A Simple Guide to Pneumothorax

A Simple Guide to Pneumothorax
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What is Pneumothorax?
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Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.

What are the types of pneumothorax?
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Tension pneumothorax:
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This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.

Non-tension pneumothorax:
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A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.

Hemopneumothorax:
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When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.

What is the causes of pneumothorax?
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It is most commonly due to:

Spontaneous pneumothorax
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This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:

1.tall young males and in Marfan syndrome

2.Tuberculosis

3.Bronchial obstruction

4.Cancer

Non-spontaneous pneumothorax
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1.penetrating chest wound

2.surgical trauma

3.pleural effusion tap

What are the Signs and symptoms of Pneumothorax?
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Symptoms:
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1.Sudden onset of chest pain, back

2.shortness of breath,

3.dry coughs,

4.cyanosis (turning blue)

5.coma

Signs:
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1.Pale or cyanotic

2.Percussion show resonance at normal lung while none at the pneumothorax lung area

3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung

4.There may be a characteristic clicking sound with respiration.

5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .

6.The flopping sound of the punctured lung can sometimes be heard

How is the Diagnosis of Pneumothorax made?
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Physical examination:
a. absence of audible breath sounds through a stethoscope

b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.

c.Two coins when tapped on the affected side results in a tinkling resonant sound

Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.

Medistinal shifts can be seen on inspiratory and expiratory films

CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.

What is the complication of Pneumothorax?
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Respiratory failure with circulatory collapse

What is the treatment of Pneumothorax?
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All pneumothorax patients are to be admitted to hospital for treatment.

1. Small spontaneous pneumothorax
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A small spontaneous pneumothorax can be left alone to reabsorb on its own.

The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.

2.Tension Pneumothorax
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Tension Pneumothorax is a medical emergency.

Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.

Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.

The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.

The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays

Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.


Penetrating wounds:
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A chest drain is inserted first before any treatment of the wounds is done.

Supprtive treatment:
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Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain


Recurrent pneumothorax
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1.pleurodesis may be required in recurrent pneumothorax.

2.bullectomy (the removal or stapling of bullae).

3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.

4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues

5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery

What is the prognosis of Pneumothorax?
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It is usually good following treatment.

However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.