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Pneumothorax

Pneumothorax

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Published by Nader Smadi

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Published by: Nader Smadi on Feb 07, 2009
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03/10/2013

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Pneumothorax
Definition

A lung can collapse for many reasons: a growing tumor blocking a major airway, an
infection, even an inhaled foreign object. One type of lung collapse, known medically
as a pneumothorax, occurs when air leaks into the area between your lungs and chest
wall (pleural space). The pressure of the air against the lung causes it to give way,
often leading to mild to severe chest pain and shortness of breath. A pneumothorax
can be caused by a chest injury, certain medical treatments, lung disease or a break in
an air blister on the lung's surface.

A lung collapses in proportion to the amount of air that leaks into your chest cavity.
Although the entire lung can collapse, a partial collapse is much more common. A
small, uncomplicated pneumothorax may heal on its own in a week or two, but when
the pneumothorax is more severe, the excess air is usually removed by inserting a
tube or needle between your ribs into the pleural space.

If air continues to build up, the increasing pressure can push your heart and blood
vessels toward the uncollapsed lung, compressing both your lung and heart. Called a
tension pneumothorax, this condition is life-threatening and requires immediate
medical care.

Symptoms

If only a small amount of air enters the pleural space, you may have few signs or
symptoms, though even a minimally collapsed lung is likely to cause some chest pain.
When your lung has collapsed 25 percent or more, you're likely to experience:

\ue000
Sudden, sharp chest pain on the same side as the affected lung
\ue000
Shortness of breath, which may be more or less severe, depending on how
much of the lung is collapsed
\ue000
A feeling of tightness in your chest
\ue000
A rapid heart rate

Because a tension pneumothorax can compress the walls of your heart as well as the unaffected lung, heart function may be impaired, leading to a potentially fatal drop in blood pressure.

Causes
Collapsed and normal lung

Your two lungs are separated by your heart, airways and the major blood vessels in
the center of your chest (mediastinum). All these structures are enclosed by your chest
wall, a combination of ribs, cartilage and muscle.

Each lung is covered by a thin, moist tissue called the pleura, which also lines the chest wall. The two layers of pleura are like pieces of smooth satin that allow your lungs to expand and contract easily.

Your lungs and chest wall are both elastic, but as you inhale and exhale, your lungs
recoil inward while your chest wall expands outward. The two opposing forces create
a negative pressure in the pleural space between your rib cage and lung. When air
enters that space, either from inside or outside your lungs, the pressure it exerts can
cause all or part of the affected lung to collapse.

There are several types of pneumothorax, which are defined according to what causes
them:
\ue000
Primary spontaneous pneumothorax. This usually occurs in otherwise

healthy people with no history of chest trauma. It's most common in tall, thin
men \u2014 many of them smokers \u2014 between 20 and 40 years of age. Primary
spontaneous pneumothorax is thought to develop when a small air blister
(bleb) on the lung ruptures. Blebs are caused by a weakness in the lung tissue
and can rupture from changes in air pressure when you're scuba diving, flying,
mountain climbing or, according to some reports, listening to extremely loud
music.

Primary spontaneous pneumothorax can run in families, and researchers think
that genetic factors also may play a role. A primary spontaneous
pneumothorax is usually mild because pressure from the collapsed portion of
the lung in turn collapses the bleb.
\ue000
Secondary spontaneous pneumothorax. This develops in people who

already have a lung disorder, especially emphysema, which progressively
damages your lungs. Other conditions that can lead to secondary
pneumothorax include tuberculosis, pneumonia, cystic fibrosis and lung
cancer. In these cases, the pneumothorax occurs because the diseased lung
tissue is next to the pleura.

Although the signs and symptoms of primary and secondary spontaneous
pneumothorax are identical, secondary pneumothorax can be more severe and
even life-threatening because diseased tissue opens a wider hole and therefore
lets more air into the pleural space than does a small, ruptured bleb.

\ue000
Traumatic pneumothorax. Any blunt or penetrating injury to your chest can cause lung

collapse. Knife and gunshot wounds, a blow to the chest, even a deployed air bag can cause
a pneumothorax. So can injuries that inadvertently occur during certain medical
procedures such as the insertion of chest tubes, cardiopulmonary resuscitation (CPR) and
lung or liver biopsies. Pneumothorax is especially common in people whose breathing is
aided by a mechanical ventilator.

\ue000
Tension pneumothorax. The most serious type of pneumothorax, this occurs when the

pressure in the pleural space is greater than the atmospheric pressure, either because air
becomes trapped in the pleural space or because the entering air is from a positive-pressure
mechanical ventilator. The force of the air can cause the affected lung to collapse
completely. It can also push the heart toward the uncollapsed lung, compressing both it and
the heart. Tension pneumothorax comes on suddenly, progresses rapidly and is fatal if not
treated quickly.

Risk factors
\ue000
Your sex. In general, men are far more likely to have a pneumothorax than

women are, though women can develop a rare form of pneumothorax
(catamenial pneumothorax) related to the menstrual cycle. Catamenial
pneumothorax, which mainly affects women in their 20s and 30s, seems to
occur when endometrial tissue \u2014 the tissue that normally lines the uterus \u2014
spreads to the lungs, pleura or diaphragm.

\ue000
Smoking. This is the leading risk factor for primary spontaneous

pneumothorax; more than 90 percent of people with a primary pneumothorax are smokers or former smokers. The risk increases with the length of time and the number of cigarettes smoked.

\ue000
Lung disease. Having another lung disease, especially emphysema, makes a
collapsed lung more likely.
\ue000
A history of pneumothorax. If you've had one pneumothorax, you're at

increased risk of another, usually within one to two years of the first episode.
This is especially true if the first pneumothorax was small and healed on its
own.

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