THORACIC

PATHOLOGY
DR. FATIMA EJAZ PT
MS NEURO PHYSICAL THERAPY
Introduction

 Pneumothorax is the medical term for a collapsed

lung.
 Itoccurs when air enters the space around your
lungs (the pleural space).
 This can happen when an open injury in your lung
tissue causes air to leak into the pleural space. The
resulting increased pressure on the outside of your
lung causes it to collapse.
Symptoms

 Ifpneumothorax results from trauma, the

symptoms often appear at the time of the injury or
shortly after. Symptoms of spontaneous
pneumothorax might appear when a person is at
rest. A sudden attack of chest pain is often the first
symptom.
 Symptoms may include:
1. a sudden, sharp, stabbing pain in the chest
2. rapid breathing or shortness of breath (dyspnea)
3. turning blue, known as cyanosis
4. a rapidTrusted Source heart rate
5. low blood pressure
• lung expansion on one side
• a hollow sound if you tap on the chest
• an enlarged jugular vein
• anxiety
• fatigue
Causes and types of pneumothorax

• Following are the types

1. Traumatic pneumothorax
2. Nontraumatic pneumothorax
• primary spontaneous
• secondary spontaneous
 Other subtypes with either traumatic or nontraumatic
causes are:
• simple, when it does not affect the position of other
structures
• tension, which affects the position of other structures,
like the heart
• open, when air moves in and out of an open wound in
the chest
Traumatic

 Traumatic pneumothorax occurs after some type of

trauma or injury has happened to the chest or lung
wall. It can be a minor or significant injury. The
trauma can damage chest structures and cause air
to leak into the pleural space.
 Here are some types of injuries that can cause
traumatic pneumothorax:
• trauma to the chest from a motor vehicle accident
• broken ribs
• a blow to the chest during a contact sport, like
football tackle
• a stab or bullet wound to the chest
• accidental damage during a medical procedure like a
central line placement, ventilator use, lung biopsies,
or CPR
• diving, flying, or being at high altitude due to air
pressure changes
 Quick treatment of pneumothorax due to chest trauma
is critical as it can lead to fatal complications like 
cardiac arrest, respiratory failure, shock, and death.
Nontraumatic pneumothorax

 This type of pneumothorax is called spontaneous, as it does not

result from trauma.
 When primary spontaneous pneumothorax happens, there’s no clear
reason why it occurs. It’s more likelyTrusted Source to happen:
• in people who smoke
• during pregnancy
• in people with Marfan syndrome
• in those with a family history of pneumothorax
• in an otherwise healthy person with a tall, thin body
 Secondary spontaneous pneumothorax can happen if a person has:
• a form of COPD, including emphysema and chronic bronchitis
• acute or chronic infection, like tuberculosis or pneumonia
• lung cancer
• cystic fibrosis
• asthma
• severe acute respiratory distress syndrome (ARDS)
• idiopathic pulmonary fibrosis
• collagen vascular disease
 Inhaling drugs like cocaine or marijuana can also trigger it.
Tension pneumothorax

 Tension pneumothorax is not a classification of pneumothorax

but a term that reflects the severity of pneumothorax. You 
may experienceTrusted Source it if you have:
• a blow to the chest
• a penetrating injury
• changes in pressure when diving, flying, or mountaineering
• a spontaneous pneumothorax progressing to a tension type
• some medical procedures
Risk factors for pneumothorax

 The risk factorsTrusted Source are different for a traumatic and

spontaneous pneumothorax.
 Risk factors for a traumatic pneumothorax include:
• contact sports, like football or hockey
• employment where there’s a risk of falls or other types of
injury
• having a medical procedure that involves the chest or lung area
• ongoing assisted respiratory care
 The people at highest risk of a nontraumatic pneumothorax
include those who:
• have a history of smoking
• have an existing lung condition, like asthma or COPD
• have a family history of pneumothorax, which may indicate
 genetic factors
• have tall, slim bodies, as this can affectTrusted Source pressure
at the top of the lung
• have inflammation in the small airways
Pneumothorax complications

 Pneumothorax can lead to a number of complications,

some of which can be life-threatening.
 They include:
• respiratory failure or inability to breathe
• pulmonary edema following treatment for pneumothorax
• pneumohemothorax, when blood enters the chest cavity
• pneumopericardium, when air enters the cavity around the
heart
• pneumoperitoneum, when are enters the space around the
abdomen
• bronchopulmonary fistula, when a passageway opens between
the lungs and the space around them
• heart attack
 Tension pneumothorax can quickly progress to:
• an inability to breathe
• cardiovascular collapse
• death
Treatment of pneumothorax

 Treatment aims to relieve pressure on the lung and allow it to re-expand.

 The options will depend on:
• how severe the condition is
• whether the chest cavity is continuing to expand
• the cause
• whether it’s happened before or has been going on for some time
 If you have tension pneumothorax or pneumothorax due to an injury, this
is a life-threatening emergency. You’ll need immediate medical care and
possibly surgery.
 Observation
 Ifpneumothorax results from a small injury, it may
heal without treatment within a few days. Check with
a doctor before flying or diving after pneumothorax.
 Ifyou’re having trouble breathing, you may need
oxygen. Using oxygen can also help speed upTrusted
Source the rate at which the lungs reabsorb air from
the cavity.
 Draining excess air
 Ifthe damage is significant or symptoms are severe, a surgeon may need to
remove the air or carry out surgery.
 Needle aspiration and chest tube insertion are two procedures designed to
remove excess air from the pleural space in the chest. These can be done at
the bedside without requiring general anesthesia.
 In needle aspiration, the doctor inserts a needle into the cavity and extracts
the air using a syringe.
 Fora chest tube insertion, the doctor will insert a hollowed tube between
your ribs. This allows air to drain and the lung to reinflate. The tube may
remain in place for 2 to 5 days or longer.
physiotherapy

 1.To improve ventilation and increase PaO2 levels

• Physical activity (stairs, walking, moderate-intensity
aerobic exercise)
• Active cycle of breathing exercises
• Sputum removal techniques i.e. percussion, cough assist
• PEP devices
• Incentive spirometry
• Non invasive ventilation (NIV)
 2. To assist in sputum removal[18]
• Postural drainage
• Active cycle of breathing exercises
• Percussion, shaking, and vibrations
• PEP devices
• Physical activity (stairs, walking, moderate-intensity
aerobic exercise)
• Coughing and huffing (forced expiratory breath)
• Airway suctioning
 3. To reduce work of breathing
• Body positioning
• Breathing control
• Relaxation techniques
• Accessory muscle use
 4. Improve exercise tolerance
• Early mobilisation and positioning
• Graded exercise program
• Breathing exercises