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Pneumothorax

Pneumothorax

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Published by: roanna joyce on Apr 12, 2010
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05/21/2012

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Pneumothorax
is amedical condition and potentialemergencywherein air or gas is present in thepleural cavity(chest). It may occur spontaneously both in people with chronic lung conditions andthose with no other health problems, but many pneumothoraces occur after physical traumato thechest, blast injury,or as a complication of medical treatment. In the past, creating a pneumothorax was used as a treatment for various lung disorders, such astuberculosis; this has now been abandoned.The symptoms of a pneumothorax are determined by the size of the air leak and the speed by which itoccurs; they may includechest pain andshortness of breath in most cases, andfainting and rarelycardiac arrest in severe cases ("tension pneumothorax"). The diagnosis can be made by physical examinationin severe cases but usually requires achest X-rayin milder forms. Small pneumothoraces typically resolve by themselves and require no treatment. In larger pneumothoraces or when there are severe symptoms, the air may be aspirated with a syringe, or a one-way chest tubeis inserted to allow the air to escape. Occasionally, surgical measures are required, especially if tube drainage is unsuccessful.
Signs and symptoms
Pneumothorax presents mainly as a suddenshortness of breath,dry coughs, cyanosis (turning blue) and pain felt in the chest, back and/or arms. In penetrating chest wounds, the sound of air flowing through thepuncture hole may indicate pneumothorax, hence the term "sucking" chest wound. The flopping sound of a punctured lung is also occasionally heard.Subcutaneous emphysemais another symptom.If untreated,hypoxiamay lead tohypercapnia, respiratory acidosis, andloss of consciousness.In a tension pneumothorax,shifting of themediastinumaway from the site of the injury can obstruct thesuperior andinferior vena cavaresulting in reduced venous return. This in turn decreases cardiacpreload andcardiac output. Spontaneous pneumothorax has been reported in young people with a marfanoid habitus. The reason for  this association, while unknown, is hypothesized to be the presence of subtle abnormalities inconnectivetissue, though not necessarily inelastinper se. Most spontaneous pneumothorax result from "blebs", expanded alveoli just under the superficial surface of the lung, that rupture allowing the escape of air intothe pleural cavity.Pneumothorax can also occur as part of medical procedures, such as the insertion of acentral venouscatheter into the subclavian vein. Other causes includemechanical ventilation, endotracheal intubation, laparoscopic surgery,emphysema and less commonly other lung diseases bacterial or viral(pneumonia), metastatic tumors especially sarcomas, lymphangioleiomyomatosis, eosinophilic granuloma, cystic
 
fibrosis, alpha1-antitrypsin deficiency, spontaneous or traumatic esophageal rupture, Pneumocystis cariniipneumonia, lung abscess, and asthma
.
Cause
 
CT scan of the chest showing a pneumothorax on the patient's left side (right side on the image). A chest tube is in place (small black mark on the right side of the image), the air-filledpleural cavity (black) and ribs(white) can be seen. Theheart can be seen in the center.
It most commonly arises:
Spontaneously(more commonly in tall slim young males and in Marfan syndrome)
Following a penetrating chest wound
Followingbarotrauma to the lungs
It may also be due to:
Chronic infections, such astuberculosis
Lung damage caused bycystic fibrosis
Rare diseases that are unique to women such as Catamenial pneumothorax(due toendometriosis in the chest cavity) andlymphangioleiomyomatosis (LAM). Pneumothoraces are divided into tension and non-tension pneumathoraces. Atension pneumothoraxisa medical emergencyas air accumulates in the pleural space with each breath. The increase in intrathoracic pressureresults in massive shifts of themediastinum away from the affected lung
 
compressing intrathoracic vessels. A non-tension pneumothorax by contrast is of lesser concern because there is no ongoing accumulation of air and hence no increasing pressure on the organs within the chest.The accumulation of blood in thethoracic cavity(hemothorax) exacerbates the problem, creating a hemopneumothorax.
 
]
Spontaneous pneumothorax
Spontaneous Pneumothorax can be classified as primary spontaneous pneumothorax and secondaryspontaneous pneumothorax. In primary spontaneous pneumothorax, it is usually characterized by arupture of ablebin the lung while secondary spontaneous pneumothorax mostly occurs due tochronic obstructive pulmonary disease (COPD).
Primary
A primary spontaneous pneumothorax may occur without either trauma to the chest or any kind of blastinjury. This type of pneumothorax is caused when a bleb (an imperfection in the lining of the lung) burstscausing the lung to deflate. The lung is reinflated by the surgical insertion of achest tube.A minority of  patients will suffer a second instance. In this case, thoracic surgeons oftenrecommend thorascopic pleurodesisto improve the contact between the lung and thepleura.If multiple and/or bilateral occurrences continue, surgeons may opt for a far moreinvasivebullectomyandpleurectomy to permanently adhere the lung to the interior of the rib cage with scar tissue, making collapse of that lung physically impossible. Primary spontaneous pneumothorax ismost common in tall, thin men between 17 and 40 years of age, without any history of lung disease.Though less common, it also occurs in women, usually of the same age and body type. The tendency for primary spontaneous pneumothorax sufferers to be tall and thin is not due to weight, diet or lifestyle, butbecause the genetic predisposition toward those traits often coincides with a genetic predispositiontoward high volume lungs with large, burstable blebs. A small portion of primary spontaneouspneumothoraxes occur in persons outside the typical range of age and body type.
Secondary

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