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Pneumothorax

Pronounced: Noom-oh-THOR-ax

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:

  • Primary spontaneous pneumothorax—no known cause, but genetics may play a role.
  • Secondary spontaneous pneumothorax—caused by air leaks from damaged lung tissue. Tissue is often weakened from lung disease or injury.
  • Tension pneumothorax—caused by trauma to the lungs and/or chest cavity (ribs and muscles). This is the most serious type because it may affect the heart's ability to pump blood.
  • Catamenial pneumothorax (women only)—caused by small holes in the diaphragm muscle. Occurs within 72 hours of start or end of menstrual cycle and most often associated with endometriosis.

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:

  • Penetrating or blunt force trauma to the chest
  • Having a medical or surgical procedure
  • Mechanical ventilation
Symptoms

Pneumothorax may cause:

  • Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
  • Acute shortness of breath
  • Cough
  • Mild fever
  • Fatigue
  • Tightness in the chest
  • Rapid heartbeat
  • Bluish color of the skin due to a lack of oxygen
  • Flaring of the nostrils
  • Feelings of anxiety , stress, and tension

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.

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:

  • Wear a seatbelt when in a motor vehicle to help prevent accident-related chest trauma.
  • If you have a history of pneumothorax, it is often recommended that you avoid scuba diving.

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.



Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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