What are the symptoms of a collapsed lung. How is pneumothorax diagnosed. Can a collapsed lung heal on its own. What are the risk factors for developing pneumothorax. How is a collapsed lung treated.

What is Pneumothorax: Defining a Collapsed Lung

Pneumothorax, commonly known as a collapsed lung, occurs when air escapes from the lung and enters the pleural space – the area between the lung and chest wall. This buildup of air creates pressure outside the lung, causing it to collapse partially or fully. Understanding the mechanics of this condition is crucial for recognizing its potential severity and seeking timely medical attention.

The term “pneumothorax” can be broken down into its Greek roots:

• “Pneumo” – relating to air or the lungs
• “Thorax” – the chest cavity

Thus, pneumothorax literally translates to “air in the chest cavity,” aptly describing the condition’s nature.

Types of Pneumothorax: Traumatic vs. Nontraumatic

Pneumothorax can be classified into two main categories based on its cause: traumatic and nontraumatic. Understanding these distinctions is essential for proper diagnosis and treatment.

Traumatic Pneumothorax

Traumatic pneumothorax results from an injury to the chest or lung wall. This type can occur due to various incidents, including:

• Motor vehicle accidents
• Broken ribs
• Sports-related chest injuries
• Stab or gunshot wounds
• Iatrogenic causes (medical procedures)
• Rapid changes in air pressure (e.g., during diving or flying)

Prompt treatment of traumatic pneumothorax is critical, as it can lead to life-threatening complications if left untreated.

Nontraumatic Pneumothorax

Also known as spontaneous pneumothorax, this type occurs without an apparent external cause. It can be further divided into two subtypes:

1. Primary Spontaneous Pneumothorax: Occurs in otherwise healthy individuals, often tall, thin people or those with a family history of the condition.
2. Secondary Spontaneous Pneumothorax: Develops as a complication of an underlying lung disease, such as COPD, cystic fibrosis, or lung cancer.

Recognizing the Symptoms of a Collapsed Lung

Identifying the symptoms of pneumothorax is crucial for seeking timely medical attention. The onset of symptoms can be sudden and may vary in severity depending on the extent of lung collapse.

Common symptoms of pneumothorax include:

• Sudden, sharp chest pain
• Shortness of breath or rapid breathing
• Cyanosis (bluish discoloration of the skin)
• Rapid heart rate
• Low blood pressure
• Anxiety
• Fatigue

Are all cases of pneumothorax symptomatic? Not necessarily. In some instances, particularly with small pneumothoraces, individuals may experience minimal or no symptoms. However, even asymptomatic cases require medical evaluation to prevent potential complications.

Risk Factors: Who is Most Susceptible to Pneumothorax?

Understanding the risk factors for pneumothorax can help individuals and healthcare providers identify those at higher risk and take appropriate preventive measures.

Risk Factors for Traumatic Pneumothorax

Certain lifestyle choices and occupations can increase the risk of traumatic pneumothorax:

• Participation in contact sports (e.g., football, hockey)
• Occupations with a high risk of falls or chest injuries
• Undergoing chest or lung-related medical procedures
• Requiring ongoing assisted respiratory care

Risk Factors for Nontraumatic Pneumothorax

Several factors can predispose individuals to spontaneous pneumothorax:

• Smoking history
• Existing lung conditions (e.g., COPD, asthma)
• Family history of pneumothorax
• Tall, slim body type
• Male gender (more common in men)
• Age (typically occurs in young adults)

Can lifestyle changes reduce the risk of pneumothorax? While some risk factors are beyond control, quitting smoking and avoiding activities that strain the lungs can significantly lower the risk of developing a spontaneous pneumothorax.

Diagnosing Pneumothorax: Medical Evaluation and Imaging

Accurate diagnosis of pneumothorax is essential for appropriate treatment. Healthcare providers employ various methods to confirm the presence and extent of a collapsed lung.

Physical Examination

A thorough physical exam may reveal signs of pneumothorax, including:

• Decreased breath sounds on the affected side
• Hyperresonance to percussion (a hollow sound when tapping the chest)
• Elevated jugular venous pressure

Imaging Studies

Diagnostic imaging plays a crucial role in confirming pneumothorax:

1. Chest X-ray: The primary imaging tool for diagnosing pneumothorax, revealing air in the pleural space.
2. CT Scan: Provides more detailed images, useful for detecting small pneumothoraces or assessing complicated cases.
3. Ultrasound: Increasingly used, especially in emergency settings, for rapid diagnosis.

How accurate are these diagnostic methods? While chest X-rays are highly effective, they may miss small pneumothoraces. CT scans offer the highest sensitivity but involve more radiation exposure. Ultrasound provides a radiation-free alternative but requires skilled operators for accurate interpretation.

Treatment Approaches: Managing a Collapsed Lung

The treatment of pneumothorax depends on its size, cause, and the patient’s overall health status. The primary goal is to remove the air from the pleural space and prevent recurrence.

Conservative Management

For small, uncomplicated pneumothoraces:

• Observation: Closely monitoring the patient while the body reabsorbs the air naturally.
• Oxygen therapy: Accelerates air reabsorption and relieves symptoms.

Invasive Procedures

Larger or complicated pneumothoraces may require more aggressive treatment:

1. Needle aspiration: Removing air using a needle and syringe.
2. Chest tube insertion: Placing a tube to continuously drain air from the pleural space.
3. Pleurodesis: Creating scar tissue to prevent future air leaks, often recommended for recurrent cases.
4. Surgery: In severe or recurring cases, surgical intervention may be necessary to repair the lung and prevent future collapses.

What factors determine the choice of treatment? The size of the pneumothorax, its cause, the patient’s overall health, and the risk of recurrence all play a role in determining the most appropriate treatment approach.

Complications and Long-term Outlook of Pneumothorax

While many cases of pneumothorax resolve with proper treatment, potential complications can arise, especially if left untreated or in severe cases.

Potential Complications

• Tension pneumothorax: A life-threatening condition where air continues to accumulate, severely compromising breathing and heart function.
• Respiratory failure: Severe cases can lead to inadequate oxygenation and ventilation.
• Recurrence: Some individuals may experience repeat episodes of pneumothorax.
• Chronic pain: Some patients report persistent chest discomfort following a pneumothorax.

Long-term Prognosis

The long-term outlook for pneumothorax patients generally depends on the underlying cause and the effectiveness of treatment:

• Primary spontaneous pneumothorax: Often has a good prognosis with proper treatment, though recurrence is possible.
• Secondary spontaneous pneumothorax: Prognosis is more closely tied to the underlying lung condition.
• Traumatic pneumothorax: Outcomes vary based on the severity of the initial injury and associated complications.

Can pneumothorax recur after successful treatment? Yes, recurrence is a significant concern, particularly in cases of primary spontaneous pneumothorax. The risk of recurrence can be as high as 50% within the first few years following the initial episode, emphasizing the importance of follow-up care and preventive measures.

Prevention Strategies: Minimizing the Risk of Pneumothorax

While not all cases of pneumothorax can be prevented, certain strategies can help reduce the risk, especially for those with known risk factors.

Lifestyle Modifications

• Smoking cessation: Quitting smoking is one of the most effective ways to reduce pneumothorax risk.
• Avoiding extreme pressure changes: Take precautions when scuba diving or traveling to high altitudes.
• Protective gear: Use appropriate safety equipment in contact sports or high-risk occupations.

Medical Management

For individuals with underlying lung conditions:

• Adherence to treatment plans: Properly managing conditions like COPD or asthma can reduce the risk of secondary spontaneous pneumothorax.
• Regular check-ups: Monitoring lung health can help detect potential issues early.
• Genetic counseling: For those with a family history of pneumothorax, genetic counseling may provide insights into risk and prevention strategies.

How effective are these preventive measures? While no strategy can completely eliminate the risk of pneumothorax, these approaches can significantly reduce the likelihood of occurrence or recurrence, especially when combined with regular medical supervision.

Living with Pneumothorax: Adjusting to Life After a Collapsed Lung

Experiencing a pneumothorax can be a life-changing event, and many patients need to make adjustments to their lifestyle and outlook following recovery.

Physical Recovery and Rehabilitation

The recovery process after a pneumothorax varies depending on the severity and treatment approach:

• Gradual return to activities: Most patients can resume normal activities within a few weeks, but should follow their healthcare provider’s guidance.
• Breathing exercises: Techniques to improve lung function and capacity may be recommended.
• Physical therapy: In some cases, especially after surgery, physical therapy may aid in recovery and prevent complications.

Psychological Impact

The experience of a collapsed lung can have psychological effects:

• Anxiety: Fear of recurrence is common among pneumothorax survivors.
• Depression: Some patients may experience mood changes during recovery.
• Post-traumatic stress: Particularly in cases of traumatic pneumothorax.

How can patients cope with the psychological impact of pneumothorax? Seeking support through counseling, support groups, or talking with others who have experienced similar conditions can be beneficial. Healthcare providers should address both the physical and emotional aspects of recovery.

Long-term Lifestyle Considerations

Patients who have experienced pneumothorax may need to make some long-term lifestyle adjustments:

• Air travel precautions: Consulting with a doctor before flying, especially soon after recovery.
• Scuba diving restrictions: Many doctors advise against scuba diving after a pneumothorax due to the risk of recurrence.
• Smoking cessation: For those who haven’t already quit, stopping smoking is crucial to reduce the risk of recurrence.
• Regular follow-ups: Maintaining scheduled check-ups with healthcare providers to monitor lung health.

Can individuals return to normal activities after recovering from pneumothorax? In most cases, yes. However, the timeline and extent of return to normal activities should be guided by medical advice, considering the individual’s specific case and risk factors.

Advances in Pneumothorax Research and Treatment

The field of pneumothorax management is continuously evolving, with ongoing research aimed at improving diagnosis, treatment, and prevention strategies.

Diagnostic Innovations

• Advanced imaging techniques: Development of more sensitive and less invasive imaging methods for early detection.
• Biomarker research: Investigating potential blood or breath markers that could indicate pneumothorax risk or occurrence.

Treatment Advancements

Recent and ongoing developments in pneumothorax treatment include:

• Minimally invasive surgical techniques: Improving outcomes and reducing recovery time.
• Novel sealant materials: Development of new biological or synthetic materials to seal air leaks more effectively.
• Personalized treatment approaches: Tailoring interventions based on individual patient characteristics and risk factors.

Prevention Strategies

Research is also focusing on better prevention methods:

• Genetic studies: Identifying genetic markers that may predispose individuals to pneumothorax.
• Predictive models: Developing algorithms to assess an individual’s risk of primary spontaneous pneumothorax.
• Targeted interventions: Exploring preventive treatments for high-risk individuals.

What impact will these advancements have on pneumothorax management? As research progresses, we can expect more accurate diagnoses, less invasive treatments, and more effective prevention strategies, ultimately improving outcomes for patients at risk of or experiencing pneumothorax.

Understanding pneumothorax, its causes, symptoms, and treatment options is crucial for both medical professionals and the general public. By recognizing the signs early and seeking prompt medical attention, the risks associated with this condition can be significantly reduced. As research continues to advance our knowledge of pneumothorax, we can look forward to improved diagnostic techniques, more effective treatments, and better prevention strategies in the future.

Pneumothorax (Collapsed Lung): Symptoms, Causes, and More

A collapsed lung is the medical term for when air escapes outside of the lungs into the chest. The pressure causes the lung to be unable to expand. This is also called pneumothorax.

Pneumothorax is the medical term for a collapsed lung. It occurs when air enters the space around your lungs (the pleural space). This can happen when an open injury in your lung tissue causes air to leak into the pleural space. The resulting increased pressure on the outside of your lung causes it to collapse.

Pneumothorax can be traumatic or nontraumatic.

Traumatic pneumothorax results from an injury, like a blow to the chest. Nontraumatic pneumothorax can happen if you have lung disease, like chronic obstructive pulmonary disease (COPD), but it can also happen for no apparent reason in people without lung disease.

The long-term impact of pneumothorax can vary. If only a small amount of air is trapped in the pleural space, there may be no further complications. If the volume of air is larger or it affects the heart, it can be life-threatening.

If pneumothorax results from trauma, the symptoms often appear at the time of the injury or shortly after. Symptoms of spontaneous pneumothorax might appear when a person is at rest. A sudden attack of chest pain is often the first symptom.

Symptoms may include:

• a sudden, sharp, stabbing pain in the chest
• rapid breathing or shortness of breath (dyspnea)
• turning blue, known as cyanosis
• a rapid heart rate
• low blood pressure
• lung expansion on one side
• a hollow sound if you tap on the chest
• an enlarged jugular vein
• anxiety
• fatigue

There are different ways of categorizing pneumothorax, according to their causes or their impact.

One way of differentiating them is as follows:

• traumatic pneumothorax
• nontraumatic pneumothorax
  • primary spontaneous
  • secondary spontaneous

Other subtypes with either traumatic or nontraumatic causes are:

• simple, when it does not affect the position of other structures
• tension, which affects the position of other structures, like the heart
• open, when air moves in and out of an open wound in the chest

Traumatic pneumothorax

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

Here are some types of injuries that can cause traumatic pneumothorax:

• trauma to the chest from a motor vehicle accident
• broken ribs
• a blow to the chest during a contact sport, like football tackle
• a stab or bullet wound to the chest
• accidental damage during a medical procedure like a central line placement, ventilator use, lung biopsies, or CPR
• diving, flying, or being at high altitude due to air pressure changes

Quick treatment of pneumothorax due to chest trauma is critical as it can lead to fatal complications like cardiac arrest, respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax is called spontaneous, as it does not result from trauma.

When primary spontaneous pneumothorax happens, there’s no clear reason why it occurs. It’s more likely to happen:

• in people who smoke
• during pregnancy
• in people with Marfan syndrome
• in those with a family history of pneumothorax
• in an otherwise healthy person with a tall, thin body

Secondary spontaneous pneumothorax can happen if a person has:

• a form of COPD, including emphysema and chronic bronchitis
• acute or chronic infection, like tuberculosis or pneumonia
• lung cancer
• cystic fibrosis
• asthma
• severe acute respiratory distress syndrome (ARDS)
• idiopathic pulmonary fibrosis
• collagen vascular disease

Inhaling drugs like cocaine or marijuana can also trigger it.

Tension pneumothorax

Tension pneumothorax is not a classification of pneumothorax but a term that reflects the severity of pneumothorax. You may experience it if you have:

• a blow to the chest
• a penetrating injury
• changes in pressure when diving, flying, or mountaineering
• a spontaneous pneumothorax progressing to a tension type
• some medical procedures

The risk factors are different for a traumatic and spontaneous pneumothorax.

Risk factors for a traumatic pneumothorax include:

• contact sports, like football or hockey
• employment where there’s a risk of falls or other types of injury
• having a medical procedure that involves the chest or lung area
• ongoing assisted respiratory care

The people at highest risk of a nontraumatic pneumothorax include those who:

• have a history of smoking
• have an existing lung condition, like asthma or COPD
• have a family history of pneumothorax, which may indicate genetic factors
• have tall, slim bodies, as this can affect pressure at the top of the lung
• have inflammation in the small airways

Pneumothorax can lead to a number of complications, some of which can be life-threatening.

They include:

• respiratory failure or inability to breathe
• pulmonary edema following treatment for pneumothorax
• pneumohemothorax, when blood enters the chest cavity
• pneumopericardium, when air enters the cavity around the heart
• pneumoperitoneum, when are enters the space around the abdomen
• bronchopulmonary fistula, when a passageway opens between the lungs and the space around them
• heart attack

Tension pneumothorax can quickly progress to:

• an inability to breathe
• cardiovascular collapse
• death

It’s essential to seek emergency medical help as soon as symptoms arise.

Treatment aims to relieve pressure on the lung and allow it to re-expand.

The options will depend on:

• how severe the condition is
• whether the chest cavity is continuing to expand
• the cause
• whether it’s happened before or has been going on for some time

If you have tension pneumothorax or pneumothorax due to an injury, this is a life-threatening emergency. You’ll need immediate medical care and possibly surgery.

Here are some of the treatment strategies:

Observation

If pneumothorax results from a small injury, it may heal without treatment within a few days. Check with a doctor before flying or diving after pneumothorax.

If you’re having trouble breathing, you may need oxygen. Using oxygen can also help speed up the rate at which the lungs reabsorb air from the cavity.

Draining excess air

If the damage is significant or symptoms are severe, a surgeon may need to remove the air or carry out surgery.

Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. These can be done at the bedside without requiring general anesthesia.

In needle aspiration, the doctor inserts a needle into the cavity and extracts the air using a syringe.

For a chest tube insertion, the doctor will insert a hollowed tube between your ribs. This allows air to drain and the lung to reinflate. The tube may remain in place for 2 to 5 days or longer.

Surgery

The doctor may need to carry out a more invasive procedure to see what’s happening in your lungs, like a thoracotomy or thoracoscopy.

During a thoracotomy, your surgeon will create an incision in the pleural space to help them see the problem. During a thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), the doctor inserts a tiny camera through the chest wall to examine the lung.

If you’ve had repeated episodes of pneumothorax, you may need a small operation to repair any weak areas in the lung where the air is getting through. The doctor may also carry out pleurodesis, in which they stick the lung to the inside of the chest wall.

Other surgical options include:

• sewing blisters closed
• closing air leaks
• or removing the collapsed portion of your lung, which is called a lobectomy

These interventions can reduce the risk of pneumothorax happening again.

In many cases, a person with pneumothorax will need emergency medical treatment, and emergency doctors will carry out the evaluation and diagnosis.

A doctor will look for signs of air in the space around the lungs.

They’ll ask about:

• symptoms
• personal and family medical history
• recent activities
• any previous cases of pneumothorax

They may also carry out imaging tests, like:

• an X-ray
• a CT scan
• a thoracic ultrasound

Your long-term outlook depends on the size of the pneumothorax, the cause, and any treatment you receive.

Most cases of primary spontaneous pneumothorax resolve with observation or minimal treatment. It’s rarely life-threatening. But there’s a 30 percent chance that this type will recur within 5 years, and the risk of recurrence increases each time it happens.

It may take longer to recover if:

• you have a large pneumothorax
• you have a secondary spontaneous pneumothorax
• you have an underlying lung condition
• pneumothorax results from an injury
• it’s not your first experience of pneumothorax

In around 10% of cases, secondary spontaneous pneumothorax is fatal. The risk is higher if you have HIV or COPD. The risk of this type recurring within 5 years is around 43 percent, and the risk increases each time it happens.

Knowing your risk of developing pneumothorax and seeking help as soon as symptoms occur can help prevent severe complications.

Pneumothorax is a condition where air collects between the lungs and the chest cavity. In some cases, it’ll go away without treatment. In others, it can be life-threatening. This will depend on the size and cause of the problem.

There are different types of pneumothorax. Traumatic pneumothorax can happen if someone has an injury to the chest wall or lungs. Nontraumatic pneumothorax can affect people with COPD and other lung diseases, but it can also affect people without lung disease.

Treatment aims to remove the air and re-expand the lungs. In some cases, a surgeon may need to repair the lungs. Pneumothorax can be a life-threatening emergency. Anyone who experiences symptoms, like a sharp, stabbing pain in the chest, should seek immediate medical help.

Pneumothorax (collapsed lung) | Asthma + Lung UK

Tension pneumothorax

If air continues to get into the pleural space as you breathe, this can start to squash organs like your other lung and heart. This is called a tension pneumothorax and can be life-threatening. Emergency treatment is needed to release the trapped air.

What causes a pneumothorax?

Primary spontaneous pneumothorax (PSP)

This is when a pneumothorax happens in an otherwise healthy person, for no obvious reason. It’s the most common type of pneumothorax and happens most often in healthy young adults. Men are more likely to have a pneumothorax than women. PSP is also more likely to happen in tall, thin people.

PSP happens due to a small tear on the outer part of the lung. The reasons for this aren’t always clear, but researchers currently believe that this happens when blebs and bullae on the lung burst.

What are blebs and bullae?

Blebs are small air-filled blisters that can form on the surface of your lung. Bullae are pockets of air that can form within your lung tissue. More research is being done into how they are formed and why they are often found in people with PSP.

Secondary spontaneous pneumothorax

This is when a pneumothorax happens in someone who has an existing lung condition. It’s more likely to happen if the condition weakens the edge of the lung – this makes it more likely to tear. Conditions that can cause a pneumothorax are:

• chronic obstructive pulmonary disease (COPD)
• tuberculosis (TB)
• sarcoidosis
• cystic fibrosis
• lung cancer
• idiopathic pulmonary fibrosis (IPF)
• lymphangioleiomyomatosis (LAM)

Injury or trauma

Pneumothorax can be caused by:

• a chest injury in an accident like a car crash
• surgery where a needle is inserted into your chest
• acupuncture needles. These can cause a pneumothorax if they puncture the lining of your lung
• lung surgery, such as endobronchial valve placement to treat emphysema.

Environmental factors

You are more likely to have a pneumothorax if you smoke tobacco or cannabis (weed). Vaping can increase the risk of pneumothorax too.

Pneumothorax has also been linked to air pollution.

Familial pneumothorax

1 in 10 patients have a family member who has also experienced a pneumothorax. This is called familial pneumothorax.

This can happen at any age and is important because the pneumothorax can lead to one of a range of underlying genetic conditions being diagnosed, like:

• Birt-Hogg-Dubé syndrome
• Marfan syndrome
• vascular Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• tuberous sclerosis
• alpha-1 antitrypsin deficiency.

Menstruation (periods)

If you have a pneumothorax three days before or after the start of your period, it could be a catamenial pneumothorax. This type of pneumothorax is more common in your right lung and can happen more than once. The reasons for this are unknown, but early research has linked it to endometriosis.

What are the symptoms of a pneumothorax?

Symptoms include:

You might also hear or feel clicking, bubbling, or crunching in your chest.

You’ll usually be diagnosed by a chest X-ray. Sometimes you might need a CT scan or ultrasound of your chest.

How is a pneumothorax treated?

The aim of treatment is to relieve the pressure on your lung so that it re-expands. The type of treatment you have will depend on:

If your pneumothorax is caused by an underlying lung condition or chest trauma, you are more likely to need treatment.

If the pneumothorax is small, the leak usually heals itself and the trapped air is gradually absorbed by your body. This normally takes 1-2 weeks. You can use over-the-counter painkillers to manage the pain and you might also be given oxygen. You may have an X-ray after a week or so to check if the pneumothorax has healed.

If your pneumothorax is larger, the excess air may be removed by:

• inserting a needle into your chest and sucking the air out through a very thin tube, using a syringe. This is called aspiration

• inserting a chest drain. This is a small plastic tube that’s inserted through the chest wall. The drain allows air out but not back in, so your lung can re-inflate. The tube is secured and stays in place until the air leak is fixed and the lung re-inflated. You will have to stay in hospital until it has been fixed. The length of your stay will depend on how well you respond to treatment, but it’s usually at least 1-2 days.

Before having either of these treatments, your chest will be numbed with local anaesthetic so you won’t feel any pain.

How a chest drain works

If a pneumothorax happens more than once on the same side, or an air leak continues despite aspiration or a chest drain, you might need to have a small operation.

The operation will seal the weak areas on the edge of the lung where the air leaks are happening. This surgery may also involve a form of pleurodesis, where the lung is stuck to the inside of the chest wall, to make sure the lung can’t collapse again.

What happens after a pneumothorax?

Will it happen again?

If you have a spontaneous pneumothorax, there is a risk it will happen again. This happens to up to 5 in 10 people and is normally within five years of their initial pneumothorax. If a pneumothorax happens more than once on the same side, you might have a small operationto ensure it cannot happen again.

If you’ve had a pneumothorax and you smoke, stopping smoking will reduce the risk of it happening again.

Flying

You shouldn’t fly while you have a pneumothorax, or for a short time afterwards. The high altitude that planes reach could cause you to have another pneumothorax, so it’s important to wait until your doctor says it is safe before flying. This is usually one week after your pneumothorax has completely improved. A chest X-ray will be done to confirm that your pneumothorax has been treated successfully.

When you’re ready to fly again, make sure to tell your travel insurance company as failing to do so could impact any claims.

Scuba diving

You should not scuba dive if you have had a pneumothorax because of the risk of your lung collapsing again underwater. In some cases, surgical treatment can remove this risk. Ask your health care professional for more information.

Anxiety and stress

It’s normal to feel anxious, worried or stressed after having a pneumothorax. Our health advice has lots of information that can help you to look after your mental health.

Physical activity

There is no link between physical activity and pneumothorax, so you can be active again as soon as your symptoms stop. However, it’s a good idea to wait until you are fully recovered and have attended your follow-up appointment before you take part in any intense exercise or sports involving physical contact.

Genetic testing

You may have further tests to identify the cause of your pneumothorax, including genetic testing. This is especially important if you have a family history of pneumothorax.

Pneumothorax in newborns. What is pneumothorax in newborns?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Pneumothorax in newborns is an accumulation of air in the pleural cavity, which occurs due to damage to the alveolar wall. Pathology occurs with inadequate ventilation of the lungs, perinatal respiratory diseases, and the influence of iatrogenic factors. Pneumothorax is manifested by increased breathing, chest asymmetry, cyanosis of the skin and other signs of hypoxia. Diagnosis of the condition in newborns is performed by transillumination, chest X-ray, pulse oximetry. The treatment is carried out conservatively with oxygen therapy or with the help of invasive interventions (pleural puncture, drainage).

ICD-10

P.25.1 Perinatal pneumothorax

• Causes
• Pathogenesis
• Symptoms of pneumothorax in newborns
• Complications
• Diagnostics
• Treatment of pneumothorax in newborns
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Prices for treatment

General information

Pneumothorax in neonatology refers to the manifestations of the air leakage syndrome, occurs in 0.07-1% of babies, according to Russian data, and up to 1-1.5%, according to foreign colleagues. Among infants in the intensive care unit, the prevalence of the problem is 1.86%. This condition is 6 times more likely to be detected in preterm infants, and there is an inverse relationship between gestational age and the likelihood of the disease. In 85% of cases, unilateral pneumothorax develops, about 2/3 of the pathologies occur in the right lung.

Pneumothorax in newborns

Causes

Pneumothorax sometimes has physiological prerequisites: at the first breaths of a newborn, a large negative intrathoracic pressure is formed, the lungs quickly stretch, as a result of which rupture of the alveoli is possible. However, the child’s condition rarely worsens, and the consequences of damage to the lung tissue disappear without a trace after the normalization of the function of external respiration. Among the pathological causes of neonatal pneumothorax are the following:

• Respiratory therapy. Mechanical ventilation remains the main etiological factor in the occurrence of the condition, since 34% of newborns develop ruptures of the lung tissue. When ventilating in CPAP mode, the risk is reduced to 16%. In infants who received oxygen therapy with a mask, it is no more than 4%.
• Diseases of the respiratory system. Pneumothorax is diagnosed in 5-20% of newborns with RDS (hyaline membrane disease), which is caused by a violation of the elastic properties of the lungs. With transient tachypnea, the condition develops in 10% of cases. With aspiration of meconium, the risk increases to 20-50%.
• Lung injuries. In newborns, pneumothorax sometimes becomes the result of inaccurate performance of medical and diagnostic manipulations – catheterization of the subclavian and jugular veins according to the Seldinger method, sanitation of the tracheobronchial tree.
• Caesarean section. Elective surgery significantly increases the risk of pneumothorax compared with natural childbirth or emergency surgery, which was performed after a certain period of contractions. This pattern is explained by the more frequent development of the “wet lung” syndrome after a planned caesarean section.

Pathogenesis

The disease occurs when the alveoli are overstretched and ruptured, as a result of which air leaves the lung into the pleural cavity and accumulates there. The main producing factor is a physiological or pathological increase in intrapulmonary pressure. Pneumothorax often develops with uneven ventilation, for example, during mechanical ventilation, when air enters the subpleural alveoli with a large flow.

The frequent manifestation of pathology in premature newborns is due to underdevelopment of the lungs, their insufficient elasticity and lack of surfactant. As a consequence, there is a high predisposition to emphysema and the formation of “air traps”, against which the air leak syndrome appears. Sometimes pathology is formed when fluid is retained in the lung tissues, which provokes excessive extensibility of the alveoli.

Symptoms of pneumothorax in newborns

In 90% of cases, the disease is asymptomatic, since there is a small air leak, which does not give negative health effects. In the rest of the newborns, the main manifestation of pneumothorax is an increase in breathing more than 60 times per minute. During breathing, the child makes loud grunting or groaning sounds. Babies who are breastfed often drop their breasts because they don’t get enough oxygen.

Inadequate ventilation leads to respiratory failure. The skin of the newborn acquires a bluish tint in the area of ​​the nasolabial triangle and fingertips, with an increase in hypoxia, total cyanosis is formed. With massive pneumothorax, the affected side of the chest bulges, there is a noticeable asymmetry. There are cardiovascular disorders: tachycardia, arterial hypotension.

Complications

The most dangerous consequences of pneumothorax for premature babies with signs of RDS. Mortality in this case ranges from 14% to 31%, the rest of the newborns require long-term treatment in the intensive care unit. In 15% of infants, against the background of air leakage into the pleural cavity, persistent pulmonary hypertension is formed, which is associated with a pathological change in pressure in the vessels of the bronchopulmonary system.

With pneumothorax, air often accumulates in other cavities and tissues, which is manifested by pneumomediastinum, pneumopericardium, pneumoperitoneum. Serious consequences have interstitial emphysema, which, in combination with the presence of air in the pleural cavity, causes severe respiratory distress. Due to the increase in pressure in the venous system, blood flow to the heart decreases, cardiac output decreases and HF is formed.

Diagnostics

To suspect pneumothorax, a neonatologist needs only an external examination of the newborn and an assessment of physical data. The doctor pays attention to the asymmetry and size of the chest, counts the respiratory rate, during auscultation notes the weakening or absence of respiratory noises on the affected side. In order to diagnose the pathology and its negative consequences with 100% certainty, the following are used:

• Transillumination. When transilluminating the chest with a fiber-optic lamp in a darkened room, the doctor sees free air around the lungs. Such manipulation is informative only for prematurity of newborns.
• X-ray of OGK. On the x-ray, the neonatologist detects enlightenment in the peripheral parts of the chest and collapse (collapse) of the lung. In this case, the mediastinum, as a rule, is shifted to the healthy side. X-ray examination is also used to diagnose pneumopericardium.
• Pulse oximetry. Saturation assessment is necessary to determine the presence and degree of respiratory failure, making a decision on oxygen support. The lower the blood oxygen saturation, the more often adverse effects develop, and the higher the risk of death in the newborn.

Treatment of neonatal pneumothorax

Conservative therapy

Treatment is not indicated for asymptomatic incidental pneumothorax. In such a situation, the condition resolves on its own, does not cause long-term consequences, and does not disrupt the life of the newborn. In the presence of symptoms of respiratory failure, respiratory support is recommended in the form of an oxygen tent or nasal-mouth mask, which do not create high pressure in the bronchopulmonary system.

To prevent adverse consequences, it is necessary to find out the cause of the pathology in time and correct it. For example, with respiratory distress syndrome, a surfactant is inhaled into a newborn to normalize the functioning of the lungs. To prevent infectious complications, antibiotics are prescribed if necessary.

Surgical treatment

With severe pneumothorax or its rapid increase (valvular form), a newborn child requires invasive manipulations. The easiest way is to aspirate air with a syringe through the catheter. The method is suitable for the single removal of a small volume of gas. Also used is constant drainage of the pleural cavity with narrow tubes, which provide a gradual expansion of the lung and the elimination of the defect.

Prognosis and prevention

The probability of complete recovery depends on the degree of damage to the lungs, the presence of congenital or acquired bronchopulmonary diseases. Term newborns without RDS and the need for mechanical ventilation have a favorable prognosis; preterm infants often have negative consequences. Prevention involves a rational choice of tactics of mechanical ventilation and CPAP ventilation, accurate performance of invasive procedures.

You can share your medical history, what helped you in the treatment of pneumothorax in newborns.

Sources

1. Neonatology. T.1 / N.P. Shabalov. — 2020.
2. Analysis of cases of development of spontaneous pneumothorax in newborns / Yu.V. Peregudova, O.I. Petrusenko, A.V. Shaklein. – 2016.
3. Pneumothorax in newborns / V.EG. Vakulchik, A.V. Khudovtsova, Yu.V. Popova // Topical issues of surgery: materials of the XV Congress of Surgeons of the Republic of Belarus. – 2014.
4. Neonatology / ed. N.N. Volodin. — 2008.
5. This article was prepared based on the website: https://www.krasotaimedicina.ru/

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Atypical lung resection in St. Petersburg

The article was checked by thoracic surgeon of Euromed Clinic Nechiporuk Vasily Mikhailovich.

What is pneumothorax?

Pneumothorax is an accumulation of air in the pleural cavity, resulting in a complete or partial collapse (collapse) of the lung with a violation of its function. This leads to hypoxia and respiratory failure. Open pneumothorax occurs, as a rule, with injuries of the chest, closed – with various diseases, such as bullous lung disease, tuberculosis, tumors.

The Euromed clinic treats spontaneous recurrent pneumothorax in bullous lung disease.

Why Euromed?

• Euromed thoracic surgeons have extensive experience in the treatment of chest diseases, they are proficient in modern methods of performing operations, which contributes to the high effectiveness of the intervention and comfortable quick rehabilitation.
• Euromed is a full cycle clinic. Before the operation, we will arrange for you, if necessary, consultations with a therapist, cardiologist and any other specialist, here you can quickly take tests in our laboratory and immediately get the result. The process is organized clearly and takes much less time than in other clinics.

Treatment of pneumothorax

Atypical lung resection with costal pleurectomy
The operation is performed mainly in young patients (under 50, preferably under 40) with recurrent pneumothorax.

Atypical (marginal) resection is the excision of a part of the lung located on its edge. After the operation, as a rule, it is possible to restore lung function.

Costal pleurectomy is an operation that creates adhesions between the chest wall and the lung to prevent recurrence of pneumothorax. In this case, the lung, as it were, is soldered to the inner surface of the chest wall, which prevents recurrence of pneumothorax and collapse of the lung. The modern version of the operation eliminates large incisions on the surface of the chest: the operation is performed thoracoscopically – through three small incisions about 1 cm long.

Contraindications for surgery:

• Severe respiratory failure.
• Severe concomitant diseases with severe organ failure (renal, liver, heart).
• Coagulopathy (blood clotting disorder).
• Pronounced adhesive process in the pleural cavity.
• Hypertension (high blood pressure) of the pulmonary circulation.

Postoperative period

In the postoperative period after any atypical lung resection, a cough is possible, associated not with the operation itself, but with anesthesia. Some blood may come out during coughing – this is a common postoperative phenomenon and is not a complication. In case of heavy bleeding, you should immediately contact your doctor.

The drains are removed after 3-5 days, after their removal the patient can leave the hospital. A month later, it is necessary to perform a control computed tomography of the chest.
The proportion of relapses after surgery for spontaneous pneumothorax does not exceed 1%.

Operation cost: Atypical lung resection with costal pleurectomy* — from 82,000 rubles.

*The base cost of operation does not include : preoperative examination, anesthesia allowance, histological examination of the surgical material and hospital stay.

Nechiporuk
Vasily Mikhailovich

surgeon

Thoracic surgeon

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Patient reviews Euromed Clinic

Irina Arkhipchenko May 31, 2023

Please express my gratitude to Dr. M Elnikova Natalya Yuryevna, I have been seeing her for over 20 years and I can confidently to say that it is difficult to find a more qualified, experienced and friendly specialist. Natalya Yuryevna, in addition to her main specialty – gynecology, also has a deep understanding of related disciplines, which often simplifies the path to the right choice of treatment.

Clinic answer: Irina, good afternoon! Thanks for your feedback! Thank you for trusting your women’s health to the doctor of our clinic. We are very pleased that you appreciated the professional qualities of Natalya Yuryevna and her thorough and sensitive approach. We wish you good health! With care for you, Euromed In Vitro

Diana May 20, 2023

I have been a patient of the gynecologist Natalya Yuryevna Melnikova for more than 6 years. Previously, I came annually for checkups, and now I am conducting my first pregnancy with her. Natalya Yuryevna is a doctor with extensive experience, who was able to help me in various situations, such as: restoring the cycle, normalizing hormonal levels, preparing for pregnancy. Unnecessarily, he never prescribes aggressive drugs and antibiotics, we always understand the origins of the problem. Thanks to the doctor’s observations, hypothyroidism was detected in a timely manner, due to which it was not possible to immediately conceive a child.