What is pneumothorax?

Pneumothorax is the medical term for a collapsed lung that occurs when the air is present in the space between the lungs, which is known as the pleural space. This causes loss of lung volume as the pressure that keeps the lungs inflated is disrupted. The air can come from the lung or from outside of the body if there has been a serious injury to the chest. It is more common in people with a lung condition such as asthma or cystic fibrosis but it can occur in anyone.

There are two basic types of condition: traumatic pneumothorax and non-traumatic pneumothorax. The first is a result of an injury that has happened to the chest or the lung wall, which could occur after a motor vehicle accident, from broken ribs or after a hard hit to the chest playing contact sports. Non-traumatic pneumothorax happens spontaneously and primary spontaneous pneumothorax occurs in people who have no known lung disease. Secondary spontaneous pneumothorax is more likely to appear in older people with known lung problems.

What are the symptoms?

The main symptoms of pneumothorax are:

  • Shortness of breath
  • Tightness and an ache in the chest
  • Severe tachycardia (a fast heart rate)
  • Change in skin colour to blue due to lack of oxygen.

Who is most at risk of pneumothorax?

The people at highest risk for primary spontaneous pneumothorax include those who are:

  • Thin
  • Young
  • Male
  • Between ages 10-30
  • Smokers
  • Present a congenital disorder such as Marfan’s syndrome

What are the causes of pneumothorax?

A pneumothorax can be caused by:

  • Chest injury – from impact, a car accident, a medical procedure, or a wound from a firearm or knife.
  • Lung disease – damaged lung tissue may collapse and there may be conditions such as asthma, pneumonia or cystic fibrosis.
  • Ruptured air blisters – these small blisters can develop on top of the lung and sometimes burst, which causes air to leak into the surrounding space.
  • Mechanical ventilation – this can occur in some people who need mechanical assistance to breathe.

How is pneumothorax diagnosed?

A stethoscope can pick up changes in lung sounds but pneumothorax can be difficult to detect. Imaging tests, such as a thoracic ultrasound, a CT scan or a posteroanterior chest radiograph may be used to diagnose pneumothorax.

How is pneumothorax treated?

The treatment of pneumothorax depends on the individual person and the severity of their condition. Observation is recommended for those with small pneumothorax and the doctor will monitor the patient on a regular basis. There will be frequent X-rays to check if the lungs expand again. Depending on the amount of air present and the degree of compression exerted on the lung, rest will be prescribed or a chest tube between the ribs will be placed to allow air evacuation. This drainage can last several days and its control in a medical centre is necessary.

In cases of recurrent pneumothorax, surgery is required. There are several types of surgery for the condition. One is thoracotomy, where the surgeon creates an incision in the pleural space to see the problem. Another is thoracoscopy with which the surgeon inserts a small camera through the chest wall to be able to see inside. The possibilities of treatment include sewing blisters closed, closing air leaks or removing the collapsed part of the lung (lobectomy).

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