Definition of "Pneumothorax"

Last modified: 1 day



Pneumothorax (PTx) is an abnormal collection of air/gas in the pleural space (separating lung from the chest wall), that causes an uncoupling of the lung from the chest wall, thus interfering with normal breathing.

Patient information

What is pneumothorax, and how is different from hemothorax?
Pneumothorax is where air collects in the pleural space. It's different from hemothorax, because it's blood rather than air, in that situation, that collects in the pleural space.

What is the pleural space, is there usually anything inside there?
It's the thin space between the visceral and parietal pleura of the lung, and usually has a bit of fluid between it.

Sx
  • Chest pain
  • SOB
  • Hypoxemia (decreased blood oxygen), seen as cyanosis (bluish discoloration of skin, due to low oxygen)
  • Hypercapnia (accumulation of CO2 in blood)
  • Altered consciousness, confusion, and even comas
  • Breath sounds, may be diminished on the affected side, because air in the pleural space dampens the transmission sound
  • Measures of the conduction of vocal vibrations ot the surface of the chest may be altered, including vocal resonance and tactile fremitus
  • Hyperresonant percussion note, on exam of the affected side

Patient information

What happens when air collects in the pleural space?
It can cause chest pain. It can also affect with breathing, so you can become short of breath. This can cause blood to have less oxygen and more carbon dioxide, it can affect your disposition. If you listen to the affected part, it will have LESS sound, because air in the pleural space DAMPENS transmission of sound. If you hit the affected area, it might also be more resonant, because of the air that's collected in there.

Tension pneumothorax, presents w/ Sx of hypoxia and shock:

  • Chest pain
  • Respiratory distress
  • Tachycardia
  • Tachypnea
  • Quieter breath sounds on 1 side of the chest
  • Low BP
  • Displacement of the trachea AWAY from the affected side
  • Reduced expansion an decreased movement
  • Pain in the epigastrium (upper abdomen)
  • Displacement of the apex beat (heart impulse)
  • Resonant sound when tapping the sternum

Patient information

What happens if air in the pleural space, becomes so bad, it affects your breathing and blood?
Your breathing can be so affected, that your body responds by trying to breathe more often, and increase heart rate.

Dx
  • Dx by physical exam alone can be difficult or inconclusive, particularly in smaller pneumothoraces
  • To confirm it's presence:
    • CXR
    • CT scan, presenting as an extra black space, as it is full of air/gas


Source: http://s1.e-monsite.com/2009/01/19/10/40556091pneumothorax-gif.gif

Cause
  • Physical trauma to the chest, including blast injury
  • Iatrogenic (complication of medical/surgical intervention)
Classification
  • Primary pneumothorax, which occurs w/o an apparent cause, and in the absence of significant lung disease
  • Secondary pneumothorax, which occurs in the presence of existing lung pathology. This includes:
    • Diseases of the airways
    • Infections of the lung
    • Interstitial lung disease
    • Connective tissue disease
    • Cancer
    • Miscellaneous
Tx
  • No Tx, as small pneumothorax
  • In larger pneumothorax, or when there are marked Sx:
    • Needle decompression, to extract air with a 1-way syringe, inserted at the 2nd intercostal space, mid clavicular line
    • Chest tube, connected to a 1-way valve system, is inserted in an area under the axilla called the safe triangle, inserted at the 5th intercostal space, mid-axillary line
    • Surgery, when the tube drainage is unsuccessful, or as a preventative measure, if there have been repeated episodes. It involves:
      • Pleurodesis, in which the layers of pleura are induced to stick together
      • Pleurectomy, the surgical removal of pleural membranes

Patient information

What can you do about air in the pleura space?
If it's just a little bit, it doesn't matter too much. If it's large, or causing problems, you can use a syringe or tube to suck the air out. You can also do surgery.

Prognosis
  • Small spontaneous pneumothoraces typically resolve w/o Tx, and require only monitoring
Complications
  • Tension pneumothorax, is where there is a pneumothorax causing significant impairment of respiration and blood circulation. It occurs in clinical situations, e.g. ventilation, resuscitation, trauma, or in Pt's w/ lung disease. This is a medical EMERGENCY, that causes steadily worsening hypoxia (oxygen shortage), hypotension, and respiratory arrest shortly after. Unless reversed by effective Tx, it can cause death

Patient information

Tension pneumothorax, how is that different from pneumothorax?
It's where the pneumothorax becomes so bad, it causes problems with breathing and blood. So it's quite a worry.

See also
  • Pleural effusion (liquid buildup in the chest wall), which also interferes w/ normal breathing
  • Atelectasis (another term that the word "collapsed lung" can refer to)
  • Phototherapy (another abbreviation for PTx)

Find a practitioner

Practitioner count: 0
Sponsor a disease. And see how your proceeds help.
$1
Express interest
$10
Write text
$40
Write FAQ
$100
Snap photos
$400
Record audio
$1k
Produce video
$4k
Interview experts



Definition of Pneumothorax | Autoprac


RSS feeds: Most recent Most viewed