Pneumothorax (Collapsed Lung) | Saint Luke’s Health System

When air fills the space between your
lung and chest wall (pleural cavity), it can cause all or part of your lung to collapse.
The main cause of this is an injury to the chest cavity that punctures the lungs.
Damage
may result from a stab or gunshot wound, car accident, fall, or certain surgeries.
In some
cases, it happens without a clear cause (spontaneous). 

You’re more likely to have
spontaneous collapsed lung if you smoke or have a chronic lung disease, such as
emphysema.

When to go to the emergency room (ER)

Serious collapsed lung can be fatal
if not treated. Call
911 for a bad chest wound or any of the following symptoms:

• Sudden, sharp chest pain that may spread to your shoulder or back

• Shortness of breath or
  trouble breathing

• A bluish color to the skin

• Loss of consciousness or feeling faint with any of the above symptoms

What to expect in the ER

• You will be examined carefully.

• Your lungs and heart will be listened to through a stethoscope.

• You may have X-rays or a CT scan. A CT scan combines X-rays and computer scans to
  provide detailed pictures of your lungs.

• You will be given help with breathing if you need it.

Treatment

• If the collapsed lung is
  small, you may stay in the ER for 5 to 6 hours to see if it gets any worse. If it
  does not get worse, you may be sent home without treatment and told to follow up
  with your regular healthcare provider.

• If the collapsed lung needs
  treatment, the provider may use a needle fit into the chest wall to suction extra
  air out of the pleural cavity. Or the provider may place a small catheter or a
  larger tube into your chest to better remove air from the pleural cavity. This is
  done at the bedside, and you will be given local anesthesia. If a larger tube is
  used, it is attached to a suction device that removes the air. Depending on the
  type of suction device, you may be able to return home to continue the suction and
  keep track of your condition there. Or you may be admitted to the hospital for a
  few days while the lung re-expands. If a small catheter was used to remove the
  air, it may be removed before you go home. If you are allowed to go home, you will
  be watched in the emergency room for 4 to 6 hours first to see if the collapsed
  lung gets worse during that time.

After treatment, you will be told
what to do to care for yourself and when to follow up with your healthcare provider.

What Does a Punctured Lung Feel Like?

Published on February 1, 2022

in Articles

If you are feeling an intense amount of pain when you breathe, you may be suffering a punctured lung. This condition is also called pneumothorax, from pneumo, which means related to the lungs, and thorax, which refers to the chest. Some people may refer to it as a collapsed lung.

Air can collect in the space between your lungs and the wall of your chest. When this happens, that extra air can cause pressure to push back on the outside of your lung. As a result, the lung can collapse.

A punctured lung, or collapsed lung, can be a complete collapse, or it can affect just one portion of the lung.

Symptoms of a Punctured Lung

The symptoms of a punctured lung mainly affect your breathing. However, lack of oxygen can cause other issues within the body as well. If you are suffering from punctured lung symptoms, you may be experiencing the following:

• Sudden, sharp pain in the chest, which increases or worsens when you take a deep breath, cough, or otherwise make a sudden move requiring air
• Shortness of breath – you may have to remind yourself to take deep breaths, you may feel winded doing things that are otherwise easy for you, and you may have trouble doing things that require a lot of air, such as singing
• Tightness in the chest
• Fatigue – you may find yourself getting tired much more quickly than usual
• Rapid heart rate – if you have something with a heart rate tracker, such as a smartwatch, it can help alert you to a rapid heart rate. The average heart rate for adults ranges from 60 to 100 beats per minute.
• Bluish tinge to the skin – this symptom is a result of a lack of oxygen.

Types of Punctured Lung

A punctured lung is categorized in three major ways, and the categorization helps explain potential causes. These causes are not definitive, but they can be helpful for you to understand the nature of your condition.

Traumatic Pneumothorax

This form of punctured lung occurs during direct trauma to the chest. Trauma can be anything from a gunshot or a broken rib sustained during a car accident. This is the form of a punctured lung that might inspire you to seek medical help from professionals who specialize in trauma care, such as Pro-Care Car Accident Doctors. There are also certain medical procedures that require pneumothorax for successful medical support. This deliberate form of pneumothorax also qualifies as traumatic pneumothorax.

Primary Spontaneous Pneumothorax

This form of punctured lung is the most difficult to determine a cause for. It can happen without any apparent precedent, and there is no specific cause to point to. As the name suggests, it can happen spontaneously. The most common way by which this form of punctured lung occurs is when a small air sac on the outside of the lung raptures, causing a leak into the cavity around the lung, between your lung and chest wall.

Secondary Spontaneous Pneumothorax

Like the above-mentioned primary spontaneous pneumothorax, this form of punctured lung can seem to appear out of nowhere. However, this type of punctured lung usually occurs as a side effect of a pre-existing lung disease. Some diseases that can result in collapsed or punctured lung symptoms can include lung cancer, asthma, or chronic obstructive pulmonary disease, known as COPD. It has also been identified as a concerning complication of COVID-19, occurring in as many as one in one hundred COVID-19 patients.

Tension Pneumothorax

This is one of the rarest but most life-threatening forms of lung collapse. Positive pressure is defined as pressure that is greater than the pressure in the environment surrounding it. In the case of pneumothorax, air gets trapped in the pleural cavity. The pleural cavity is the space between the two pleurae, or sections, of a lung.

Other Causes

Damaged lung tissue is much more likely to collapse than healthy tissue. Damage to the lungs can happen as a result of the diseases mentioned above, as well as cystic lung diseases, in which round air sacs form within the tissue. Lung damage is also a common result of smoking. Smoking also damages the small air sacs (also known as alveoli) in your lungs, making them more prone to collapse. Smoking is also the main cause of lung cancer cases, which frequently results in secondary spontaneous pneumothorax.

Some people experience diseases that require them to use mechanical tools to aid in their breathing. As a result, mechanical ventilation, such as those used frequently with COVID-19 patients, especially at the beginning of the pandemic, can cause pneumothorax. This occurs because ventilators may create imbalances within the lung and chest cavity which lead to air pressure collapsing the lung.

Risk Factors

The chances of sustaining a punctured lung may increase depending on certain factors about who you are, what your lifestyle is like, and your health history. There may also be some effect that comes from your genetic heritage. The risk factors increasing the likelihood of experiencing pneumothorax depend on the form of pneumothorax.

You may recall that primary spontaneous pneumothorax is the form of a punctured lung that can occur for seemingly no reason. You may be likely to experience this form of punctured lung if you are a smoker. People who are otherwise healthy but have a tall, thin body type are also more at risk for this kind of collapsed lung. Pregnancy is another risk. Although it can be treated in pregnant women, the chance of punctured lung symptoms recurring is anywhere between thirty to forty percent, with an increased likelihood during labor.

Marfan syndrome is a connective tissue disorder passed down through families, which can affect your heart, eyes, blood vessels, and skeleton. Pneumothorax is a common issue for people with this diagnosis.

Epidemiology

Young adults ranging in age from twenty to thirty are the most common sufferers of primary spontaneous pneumothorax. Men are more likely to experience punctured lungs of this nature, with the incidence rate in the United States being 7 per 100,00 men versus 1 per 100,00 women. Recurrence of symptoms for this form of punctured lung usually occurs within the first year after it is first diagnosed, with that recurrence rate at its highest during the first thirty days after diagnosis.

Secondary spontaneous pneumothorax, on the other hand, is more common among older adults, especially in the sixty to sixty-five age range. Men are still more likely to experience this form of the disorder, with an incidence rate of 6.3 per 100,000 men in the United States, compared to 2 per 100,000 women. Smokers are at risk more than any other population, with a risk one hundred and two times higher than non-smokers.

Traumatic pneumothorax, which is the form of punctured lung that occurs as a result of trauma to the chest area, occurs in one-fifth of victims of major trauma. The incidence rate for this form of punctured lung symptoms is 81 per 100,000 people of any gender, such that 20% of patients in a trauma care center may experience it.

Diagnosis

Pneumothorax is relatively easy for medical professionals to diagnose. Your doctor will most likely begin by using a stethoscope to listen to your breathing. If a punctured lung is the problem, then the doctor will hear breathing that is either greatly decreased or nonexistent. The doctor will then run a series of tests. The first among these tests will most likely be an x-ray of the chest to determine whether there is, in fact, air in the cavity between the lung or lungs and chest wall.

The doctor may also administer an arterial blood gas test, or ABG. This test measures the level of oxygen and carbon dioxide present in the blood. This test helps the doctor understand why you may have a hard time breathing. When your breathing is limited due to a punctured lung or a collapsed lung, there will be less oxygen and more carbon dioxide in your blood. This test is fairly quick, with results ready within fifteen or fewer minutes. Of course, this test alone is not enough to make a diagnosis, but it will give your doctor important information towards a complete and confident diagnosis.

In some cases, x-ray and arterial blood gas testing are not enough for your doctor to be completely sure that you are experiencing a punctured lung. In these cases, your doctor may order more detailed imaging, such as an ultrasound or a computerized tomography (CT) scan.

Treatment

The most important first step, and in fact the most important goal, is relieving any pressure on your lung. The pressure is what prevents your lung from fully expanding, thus causing the lack of oxygen reaching your blood. Your medical team may also administer treatment with the express purpose of reducing the likelihood of recurrence. Options for treatment are listed below.

Observation

Small pneumothoraces sometimes repair themselves. In these cases, your doctor may choose observation as the best course of treatment. This will consist of x-ray monitoring and returns to your pulmonary specialist, who will look for signs of the excess air being reabsorbed. It may be several weeks before your lungs can fully expand on their own again.

Aspiration

This form of treatment is most common when there is a large portion of collapsed lung. This method uses either a needle or a chest tube to remove the excess air from the cavity surrounding your lung.

In the case of needle aspiration, your doctor will insert a hollow needle with a small tube, or catheter, in between the ribs. When it is in the cavity creating the pressure on your lungs, the needle is removed. A syringe is attached to the catheter so that the air can be pulled out. The doctor may leave the catheter in so that the lung can fully expand and in order to avoid recurrence of the pneumothorax.

For chest tube insertion, a flexible tube is inserted into that air-filled cavity. It will be attached to a valve that continuously and carefully allows air to exit through the tube. As with a needle, this could take several hours, and your doctor will look for signs of recurrence.

Surgery

Sometimes, especially in the case of frequent recurrence, you may need surgery in order to address the way in which the air continues to leak into the cavity. This surgery is done by using a tiny camera to make a series of small incisions. The incisions are to help the doctor find the area of the lung that is causing the leak so that it can be closed off.

Less Invasive Treatment

There are some nonsurgical forms of treatment that may be appropriate, depending on the severity of your punctured lung. For example, your doctor may administer a substance that will inflame the lung tissue such that the tissues stick together and seal leaks.

Another nonsurgical option is to use a thin tube through your bronchial area (known as a bronchoscope). This tube will help the doctor look into your lungs and air passages. The tube can also be used to place a valve into your throat, which will help the lung expand.

Recovery

Like any injury, the amount of time it will take you to fully recover will depend on a number of varying factors. However, if you are otherwise healthy, treat the problem quickly, and follow your doctor’s prescribed aftercare plan, your lung will most likely be fully healed in six to eight weeks. To ensure that recovery is swift, make sure to take all medication as prescribed, participate in light activity with lots of rest, avoid smoking or sudden changes in air pressure such as during a flight, and practice breathing exercises.

Outlook

While some cases of punctured lung can be deadly if not treated right away, most people with this condition survive, especially if it is treated quickly. However, a major complication with pneumothorax is the increased likelihood of recurrence. Recurrence is especially likely if your punctured lung is the result of trauma to the chest, such as in the case of a car accident or if you are a smoker.

References

• Pneumothorax – Symptoms and Causes
• Health Effects of Cigarette Smoking
• Pneumothorax
• What is tension pneumothorax
• Recurrent spontaneous pneumothorax during pregnancy
• Marfan Syndrome
• The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia

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14. Pneumothorax. Clinic. Diagnosis, treatment tactics.

Pneumothorax
– accumulation of air in the pleural space
cavity, which usually leads to
compression of the lung, decreased respiratory
(ventilated) surface. depending
from prevalence are distinguished
the following types of pneumothorax: total,
when air fills the entire pleural space
cavity; partial, or cloak-like,
when the lung does not collapse completely, but
the air surrounds him on all sides, and
circumscribed pneumothorax.

By
the nature of the damage and communication with
external environment allocate a closed and
open pneumothorax and valvular
and spontaneous pneumothorax.

open
pneumothorax occurs
with penetrating wounds of the chest.
In this type of pneumothorax, pleural
the cavity communicates freely with the atmosphere
air through an open chest wound
cells (open to the outside) or a defect in
bronchus or trachea (open inwards).
Pressure in the pleural cavity
side of the lesion becomes positive.
Due to its elastic properties, the lung
subsides. There is a so-called
paradoxical breathing. When inhaling air
enters a healthy lung not only
from the atmosphere, but also from a collapsed lung
on the side of the damage. When exhaling part
air from a healthy lung enters
into a collapsed lung, somewhat inflating
his. Thus, with open
pneumothorax collapsed lung makes
weak breathing movements
straightening out when exhaling and subsiding when
inhale, i.e. performs when breathing
movements that are opposite to a healthy lung.
As a result, the depth of breathing sharply
decreases, ventilation is disturbed
lungs, respiratory and
heart failure, respiratory
hypoxia, shock. Often there is
“flotation” of the mediastinum, i.e. displacement
it either to the sick side, then to the healthy side
with each inhalation and exhalation. At
delayed provision of medical
assistance may result in death from shock,
cardiac disorders.

Sick
complains of shortness of breath, pain in the area
wounds. Examination reveals a wound
from a knife or gunshot wound,
from which, when breathing with noise, they stand out
air and blood spatter. When percussion on
the affected side are determined high
tympanic sound on auscultation
weakening or disappearance of the respiratory
noise. On x-ray examination
reveal the shadow of the collapsed lung
with a clear outer border, no
lung pattern on the periphery.

Treatment.
First aid when open to the outside
pneumothorax (chest wall injury)
reduced to the imposition of occlusal
dressing to seal the wound.
At the same time, events
maintaining cardiovascular function
and respiratory system, anesthesia,
restoration of blood loss by the introduction
various means.

B
hospital perform surgical
treatment and suturing of the wound of the chest wall
followed by continuous aspiration
air and accumulating in the pleural
exudate cavities through drainage. At
concomitant lung injury
the volume of the operation is determined by the nature
this damage. The operation is carried out
with maximum health
organ tissue.

At
open pneumothorax, communicating
with the external environment through the bronchi, damaged
destructive process in the lung (breakthrough
abscess, tuberculous cavity,
cavity form of cancer), treatment is directed
to eliminate the main process,
drainage of the pleural cavity
continuous aspiration of exudate and
air. With a large defect in the bronchus
and an unsuccessful attempt to straighten the lung
resort to temporary obstruction of the bronchus
a special cork made of foam rubber or
other material, after which the receipt
air into the pleural cavity stops,
favorable conditions are created for
expansion of a collapsed lung.
Visceral pleura expanded
lung during bronchial obstruction can
fuse with the parietal, which will lead
to eliminate pneumothorax. For a cure
underlying lung disease
adopted both conservative and
operational methods.

Most
severe and difficult form of pneumothorax
for diagnosis and treatment is
valve
pneumothorax. Valved
pneumothorax is a type
open. It differs in that the air
enters the pleural cavity through
a narrow opening in lung tissue (or
chest wounds) with each breath,
and when you exhale it does not come out completely
due to blockage of the opening in the pleura
surrounding tissues, forming a similarity
valve. As a result, the inhaled air
enters the pleural cavity with each breath
cavity and only partially exits when
exhale. Gradually increasing
pressure in the pleural cavity compresses
lung and large vessels.

B
some cases of valvular pneumothorax
air is pumped through the “valve”
only in one direction, to the pleural
cavity. Pressure (voltage) in
pleural cavity is growing rapidly.
This type of valvular pneumothorax
called tense (Fig. 6.15). When
pressure in the pleural cavity becomes
very high, the lung collapses completely,
the mediastinum moves to the opposite
side, while squeezing healthy
lung. Sometimes there is flotation
mediastinum (i.e. moving it when
breathing in one direction or the other).
In this regard, large
blood vessels, blood circulation is sharply disturbed
and breathing, shock may develop.

Basic
symptoms of valvular pneumothorax
fear, anxiety, cyanosis of the face and neck,
swelling of the veins of the neck, puffiness of the face,
sometimes subcutaneous emphysema, enlargement
intercostal spaces; decline
blood pressure, tachycardia,
arrhythmia. On percussion on the affected
side determine high tympanic
sound, on auscultation – weakening
or disappearance of breath sounds
lack of voice trembling. At
x-ray examination
reveal a total collapse of the lung,
mediastinal shift, low standing
diaphragm, expansion of the intercostal
intervals.

Treatment.
First aid is urgent
unloading (reducing pressure)
puncture of the pleural cavity
needle. Needles are put on the pavilion
plastic tube, and at its end
put on and fix split on
the tip of a “finger” from a glove or
fingertip that will play the role
valve, i.e. to release air from
pleural cavity and prevent
its flow in the opposite direction.
This reduces the voltage in
pleural cavity, create conditions
for spreading (at least partial)
lung on the affected side, enlargement
ventilated surface.

Subsequent
therapeutic measures are carried out in
hospital according to the nature
damage and causes
valvular pneumothorax.

Spontaneous
pneumothorax is
kind of closed. Spontaneous
pneumothorax is usually closed.
However, if valvular
mechanism for a ruptured cyst or
bulle it becomes valvular, tense.

Gap
cysts or bullae may occur
due to increased intrapulmonary
pressure under physical stress, in
time of coughing. Spontaneous
pneumothorax can develop in any
age.

At
rupture of a cyst or bulla into a limited
adhesions part of the pleural cavity
Patients do not report any abnormalities
if the amount of air supplied
into the pleural cavity, does not exceed
5-15% of its volume. Upon admission to
pleural cavity more significant
amount of air develops a typical
pattern of closed or valvular
pneumothorax as according to the physical
research, as well as X-ray
picture.

Treatment.
With a small asymptomatic pneumothorax
no special treatment is required.
Air is usually sucked in during
a few days, and the lung cracks down
on one’s own. If you need to speed up
air evacuation, produce 1-2
pleural punctures.

At
their inefficiency pleural cavity
should be drained and a permanent
aspiration of air to straighten
lung. In a number of cases it is necessary
resort to surgical treatment. way
marginal resection of lung bulla and cyst
can be removed with
videotor-coscopic technology. At
lack of appropriate equipment

15.
Pulmonary bleeding. Causes,
diagnostic and therapeutic tactics .

– expiration
blood from lungs or bronchi
vessels, accompanied by secretion
blood from the respiratory tract. Reasons. LC
may be with non-specific
inflammatory processes in the lungs or
bronchi, tuberculosis and lung cancer,
aneurysms, in the pulmonary system
circulation, pulmonary endometriosis,
in the presence of foreign bodies in the lungs and
bronchi, pulmonary embolism,
fungal and parasitic diseases
lungs, wounds and injuries of the chest
cells, mitral valve defects
♥. A small amount of blood in the sputum
is usually determined in the first days after
operations on the lungs, incl. after biopsy
lung tissue. Often LC comes from
bronchial arteries, which are excessively
developed and aneurysmally changed in
areas of chronic inflammation
process. In case of acute
destructive lesions of the lung tissue,
with wounds and injuries of the chest
source of bleeding is usually pulmonary
arteries and veins. The emergence of LC
contribute to hypertension in the small circle
circulatory disorders, clotting disorders
blood. Respiratory blood is usually
excreted with cough. Its quantity can
be different – from streaks of blood in the sputum
(hemoptysis) to profuse bleeding
continuous stream. In some cases
hemoptysis – a harbinger of abundant
bleeding from the lungs. Distinguished from
respiratory tract blood is liquid, without
clots, frothy, has an alkaline
reaction. In patients with heavy bleeding
in the lower parts of the lungs can be heard
various moist rales. Diagnostics
.
Localization of the source of bleeding
can be determined by x-ray
(according to the nature of lung damage), more than
exactly – with tracheobronchoscopy. If
cannot be identified, resort to
catheterization of bronchial arteries and
bronchial arteriography. Differential diagnosis .
For stomach bleeding, blood
excreted with vomit,
mind – coffee grounds, has an acidic reaction,
which is preserved during aspiration. At
fresh bleeding from varicose veins
esophageal veins blood in vomit
may look little changed, but
usually it has a dark color and does not happen
foamy. Diagnosis with bleeding
from arrosed mucosal vessels
membranes of the mouth, nose and pharynx
such bleeding is detected during examination
oral cavity, pharyngo- and rhinoscopy.
Treatment. All
LC patients should be hospitalized
to the pulmonology department or
department of thoracic surgery. Treatment
should be a warning
obstruction of the bronchi with blood clots, and
in case of respiratory failure – for recovery
airway patency. sick
give a sitting or semi-sitting position
with an inclination towards the lung, from which
bleeding is expected; -decreases
danger of aspiration of blood in the opposite
lung. Persistent cough should not
completely suppress so as not to hinder
coughing up blood that has flowed into the bronchi
and not create conditions for the emergence
aspiration pneumonia. If bronchial
patency is not restored when
coughing, blood is sucked out through a catheter
or, more efficiently, through
bronchoscope. Concomitant obturation
bronchial bronchospasm stop
m-anticholinergics (atropine sulfate according to
0.5-1 ml of 0.1% solution subcutaneously) and β-agonists
(alupent, salbutamol, berotekingalation).
Asphyxia – emergency intubation
trachea, blood suction and ventilation.
At the same time, hemostatic therapy.
In LC without hemodynamic disturbance V/V
protease inhibitors (kontrykal according to
10,000-20,000 IU or Gordox 100,000 IU) and
fibrinolysis (aminocaproic acid – to
100 ml 5% solution). To prevent thrombosis
and embolism treatment with these drugs
carried out under the control of thromboelastogram
and coagulograms. If it is impossible
determine the indicators of clotting
blood systems – hemophobin (2-3 teaspoons
spoons), etamsylate (2-4 ml of 12.5% ​​solution B / B
or V\M), fibrinogen (2 g each in NaClB\B).
bleeding from the bronchial system
arteries – lower blood pressure (if it is N or
↑), maintaining systolic blood pressure at
80-90 mmHg Art. For this, pentamine is administered.
3 ml of 5% sol.W\M, benzohexonium 0.5-1 ml
2.5% solution subcutaneously or intramuscularly; V\V drip
under constant BP monitoring
arfonad. LC causing posthemorrhagic
anemia – an indication for replacement
transfusions of Ermass.
To eliminate hypovolemia after a large
blood loss-injection of native plasma,
polyglucin, rheopolyglucin or
gelatinol. In the absence of hemostatic
effect of drug treatments
bronchoscopy, during which
occlusion of the bronchus of the bleeding segment.
In case of inefficiency – bronchial
arteriography followed by endovascular
occlusion of the bronchial arteries. Often
surgery is needed
on the lungs.

Types of pulmonary pneumothorax: symptoms, treatment, causes