PNEUMOTHORAX

Overview
• A pneumothorax (noo-
moe-THOR-aks) is a
collapsed lung. A
pneumothorax occurs
when air leaks into the
space between your lung
and chest wall. This air
pushes on the outside of
your lung and makes it
collapse. Pneumothorax
can be a complete lung
collapse or a collapse of
only a portion of the lung.
 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.
• Examples of injuries that can cause a traumatic pneumothorax include:
-trauma to the chest from a motor vehicle accident
-broken ribs
-a hard hit to the chest from a contact sport, such as from a football tackle
-a stab wound or bullet wound to the chest
-medical procedures that can damage the lung, such as a central line
placement, ventilator use, lung biopsies, or CPR
-Changes in air pressure from scuba diving or mountain climbing can also
cause a traumatic pneumothorax. The change in altitude can result in air
blisters developing on your lungs and then rupturing, leading to the lung
collapsing.
 Nontraumatic pneumothorax

• This type of pneumothorax doesn’t occur after injury.

Instead, it happens spontaneously, which is why it’s
also referred to as spontaneous pneumothorax.
• There are two major types of spontaneous
pneumothorax: primary and secondary. Primary
spontaneous pneumothorax (PSP) occurs in people
who have no known lung disease, often affecting
young males who are tall and thin. Secondary
spontaneous pneumothorax (SSP) tends to occur in
older people with known lung problems.
 Nontraumatic pneumothorax
• Some conditions that increase your risk of SSP
include:
• COPD, such as emphysema or chronic bronchitis
• acute or chronic infection, such
as tuberculosis or pneuomonia.
• Lung cancer
• Cystic fibrosis, a genetic lung disease that causes
mucus to build up in the lungs
• Asthma, a chronic obstructive airway disease that
causes inflammation
 Symptoms
• The symptoms of a traumatic pneumothorax often appear at the
time of chest trauma or injury, or shortly afterward. The onset of
symptoms for a spontaneous pneumothorax normally occurs at
rest. A sudden attack of chest pain is often the first symptom.

• Other symptoms may include:

• a steady ache in the chest
• shortness of breath, or dyspnea
• breaking out in a cold sweat
• tightness in the chest
• turning blue, or cyanosis
• severe tachycardia, or a fast heart rate
 Risk factors
Risk factors for a traumatic pneumothorax include:

• playing hard contact sports, such as football or

hockey
• performing stunts that may cause damage to the
chest
• having a history of violent fighting
• having a recent car accident or fall from a height
• recent medical procedure or ongoing assisted
respiratory care.
 Risk factors
The people at highest risk for a PSP are those who are:
• young
• thin
• male
• between the ages of 10 and 30
• affected by congenital disorders like Marfans Syndrome
• smokers
• exposed to environmental or occupational factors, such as silicosis
• exposed to changes in atmospheric pressure and severe weather
changes
• The main risk factor for SSP is having previously been diagnosed
with a lung disease. It’s more common in people over 40.
 Diagnosis
Diagnosis is based on the presence of air in the space
around the lungs. A stethoscope may pick up changes in
lungs sounds, but detecting a small pneumothorax can be
difficult. Some imaging tests may be hard to interpret due
to the air’s position between the chest wall and lung.

• Imaging tests commonly used to diagnose

pneumothorax include:
• an upright posteroanterior chest radiograph
• a CT SCAN
• a thoracic ultrasound
 TREATMENT
• Draining excess air
-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.
-Needle aspiration may be less uncomfortable than
placement of a chest tube, but it’s also more likely to
need to be repeated.
-For a chest tube insertion, your doctor will insert a
hollowed tube between your ribs. This allows air to drain
and the lung to reinflate. The chest tube may remain in
place for several days if a large pneumothorax exists.
 TREATMENT
• Pleurodesis
Pleurodesis is a more invasive form of treatment for a
pneumothorax. This procedure is commonly
recommended for individuals who’ve had repeated
episodes of pneumothorax.
During pleurodesis, your doctor irritates the pleural space
so that air and fluid can no longer accumulate. The term
“pleura” refers to the membrane surrounding each lung.
Pleurodesis is performed to make your lungs’ membranes
stick to the chest cavity. Once the pleura adheres to the
chest wall, the pleural space no longer expands, and this
prevents formation of a future pneumothorax.
 TREATMENT
• There are several types of surgery for pneumothorax. One
option is a thoractomy. During this surgery, your surgeon
will create an incision in the pleural space to help them see
the problem. Once your surgeon has performed a
thoracotomy, they’ll decide what must be done to help you
heal.
• Another option is thoracoscopy, also known as video-
assisted thoracoscopic surgery (VATS). Your surgeon inserts
a tiny camera through your chest wall to help them see
inside your chest. A thoracoscopy can help your surgeon
decide on the treatment for your pneumothorax. The
possibilities include sewing blisters closed, closing air leaks,
or removing the collapsed portion of your lung, which is
called a lobectomy.