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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, the chest wall, or the diaphragm (a muscle 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 or how it acts, for example:
Rib Fractures With Pneumothorax
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Risk Factors

Primary spontaneous pneumothorax is more common in tall, thin 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. Conditions that can cause weak lung tissue include:
Factors that may increase your chance of tension pneumothorax include:

Symptoms

Pneumothorax may cause:
If you have lung disease, be aware of the symptoms associated with pneumothorax. Get help as soon as symptoms arise.

Diagnosis

You will be asked 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.
Images of your chest cavity, including your heart and lungs, will need to be taken. This can be done with:

Treatment

A small pneumothorax may resolve on its own or with oxygen therapy and observation. A larger pneumothorax and tension pneumothorax always requires 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 pneumothorax treatment plan. More than half of people with a pneumothorax have a recurrence.
Follow-up is an important part of any pneumothorax treatment plan. More than half of people with a pneumothorax have a recurrence.

Prevention

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

RESOURCES

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

American Thoracic Society http://thoracic.org

CANADIAN RESOURCES

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

Health Canada http://www.hc-sc.gc.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 August 7, 2015.

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 September 17, 2015.

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 children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 12, 2014. Accessed August 7, 2015.

Spontaneous pneumothorax in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 23, 2015. Accessed August 7, 2015.

Tension pneumothorax. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 12, 2015. Accessed August 7, 2015.

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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