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Pneumothorax

Definition

Pneumothorax is a condition in which air collects in the space between the lungs and the chest wall. This air pocket puts pressure on the lung and can collapse a portion of the lung.

Causes

The chest cavity is normally a sealed chamber. Air can leak into the chamber through damaged lung tissue, chest wall, or the diaphragm, a muscles that separates the abdominal and chest cavity. The air can eventually become large enough to collapse a section of lung.
Pneumothorax may be named according to its cause, for example:
Rib Fractures With Pneumothorax
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Risk Factors

Primary spontaneous pneumothorax is more common in young men, generally from teenagers up to the age of 30. Other factors that may increase your chance of primary spontaneous pneumothorax include smoking or having a genetic abnormality.
Weakened lung tissue increases your risk of secondary spontaneous pneumothorax. Condition that can cause having weak lung tissue include:
Factors that may increase your chance of tension pneumothorax include:

Symptoms

Pneumothorax may cause:
Contact your doctor if you are having these symptoms.
If you have lung disease be aware of the symptoms associated with pneumothorax. Get help as soon as symptoms arise.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to hear reduced or absent breath sounds on the affected side. The level of oxygen in your blood may be monitored with pulse oximetry.
Your doctor will also need images of your chest cavity, including your heart and lung. Images may be taken with:

Treatment

A small pneumothorax may resolve on its own or with oxygen therapy and observation. A larger pneumothorax and tension pneumothorax always require treatment. Treatment focuses on removing the air from the space so the lung can again expand to its full capacity.
You may also need treatment for health conditions that are causing the pneumothorax.

Removing Air

A needle may be inserted into the affected area. The excess air can be pulled out of the chest cavity through the needle.
Sometimes a chest tube will be placed in the chest. This tube will allow air to drain until it can be confirmed that the lung has fully expanded. It may take several days for this to occur.

Surgery

Surgery may be necessary for persistent air leaks or to prevent recurrence of some pneumothorax. Surgery may include:
  • Removal of weak spots in the lungs that are allowing air to leak out of the lungs
  • Closing the space between the lung and chest wall—called pleural abrasion or pleurodesis
  • Removing part or all of the lining that adheres to the chest wall—pleurectomy
  • Removing any lung lesions
Follow-up is an important part of any pneumthorax treatment plan. More than half of people with a pneumothorax have a recurrence.
Follow-up is an important part of any pneumthorax treatment plan. More than half of people with a pneumothorax have a recurrence.

Prevention

Prevention will depend on the cause. For healthier lungs, if you smoke, talk with your doctor about how you can quit.
Other steps to reduce your risk include:

RESOURCES

American College of Chest Physicians http://www.chestnet.org

American Thoracic Society http://thoracic.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

The Canadian Lung Association http://www.lung.ca

References

Baumann MH. Management of spontaneous pneumothorax. Clin Chest Med. 2006; 27:369-81.

Catamenial Pnuemothorax. National Organization for Rare Disorders website. Available at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1227/printFullReport. Updated February 14 2012. Accessed November 25, 2013.

Currie GP, Alluri R, Christie GL, Legge JS: Pneumothorax: an update. Postgrad Med J. 2007;83:461-5.

Explore pleurisy and other pleural disorders. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pleurisy . Updated September 21, 2011. Accessed August 28, 2013.

Leigh-Smith S, Harris T. Tension pneumothorax-time for a re-think? Emerg Med J. 2005;22: 8-16.

Sahn S, Hefner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342:868-73.

Spontaneous pneumothorax in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated June 28, 2013. Accessed August 28, 2013.

Tension pneumothorax. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated December 8, 2012. Accessed August 28, 2013.

Tschopp JM, Rami-Porta R, Noppen M, Astoul P: Management of spontaneous pneumothroax: state of the art. Eur Respir J. 2006;28:637-50.

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