Pneumothorax refers to collapsed lungs that appear when the air pushes out between the lungs and chest wall spaces. This leakage of air from the lungs makes it collapse. It is a particular portion of a lung or a complete collapse of the lungs. It can result from a chest injury, specific other medical procedures, or destruction from underlying lung disease. A collapsed lungs need immediate medical care.
Types of collapsed lungs
There are five types of collapsed lungs; including;
- Primary spontaneous pneumothorax. It can appear due to the abnormal build-up of air sacs that break and release air in the lungs.
- Secondary spontaneous pneumothorax. It appears due to lung diseases such as chronic obstructive pulmonary disease (COPD), emphysema, and cystic fibrosis.
- Injury-related pneumothorax. Some people experience due to a brutal hit to the chest, gunshot wound, or fractured ribs.
- Latrogenic pneumothorax. Some medical procedures, such as central venous line insertion or lung biopsy.
- Catamenial pneumothorax. It is a rare condition in women who have endometriosis. Endometrial tissue can grow more outside the uterus and attach to the internal area of the chest. Then endometrial tissues create cysts and bleed into the pleural spaces of the lungs.
Symptoms of Pneumothorax
Symptoms depend on the lungs condition, but some are the following;
- Frequent chest pain
- Shortness of breath
- Bluish skin due to lack of oxygen
- Fatigue
- Rapid breathing
- Rapid heartbeat
- A dry, chopping cough
Causes of pneumothorax
Pneumothorax is caused due to following;
- Chest injury: Any penetrating or blunt injury to the lungs can cause the lungs to collapse. Some injuries happen due to a physical hit or car crash, while others occur accidentally during medical procedures such as needle insertion in the chest.
- Lung diseases: Damage to lung tissues can cause the lungs to collapse. Lung damage can be caused by many underlying diseases such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), pneumonia, or lung cancer. Cystic diseases are Birt-Hogg syndrome and lymphangioleiomyomatosis, making round and thin walls of sacs in the lungs tissues that can rupture and cause pneumothorax.
- Ruptured or destroyed air blisters: A small obstruction of air blisters or blebs can develop or originate on the top of the lungs. These air blebs can burst sometimes, and air leaks into the spaces encircling the lungs.
- Mechanical ventilation: A severe pneumothorax can happen in people who need mechanical support to breathe. The ventilator can create a gap or imbalance of air pressure within the lungs. So that’s why lungs can collapse completely.
Risk factors:
Men have more chances of having pneumothorax than women. It can cause by a ruptured air blister that is more likely to appear in age between 20 and 40 years. It occurs mainly in a person who is tall and underweight.
Mechanical ventilation or underlying lung diseases can cause risk factors. Other risk factors are;
- Genetics: Certain pneumothorax runs in families.
- Smoking: Without emphysema, the risk of pneumothorax increases with the period and the number of smoked cigarettes.
- Previous pneumothorax: A person who has a prior record of pneumothorax is at increased risk of re-occurring.
Complications:
Potential complications of pneumothorax can vary or differ depending on the severity and size of the pneumothorax. Sometimes air leaks continually if the opening of the lungs won’t close, or pneumothorax can re-occur. Following complications can occur;
- Infection caused by treatment
- Re-expansion pulmonary edema occurred when lungs filled with extra fluid
- Inability to breathe
- Heart failure
- Death
Prevention:
If you have some medical conditions/problems or a family history of pneumothorax, then you may not be able to prevent pneumothorax. The following steps may reduce the chances of getting pneumothorax;
- Quit smoking
- Avoid activities that put pressure on your lungs. Follow your health care provider’s recommendations before doing these activities.
- Go to your health care provider for regular monitoring.
Diagnosis:
A pneumothorax can be diagnosed by chest X-rays, ultrasounds, and computerized tomography scan (CT scan); these all provide detail of pneumothorax.
Treatment of Pneumothorax
The treatment goal is to alleviate the air pressure on the lungs and allow it to re-expand. The treatment objectives depend on the cause of pneumothorax; the second goal may be to prevent the re-occurrence of pneumothorax. The methods for achieving these above-mentioned goals depend on the severity of the pneumothorax or lungs collapse and sometimes on overall health. Treatment options are;
- Observation
- Needle aspiration
- Chest tube insertion
- Nonsurgical repair
- Surgery
- Supplemental oxygen therapy for speedy lungs expansion
These treatments, as mentioned above, may be suitable for curing pneumothorax.
- Observation: Observation is an initial treatment for small and closed primary spontaneous pneumothorax in stable patients without shortness of breath at rest. Patients with large PSP can be treated through observation along. A hospital stay can be increased to 48 hours during high risk of pneumothorax progression. Observation is a sensible and functionally best initial or primary option for the management of pneumothorax, especially for ICU patients. You cannot use observation for secondary spontaneous pneumothorax patients. Observation is only reliable for the PSP patients where a minor pneumothorax attack occurs or a small issue.
- Needle aspiration or chest tube insertion: If a large area of the lung collapses, then a needle or chest tube is used to remove the extra or excess air from the lungs.
- Needle aspiration: An empty needle with a small flexible catheter is inserted between the ribs in which air is filled in spaces that are pressing on the collapsed lung. Then doctors detach the needle, attach the syringe to the catheter, and pull out the excess air from air-filled areas. The catheter may be left for a few hours in the lungs, which will help to ensure the lungs are re-expanded, and pneumothorax doesn’t occur again.
- Chest tube insertion: A flexible or elastic chest tube is inserted into the air-filled spaces, which may be attached to a one-way valve device that constantly removes excess air from the chest cavity until the lungs are re-expands and healed.
- Pain management: In most cases of SP patients, you can resolve common symptoms like spontaneous chest pain on the first day. Appropriate management with opiate therapy can reduce pain and breathlessness in all respects. There is no data report on the adverse analgesic effect on respiratory depression.
- Nonsurgical repair: If a chest tube doesn’t work well, then nonsurgical treatment options are used to close the air leakage from the lungs, including;
- Using a substance that seals the irritated tissues around the lungs so that they will stick together and seal any leakage. But it may be done by surgery through the chest tube.
- Pulling out the blood from the arm and placing it into the chest tube. The blood makes a fibrinous path on the lungs that seals the air leaks.
- Delivering a thin tube down via your throat into the lungs to check the lungs and air passages and place a one-way valve. The valve heals the air leaks and allows the lungs to re-expand.
- Surgery: Sometimes, surgery becomes necessary to close the air leaks. In many cases, small incisions can be used to perform surgery through a mini fiber-optic camera and narrow long-handle surgical tools. The surgeons will look at the air leakage area or ruptured blisters and seal them off. In rare cases, surgeons will make a large incision between the ribs for better access to the air leaks.
- Ongoing care: After pneumothorax heals, you need to avoid certain activities that pressure your lungs, such as; playing with wind instruments, flying, or swimming underwater (scuba diving). Talk to your health care provider about activity restrictions. Moreover, you must be in close contact with the doctor to monitor healing.