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Pneumothorax: Causes, Symptoms, And Treatment

Whenever gas is trapped in your pleural cavity, that means you have got a lung disorder, which is known as pneumothorax. This content provides you with details about this lung disorder, but keeps in mind this content is just for your acknowledgment. If you have any queries or problems regarding your health, you should be concerned with your doctor.

What is pneumothorax?

The term Pneumothorax means air or gas is present in the pleural cavity (space between parietal and visceral pleura), which impedes the oxygenation as well as ventilation. This is due to the collapse of the lungs. 

Pathophysiology of pneumothorax:

In a healthy young person, the pressure of surrounding lungs (pleural pressure) is harmful as relative to the atmospheric pressure in the alveoli, the respiratory cycle. The pressure difference between the pleural cavity and pulmonary alveoli is known as transpulmonary pressure. This transpulmonary pressure cause recoil of lungs. But in pneumothorax, the airway connected to the pleural cavity, and the air or gas wander from the alveoli to pleural space till both pressure have come in an equilibrium state. Correspondingly when the pleural cavity and chest wall become connected, air or gas migrates into the pleural cavity till the differences of the pressure no longer are present, and the connection between both (chest wall and pleural cavity) is closed.

 When the pressure of air in the pleural cavity is adequate to increase, and the pleural pressure from -5cm H2O to -2.5 cm H2O, the difference between pulmonary alveoli and pleural cavity reduces from 5cm H2O to 2.5cm H20, the lung vital capacity (amount of air inhaled and exhaled during the respiratory cycle) decreases by 33% space for the influx of pleural cavity air is generated by compress the lungs with decreases the vital capacity by 25%. Additionally, intra-pleural cavity pressure varies by increasing the thoracic volume and resulting in variation of thoracic recoil wall and round about 8% reduction in vital capacity. While the pleural cavity pressure increases and the mediastinum move in the opposite direction, inflate the thorax in the same direction, with depressing the diaphragm. These changes are noticed in tension pneumothorax and other types of pneumothorax. 

The physiologic changes occur in pneumothorax by reducing arterial oxygenation and vital capacity and patients experience primary pneumothorax, and as well as patients also experience secondary pneumothorax due to the underlying cause of any pulmonary diseases. This may also lead to hypoventilation (shallow or slow breathing). Decrease amount of oxygen caused by due to anatomic shunt. In some cases, hypoventilation in the pneumothorax occurs due to decrease ration of ventilation-perfusion in the alveoli.  

What are the types of Pneumothorax?

Numerous classification of these diseases are used all around the world, but Pneumothorax is classified into three broad categories due to its severity and etiology, these are

Spontaneous pneumothorax:

Spontaneous pneumothorax also knew as non-traumatic pneumothorax means this is not caused by any injury. In this spontaneous pneumothorax, sudden onset of lungs collapsed or deteriorate of lungs occur without any detectable cause. This collapsed of lungs is due to air-filled surrounding the lungs which are known as bleb ruptured and it builds the pressure on the lungs. As a result of this pressure, lungs do not expand fully when you take a breath. Spontaneous pneumothorax further classified into two types, such as

Primary Spontaneous Pneumothorax:

The collapse of the lung occurs without any apparent reason (absence of an underlying cause of lung diseases).In PSP, an abnormal collection of air is present between the lungs and chest cavity. 

Secondary spontaneous Pneumothorax: 

Multiple respiratory diseases describe secondary spontaneous pneumothorax.SSP occurs with apparent (with underlying cause), and it occurs in those people who have lung parenchymal diseases and have numerous pulmonary pathology that disturb the structure of lungs. 

Traumatic Pneumothorax (Iatrogenic pneumothorax):

Traumatic pneumothorax is caused by an injury that tears the lungs and permits the air to comes in the pleural cavity. This type of pneumothorax may occur in one or both lungs, and the air is confined in the pleural cavity that causes the collapse of the lungs. Traumatic pneumothorax is classified as

Open Pneumothorax: 

Open pneumothorax is the accumulation of air between the lungs and chest wall because of open wound injuries or due to any physical defect. If the opening of the wound or injury is larger, then the degree of collapsed lungs becomes larger, and most difficulty in breathing occurs. 

Closed Pneumothorax: 

Closed pneumothorax when the accumulation of air between the lungs and chest wall because of closed wounds or injuries (without outside wound). Closed pneumothorax usually occurs when already lung is injured due to any diseases (such as cystic fibrosis and cancer). Because this disease makes an excessive amount of mucus, and this thick mucus blocks the ducts. 

Occult Pneumothorax:

Occult pneumothorax is defined as the pneumothorax that not diagnosed on a clinical examination basis, and chest radiograph instead of it is observed in computed tomography (CT). This condition is increasing day by day in trauma care with the advanced use of CT. The management of this blunt trauma pneumothorax is somehow controversial. Some doctors suggest the thoracostomy tube, and some are favor in positive pressure ventilation (PPV). Meanwhile, some of them undergoing chest drainage.

Tension Pneumothorax:

Tension pneumothorax is the condition of your lungs that can happen due to trauma of chest and air is trapped in pleural space, it may lead to the patient’s deterioration, and they are unable to maintain oxygenation. This life-threatening condition is occurring in a traumatic condition that involves the opening of the chest wall due to wound, bullet, knife, any injuries, or the patients who are on a mechanical ventilator. 

What is the pathophysiology of Tension pneumothorax?

The air is escaping from pleural space, and it may prevent from one-way valve mechanism because at the time of inhalation large amount of air enters in the pleural cavity and it may increase the pressure of the heart and lungs that occur as a result of respiratory compromise and sudden drop of blood pressure. If this condition is not treated properly that it becomes the cause of death. 

Catamenial pneumothorax

Here the term catamenial means menstruation. Catamenial pneumothorax is the condition of your lungs in which air may leak in the pleural cavity happening in conjunction during ovulation or with the menstruation that causes by endometriosis (endometrial tissues present outside the uterus) and it may leads with pain. 

What is the pathophysiology of Catamenial pneumothorax?

Catamenial pneumothorax affects women, and it is a rare condition. The women who experienced this type of pneumothorax have repeated episodes after the initiation of the menstrual cycle within 72hours in which tissues of endometrium becomes connected to the thorax and form the cyst that may release the blood and get enter in the pleural cavity that leads the lung collapse. The etiology of this pneumothorax is unknown.  

Sign and symptoms of pneumothorax:

Sign and symptoms of pneumothorax depend on its classified condition but the most common symptoms of pneumothorax include

  • Shortness of breath
  • Patient finding difficulty in breathing
  • Tightness of chest
  • Sharp and exacerbating pain that leads the tearing of chest
  • The rapid increase in heartbeat
  • Cough and fatigues
  • Cyanosis (skin turned in bluish due to an inadequate supply of oxygen in the blood).

What are the causes of pneumothorax?

Pneumothorax caused by several ways this cause are,

  1. Lung diseases- If the patient may have any lung diseases than they have chances to develop the pneumothorax because damaged tissues allow the air to leak in the pleural cavity, especially in Chronic Obstructive Pulmonary Diseases (COPD). 
  2. Chest injuries- Any wound or blunt collapsed or punctured your lungs. The damage occurs due to any mishap (such as broken of ribs, penetrating knife, gunshot). In contrast, some injuries introduce due to medical interventions (such as inset of a needle or Mechanical ventilator). Chest injuries become life-threatening to the patient due to a sudden drop in blood pressure.
  3. Ruptured of air blisters- The blebs (small blisters of air) may develop in the lungs, and sometimes these blisters are burst and may allow the air to get enter in pleural space and surroundings of your lungs that build the pressure and leads pneumothorax.  
  4. Mechanical Ventilator– Mechanical ventilator is the machine that provides the artificial breath to the patient for reducing the work of breathing, but sometimes it may cause a severe type of pneumothorax. But sometimes this machine builds uneven pressure on your chest that collapse your lungs completely or partially. 
  5. Menstruation- Pneumothorax caused by menstruation is rare, but in this case, cyst forms inside the chest that releases the blood in your lung and chest wall before or after the periods. 
  6. Smoking- Smoking is not the appropriate cause of pneumothorax. It is also rare, but if someone smokes a long period that may because collapsed of lungs within 1-2 years after smoking.

What are the differential diagnoses of Pneumothorax?

The differential diagnosis of pneumothorax is ruled out by the bilateral finding of sliding lungs. The absence of bilateral with the absence of lung sliding and lung pulse is marked as a presence of pneumothorax. The bilateral lung slidings are,

  • Abdominal compartement syndrome
  • Fibrosed diseases of lungs
  • Apnea 
  • Cardiopulmonary arrest
  • Unilateral loss- The loss of unilateral sliding show bronchus intubation of right mainstem due to any chest injury and current endotracheal intubation
  • Atelectasis- Sign of complete atelectasis is potent and due loss of sliding lung point is absent; the pulse of the lung is exposed with the elevation of the diaphragm.

Diagnosis of Pneumothorax:

The diagnosis of pneumothorax is based on the evidence of clinical examination, laboratory test, and the imaginary test,

Clinical examination:

The clinical examination of the patient with pneumothorax includes shortness of breath and sometimes absent of breath with hyper resonance percussion. Sometimes the hemodynamic stability is compromised and patients develop hypoxia but this is confirmed after performing the laboratory radiographic test.

Laboratory Test- 

  1. Arterial Blood Gases-It is necessary that your physician should perform ABGs because Arterial blood gases (ABGs) divulge the hypoxemia and the acute respiratory alkalosis. 
  2. Electrocardiogram (ECG)- ECG helps to diagnose left-sided pneumothorax because after performing the ECG, your physician observes the mimic changes in the QRS axis and precordial T-waves.
  3. UltraSound- To diagnosed the pneumothorax ultrasound was first introduced in 1986. Many studies suggested the bedside ultrasound rapidly diagnosed the pneumothorax. Ultrasound played a role in the diagnosis of pneumothorax. 
  4. Chest Radiograph- The patient with pneumothorax suggested a posterior-anterior chest radiograph, and it may consider a standard examination of the patient. In a chest radiograph, your physician finds the long shadow of visceral pleura with insufficiency of marking of lungs on the peripheral side that shows the collapse of lungs.
  5. Computed tomography (CT)- Computed tomography is the most reliable study to diagnose pneumothorax. CT helps to distinguish the large and small bulla, but it is not recommended in the majority of cases. CT also avoided in young patients because of its side effects. 

What is the treatment of pneumothorax?

The treatment of pneumothorax depends on the severity of the condition, size of pneumothorax, and its underlying cause it includes,

Observation of Patients: 

Initial management of the pneumothorax patient is to observe the sign and symptoms because if the size of pneumothorax is small, no symptoms are present but the sign of cardiac or respiratory problems may occur. Your doctor should plan a schedule for follow-up.

Supplemental of Oxygen: 

If the patient has a small size of pneumothorax, then they only need supplemental oxygen. It is beneficial to observe the patient during the providing of supplemental oxygen that the patient is stable or not. In addition, a chest X-ray also required at that time period.

Chest tube drainage: 

If the patients have a large size of pneumothorax, then they face difficulty in breathing. The small size of the plastic tube is placed in the pleural cavity to eliminate the amount of air. The deteriorate lungs re-inflate again as the pressure of the lung is reduced. Imaging techniques are used to evaluate the insertion of a chest tube.

Needle aspiration: 

The needle is also used for the management of pneumothorax that helps to aspirate the air from the chest cavity via suctioning.

Chemical Pleurodesis: 

In this procedure, an irritant chemical is introduced in the pleural cavity that attached outside of the lungs (to chest cavity) to prevent lung collapse. 

Open chest thoracotomy: 

An opening is made to enter the small-bore catheter for removing air in the pleural cavity. 

Mechanical pleurodesis: 

Mechanical pleurodesis is the same as the chemical pleurodesis. The minor difference is that this procedure is performed by the surgeon with the help of dry gauzes for rough the pleural membrane.

Video-Assisted Thoracoscopic Surgery (VATS): 

A procedure in which surgical instrument, thoracoscope (tiny fiber-optic camera) inserted after small incision. This camera helps the surgeon to display the lung’s cavity.

Before You Leave:

Pneumothorax is the term in which air is filled in the pleural cavity, and it is one of the most life-threatening conditions if it won’t treat properly. The severity of this disease depends on its classification and the size of the pneumothorax. Mostly the sign and symptom of these diseases is shortness of breath, cough, tightness of chest, but in some cases, there is no sign, and symptom appeared. At the primary stage, the diseases easily cure by the recommendation of medicine, but if it becomes severe, then your doctor suggested surgery. 

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