PNEUMOTHORAX

DEFINITION

Pneumothorax (pronounced noo-moh-thor-ax) is a condition in which air or some other gas collects in the chest or the pleural space. The pleural space is the space that surrounds the lungs. When a gas collects in the pleural space, it can cause part or all of a lung to collapse. For that reason, pneumothorax is also called collapsed lung.

DESCRIPTION

Normally, pressure inside the lungs is greater than pressure in the pleural space. This difference in pressure allows the lungs to stay filled with air. But air or some other gas can get into the pleural space. When it does so, the normal condition is reversed. Pressure in the pleural space becomes greater than pressure in the lungs. This extra pressure on the lungs can cause them to collapse partially or completely.

CAUSES

Sometimes pneumothorax occurs for no known reason. In such a case, the process is called spontaneous pneumothorax. This condition occurs most commonly among tall, thin men between the ages of twenty and forty. People with lung disorders are also subject to spontaneous pneumothorax. Emphysema (see emphysema entry), cystic fibrosis (see cystic fibrosis entry), and tuberculosis (see tuberculosis entry) are examples of such lung disorders.

Pneumothorax can also occur as the result of an accident or injury to the chest cavity. This type of pneumothorax is called traumatic pneumothorax. Certain kinds of medical procedures can cause traumatic pneumothorax. An example is the procedure known as thoracentesis (pronounced thoruh-sen-tee-sis). In thoracentesis, a large needle is inserted into the chest wall to remove fluids. Sometimes air accidentally enters the chest during this procedure. If so, traumatic pneumothorax can result.

The most serious type of pneumothorax is tension pneumothorax. Tension pneumothorax can be caused by injuries, such as a fractured rib, or by lung disease, such as asthma (see asthma entry), chronic bronchitis (see bronchitis entry), or emphysema. In this form of pneumothorax, a large amount of air gets into the chest cavity and cannot escape. It can cause the lung to collapse quickly. It can also push on the heart and its blood vessels. Without immediate treatment, tension pneumothorax can result in death.

SYMPTOMS

The symptoms of pneumothorax depend on a number of factors. These include the amount of air that enters the chest, the extent to which the lung collapses, and the presence of any kind of lung disease.

Spontaneous pneumothorax can be classified as simple or complex. Simple spontaneous pneumothorax usually occurs with people who are otherwise healthy. It is caused by certain types of activity, such as scuba diving or flying at high altitudes. Complex spontaneous pneumothorax occurs with people who have lung disease. The symptoms of complex spontaneous pneumothorax are more serious than those of simple spontaneous pneumothorax.

The most common symptom of spontaneous pneumothorax is a chest pain that can be dull, sharp, or stabbing. The pain starts suddenly and becomes worse with coughing or deep breathing. Other symptoms include shortness of breath, rapid breathing, and a cough.

Traumatic pneumothorax occurs as a result of medical procedures or of injuries. For example, a stab wound allows air to enter the chest cavity. The air may have no way of escaping from the chest. The wound can result in a collapsed lung. The symptoms of traumatic pneumothorax are similar to those of spontaneous pneumothorax, but they are more severe.

The symptoms of tension pneumothorax tend to be severe with sudden onset (beginning). They include anxiety, swollen neck veins, weak pulse, and decreased breathing sounds from the lung.

Chest X ray showing a collapsed right lung (the left side of the image). (© 1990. Reproduced by permission of

Custom Medical Stock Photo

.)

DIAGNOSIS

Pneumothorax is diagnosed by listening to the patient's chest. With a stethoscope, a doctor can tell whether the normal sounds of breathing can be heard in the chest. A chest X ray is often taken to follow up on an initial diagnosis. The chest X ray will show pockets of air and a collapsed lung. An electrocardiogram (ECG; pronounced ih-LEK-tro-KAR-dee-o-gram) can also be taken. The ECG will tell whether the heart is functioning normally. Finally, blood tests can be used to diagnose pneumothorax. They will show the level of gases dissolved in the blood.

TREATMENT

Simple pneumothorax usually gets better on its own, but more complex cases require medical treatment. The object of the treatment is to remove air from the chest or pleural cavity. When the air is gone, the lung can expand to its normal size.

Removal of air is done by inserting a needle into the chest wall. Air is removed through the needle and not allowed to get back in. The lung returns to its normal size on its own within a few days. A person who experiences pneumothorax more than once may require surgery.

PROGNOSIS

Most people recover fully from spontaneous pneumothorax. About half of these people experience spontaneous pneumothorax a second time. Recovery from a collapsed lung generally takes one to two weeks. The prognosis for tension pneumothorax is not as good. In this condition, the patient's heart may fail, causing death in a short period of time. Tension pneumothorax must be treated as a medical emergency.

PREVENTION

Preventative measures for noninjury related pneumothorax include not smoking and having respiratory problems treated whenever they occur. Sometimes pneumothorax occurs in both lungs, or in one lung more than once. In such cases, surgery may be needed to prevent it from occurring again.

FOR MORE INFORMATION

Organizations

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. (972) 243–2272. http://www.aarc.org.

American lung Association. 1740 Broadway, New York, NY 10019. (800) LUNG–USA. http://www.lungusa.org.

Web sites

"Collapsed Lung: Non-Injury Related." InteliHealth. [Online] http://www.intelihealth.com (accessed on October 28, 1999).

"Pneumothorax." http://www.thriveonline.com/health/Library/sports/sport52.html (accessed on October 25, 1999).

"Spontaneous Pneumothorax." Healthanswers. [Online] http://www.healthanswers.com (accessed on October 28, 1999).