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the chest wall. It may occur spontaneously in people without chronic lung conditions ("primary") as well as in those with lung disease ("secondary"), and many pneumothoraces  occur after physical trauma to the chest, blast injury, or as a complication of medical treatment. A
pneumothorax is a collection of free air in the chest outside the lung that causes the lung to collapse.
What are the types of pneumothorax?
A spontaneous pneumothorax, also referred to as a primary pneumothorax, occurs in the absence of a traumatic injury to the chest or a known lung disease. A secondary (also termed complicated) pneumothorax occurs as a result of an underlying condition.
The major types of pneumothorax are:
Open pneumothorax results when a penetrating chest wound enables air to rush in and cause the lungs to collapse. Closed pneumothorax results when the chest wall is punctured or air leaks from a ruptured bronchus (or a perforated esophagus) and eventually ruptures into the pleural space. Spontaneous pneumothorax occurs in a previously healthy individual with no prior trauma. This is thought to be due to rupture of a bleb (a blister containing air) on the surface of the lung. This spontaneous pneumothorax is most frequent in people under the age of 40. Pulmonary barotrauma occurs when a patient whose lung function is being maintained mechanically may have air forced into the lungs, which may rupture the pleural space. Other things can cause pneumothorax. Air can enter the mediastinum (the space in the center of the chest between the lungs), especially during an asthmatic attack, and then rupture into the pleural space, causing a pneumothorax. When a lung biopsy specimen is taken at the time of bronchoscopy or during thoracentesis (removal of fluid from the pleural space), the pleura lining the lung may be penetrated, causing a leak of air which may then cause a pneumothorax.
What causes a pneumothorax?
Spontaneous pneumothorax is caused by a rupture of a cyst or a small sac (bleb) on the surface of the lung. Pneumothorax may also occur following an injury to the chest wall such as a fractured rib, any penetrating injury (gun shot or stabbing), surgical invasion of the chest, or may be deliberately induced in order to collapse the lung. A pneumothorax can also develop as a result of underlying lung diseases, including cystic fibrosis,chronic obstructive pulmonary disease (COPD), lung cancer, asthma, and infections of the lungs.
What are the signs and symptoms of pneumothorax?
Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is sharp and may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue are other
ideally with a dressing called the Asherman seal.  A small pneumothorax without underlying lung disease may resolve on its own in one to two weeks. In some cases. this situation is termed tension pneumothorax. Treatment is determined by the severity of symptoms and indicators of acute illness. they may include chest painin most cases and shortness of breath in many. and may require chest surgery to repair the hole in the lung. fluid accumulation in the lung. as it carries a high risk of leading to tension pneumothorax. In a small proportion. the presence of underlying lung disease. The diagnosis can be made by physical examination in severe cases but usually requires achest Xray or computed tomography (CT scan) in milder forms. In traumatic pneumothorax. . Any open chest wound is covered. air travel is discouraged until it has completely resolved. and can be performed by an emergency medical technician or other trained professional. which appears to be more effective than standard "three-sided" dressing. How is pneumothorax diagnosed? Examination of the chest with a stethoscope reveals decreased or absent breath sounds over the affected lung. and in some instances also on the personal preference of the person involved. the pneumothorax leads to severe oxygen shortageand low blood pressure. In spontaneous pneumothorax. If mechanical ventilation is required. see below). the estimated size of the pneumothorax on X-ray. progressing to cardiac arrest unless treated. hemorrhage (bleeding). It is not yet clear if there is a subgroup of patients with small pneumothoraces who do not require tube treatment and could be managed conservatively. Tension pneumothorax is usually treated with urgent needle decompression. Possible complications of chest tube insertion include pain. the insertion of a chest tube is mandatory as it would increase the risk of tension pneumothorax. and low blood pressure (hypotension).symptoms of pneumothorax. The Asherman seal is a specially designed device that adheres to the chest wall and allows air to escape but not to enter the chest through a valve-like mechanism. the symptoms of a pneumothorax are determined by the size of the air leak and the speed by which it occurs. and may vary from discharge with early follow-up to immediate needle decompression or insertion of a chest tube. infection of the space between the lung and chest wall (the pleural space). This is called a bronchopleural fistula. How is a pneumothorax treated? The treatment of pneumothorax depends on a number of factors. chest tubes are usually inserted (unless iatrogenic. The needle or cannula is left in place until a chest tube can be inserted. the leak does not close on its own. A larger pneumothorax and a pneumothorax associated with underlying lung disease often require aspiration of the free air and/or placement of a chest tube to evacuate the air. The skin may develop a bluish color (termed cyanosis) due to decreases in blood oxygen levels. This may need to happen before transport to hospital. The diagnosis is confirmed by chest x-ray.