Clinical Study Lung Collapse: Abdominal Pressure Assessment – Clinical Trial Registry

Thoracalgia – treatment, symptoms, causes, diagnosis

Chest pain ( thoracalgia ) is one of the most serious symptoms a person can experience. Sometimes even a doctor cannot immediately determine the cause of chest pain and find out if this symptom is a sign of a life-threatening condition.

• Chest pain can be anywhere and is caused by diseases of the heart, lungs, esophagus, muscles, bones, skin.
• Due to the complex innervation of the body, chest pain can come from another part of the body.
• Chest pain may be caused by diseases of the stomach or other abdominal organs.

Reasons

The following diseases can be potentially life-threatening causes of chest pain:

• Attack of angina pectoris or myocardial infarction. Chest pain in such cases is caused by impaired blood circulation in the coronary vessels, which can lead to myocardial ischemia.With angina pectoris, pain syndrome occurs during physical exertion, and with unstable angina pectoris even at rest. In myocardial infarction, the pain is usually intense and leads to the death of muscle tissue in a specific zone of the myocardium.
• Aortic dissection (dissecting aortic aneurysm): The aorta is the main artery that supplies blood to vital organs of the body such as the brain, heart, kidneys, lungs, and intestines. Dissection means a rupture of the lining of the aorta.This can lead to massive internal bleeding and interrupt blood flow to vital organs.
• Pulmonary embolism occurs when a blood clot enters one of the pulmonary arteries that supply blood to the lungs. This is a potentially life-threatening cause of chest pain, but is not related to the heart.
• Spontaneous pneumothorax. Lung collapse is called, and this condition occurs when air enters the space between the chest wall and lung tissue.The negative pressure in the chest cavity allows the lungs to expand. When a spontaneous pneumothorax occurs, air enters the chest cavity, the pressure balance is disturbed and the lungs cannot expand. This, in turn, disrupts the process of supplying oxygen to the blood.
• Internal perforation: In a perforated organ anywhere in the gastrointestinal tract, an opening or tear in the wall allows air to enter the abdominal cavity, irritating the diaphragm and may cause chest pain.

Other causes of chest pain that are not directly life-threatening are:

• Acute pericarditis: This is an inflammation of the pericardium (the membrane that covers the heart)
• Heart defects such as mitral valve prolapse.
• Pneumonia: chest pain due to irritation of the pleura.
• Diseases of the esophagus can also present with pain similar to angina pectoris and are sometimes difficult to diagnose.
• Neoplasms (usually malignant) of the lungs can cause chest pain.
• Osteochondritis (Tietze Syndrome): This is an inflammation of the cartilage tissue in the area where the ribs attach to the sternum. The pain is usually located in the middle of the chest, the pain can be dull or sharp, it can increase with deep breaths or movement.
• Shingles (herpes zoster) can cause severe chest pain because the virus damages nerve fibers.Pain, as a rule, is located in the course of the herpetic rash.

Problems in the musculoskeletal structures can also cause chest pain.

• Rib injuries. A rib fracture can occur both during contact sports (for example, after a blow to the chest), and in a fall and as a result of road traffic accidents. A rib fracture can sometimes be accompanied by damage to the lung and the development of pneumo or hemotrax. As a rule, the diagnosis of rib fracture does not cause any particular difficulties, since there is a clear connection between pain and injury.
• Vertebral fractures. Vertebral fractures may have a clear association with trauma (such as a fall), but sometimes, especially in the presence of osteoporosis, the patient may not recognize a specific connection to a specific trauma incident.
• Injuries to muscles can result from overuse or poor movement technique during sports, which can stretch the muscles and cause pain in the area of ​​those muscles. Muscle damage from direct injury is also possible.
• Damage to the joints. This is the most common cause of pain associated with the musculoskeletal system of the thoracic spine and chest. These disorders include injuries in the intervertebral discs, in the area of ​​attachment of the ribs to the vertebrae, in the facet joints. The onset of pain can be gradual or abrupt. Damage can occur as a result of a direct blow, a sharp movement (a sharp tilt or twisting in the trunk of a sharp extension), which leads to stretching of the ligamentous apparatus, joints, muscles, the development of an inflammatory process in the joint and muscle spasm.If such injuries are superimposed on poor posture, then the likelihood of developing degenerative changes in the joints is very high.
• In addition, dysfunction of the clavicle-sternum joints may be the cause of pain. Injuries to these joints are usually associated with injuries from direct impacts or ruptures of the ligamentous apparatus due to excessive loads. Pain can also be associated with injury.
• Intervertebral disc herniation. Herniated discs in the thoracic spine are quite rare and this is due to the anatomical rigidity of the thoracic spine.
• Inflammatory diseases of the spine such as ankylosing spondylitis (ankylosing spondylitis).
• Scheuermann’s disease – Mau. Pain syndrome is caused by severe hyperkyphosis and disorders of the spine biomechanics.
• Osteochondrosis of the thoracic spine. Changes in the intervertebral discs lead to compression of nerve structures and the appearance of pain.

Symptoms

Pain in the chest can be both acute and dull, there may be a burning sensation, tingling sensation.The pain may increase with exertion or with a deep breath, tilting the torso, down to the sides. The pain can be localized both in the right and in the left half of the chest. The pain can also go along the ribs or under the scapula, and increase with movement in the shoulder. There are a number of symptoms and signs called red flags that require emergency hospitalization because some conditions can be life-threatening. These are the following factors:

• Age under 20 or over 55
• History of injury (fall from height or road traffic accident)
• Persistent progressive non-mechanical pain
• Chest pain
• Presence of signs of cardiovascular or respiratory failure
• History of oncology
• Long-term steroid use
• Drug addiction or HIV infection
• Presence of systemic disease
• Unexplained weight loss
• Persistent impairment of trunk mobility in all directions
• The presence of neurological symptoms (numbness of the extremities, dysfunction of the pelvic organs).

Therefore, chest pain requires a very careful study of the symptoms and often there is a need to consult a specialist in different fields to make an accurate diagnosis.

Diagnostics

In the presence of chest pain, first of all, it is necessary to exclude somatic and other genesis of pain associated with the need for specialized medical care. If there is a suspicion of acute pathology (for example, myocardial infarction or injury), then the patient must be urgently hospitalized.Examination of the patient allows you to determine the presence of pain points, rashes of the area of ​​muscle spasm, etc.

In addition to studying the medical history and physical examination, instrumental research methods are used for diagnostics.

X-ray allows diagnosing fractures of ribs, vertebrae, joints. CT is necessary in cases where there is a suspicion of a pathology of bone tissue or chest organs (for example, a tumor).

MRI is the most informative for the diagnosis of changes in the soft tissues of the spine (discs, ligaments, muscles, intervertebral discs, nerves).

Scintigraphy. This examination method is prescribed only in cases where it is necessary to exclude the oncological genesis of the lesion, especially when it is necessary to differentiate the cause of the compression fracture (secondary vertebral lesion or osteoporosis).

Densitometry – this research method allows you to diagnose osteoporosis.

ENMG allows you to determine conduction disorders along nerve fibers and determine the presence of compression of nerve fibers (herniated disc stenosis of the spinal canal).

Laboratory research is necessary in cases where it is necessary to exclude the inflammatory process.

Treatment of thoracalgia

Treatment of chest pain depends on the cause of the disease (condition). In the presence of acute life-threatening conditions, the patient is urgently hospitalized. In the presence of somatic causes of pain, treatment is carried out by specialists of the appropriate profile.

Treatment of vertebral chest pain can use a number of treatments.

Drug treatment. NSAIDs are widely used for various pain syndromes, including vertebral 9034 thoracalgia . Antiviral drugs (such as acyclovir) may also be used in the presence of shingles. Muscle relaxants (mydocalm, sirdalud) are used in the presence of muscle spasm. It is also possible to use topically ointments containing NSAIDs.

Blockade. With severe pain syndrome, it is possible to carry out blockades using a combination of a local anesthetic and a steroid, which allows you to quickly relieve both pain syndrome and muscle spasm.

Manual therapy. Modern soft manual therapy techniques allow mobilizing motor segments, removing muscle blocks, eliminating facet joint subluxations and thus reducing both pain manifestations and restoring range of motion in the spine.

Massage. Therapeutic massage allows you to relieve muscle spasm, improve the elasticity of the ligamentous apparatus, and reduce pain.

Acupuncture. Impact on biologically active points allows you to restore conduction along nerve fibers and reduce pain.

Physiotherapy. There are many physiotherapeutic techniques that are effectively used in the treatment of vertebrogenic chest pain (electrophoresis, laser therapy, hivamat, cryotherapy). Physiotherapy allows you to improve microcirculation in tissues, reduce inflammation, and improve regeneration.