Pneumothorax Definition A lung can collapse for many reasons: a growing tumor blocking a major airway, a n infection, even

an inhaled foreign object. One type of lung collapse, known me dically as a pneumothorax, occurs when air leaks into the area between your lung s and chest wall (pleural space). The pressure of the air against the lung cause s it to give way, often leading to mild to severe chest pain and shortness of br eath. 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 collap ses in proportion to the amount of air that leaks into your chest cavity. Althou gh 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 tu be 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 un collapsed lung, compressing both your lung and heart. Called a tension pneumotho rax, 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 o r 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 experie nce: Sudden, sharp chest pain on the same side as the affected lung Shortness of brea th, which may be more or less severe, depending on how much of the lung is colla psed A feeling of tightness in your chest A rapid heart rate Because a tension pneumothorax can compress the walls of your heart as well as t he unaffected lung, heart function may be impaired, leading to a potentially fat al 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 cover ed by a thin, moist tissue called the pleura, which also lines the chest wall. T he 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 ou tward. The two opposing forces create a negative pressure in the pleural space b etween 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 affecte d lung to collapse. There are several types of pneumothorax, which are defined a ccording to what causes them: Primary spontaneous pneumothorax. This usually occurs in otherwise healthy peopl e with no history of chest trauma. It's most common in tall, thin men many of th em smokers between 20 and 40 years of age. Primary spontaneous pneumothorax is t hought to develop when a small air blister (bleb) on the lung ruptures. Blebs ar e caused by a weakness in the lung tissue and can rupture from changes in air pr essure when you're scuba diving, flying, mountain climbing or, according to some reports, listening to extremely loud music. Primary spontaneous pneumothorax ca n run in families, and researchers think that genetic factors also may play a ro le. A primary spontaneous

pneumothorax is usually mild because pressure from the collapsed portion of the lung in turn collapses the bleb. Secondary spontaneous pneumothorax. This develops in people who already have a l ung disorder, especially emphysema, which progressively damages your lungs. Othe r conditions that can lead to secondary pneumothorax include tuberculosis, pneum onia, cystic fibrosis and lung cancer. In these cases, the pneumothorax occurs b ecause the diseased lung tissue is next to the pleura. Although the signs and sy mptoms of primary and secondary spontaneous pneumothorax are identical, secondar y pneumothorax can be more severe and even life-threatening because diseased tis sue opens a wider hole and therefore lets more air into the pleural space than d oes a small, ruptured bleb.

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 ai r 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 comm on in people whose breathing is aided by a mechanical ventilator. Tension pneumo thorax. The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air b ecomes trapped in the pleural space or because the entering air is from a positi ve-pressure mechanical ventilator. The force of the air can cause the affected l ung to collapse completely. It can also push the heart toward the uncollapsed lu ng, compressing both it and the heart. Tension pneumothorax comes on suddenly, p rogresses rapidly and is fatal if not treated quickly. Risk factors

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 pneumothor ax) related to the menstrual cycle. Catamenial pneumothorax, which mainly affect s women in their 20s and 30s, seems to occur when endometrial tissue the tissue that normally lines the uterus spreads to the lungs, pleura or diaphragm. Smokin g. This is the leading risk factor for primary spontaneous pneumothorax; more th an 90 percent of people with a primary pneumothorax are smokers or former smoker s. The risk increases with the length of time and the number of cigarettes smoke d. Lung disease. Having another lung disease, especially emphysema, makes a coll apsed lung more likely. A history of pneumothorax. If you've had one pneumothora x, you're at increased risk of another, usually within one to two years of the f irst episode. This is especially true if the first pneumothorax was small and he aled on its own.

When to seek medical advice See your doctor right away if you have chest pain and trouble breathing. Many co nditions other than pneumothorax can cause these symptoms, but most require an a ccurate diagnosis and prompt treatment. If your chest pain is severe or breathin g becomes increasingly difficult, get immediate emergency care. Tests and diagnosis Most often, your doctor will diagnose a pneumothorax using a chest X-ray. Other tests are sometimes performed, including:

Computerized tomography (CT) scan. In certain cases, you may have a computerized tomography (CT) scan, an X-ray technique that produces more detailed images tha n conventional X-rays do. This is most often done if your doctor suspects a pneu mothorax after an abdominal or chest procedure. A CT scan can help determine whe ther an underlying disease may have caused your lung to collapse something that may not show up on a regular X-ray. Blood tests. These may be used to measure th e level of oxygen in your arterial blood. Complications The most common complication of a spontaneous or traumatic pneumothorax is a rec urrence close to half the people who have had one pneumothorax have another, usu ally within a year or two of the first. You're more likely to have more than one pneumothorax if you smoke, have an existing lung disease or HIV/AIDS, or are ta ll and thin. And if you've had a primary spontaneous penumothorax from a rupture d bleb, it's highly possible that you have or will develop a similar bleb in the opposite lung. Complications of a tension pneumothorax are more serious and inc lude:

Low blood oxygen levels (hypoxemia). Because a tension pneumothorax causes near or total collapse of one lung and can compress the other, you take in less air a nd less oxygen enters your bloodstream. As a result, you develop lower than norm al blood oxygen levels. Lack of oxygen can disrupt your body's basic functioning , and severely low levels can be life-threatening. Respiratory failure. This occ urs when blood levels of oxygen fall too low, and the level of carbon dioxide be comes too high. Severely low blood oxygen can lead to heart arrhythmias and unco nsciousness, and high carbon dioxide levels to sleepiness and confusion. Eventua lly, respiratory failure may prove fatal. Cardiac arrest. In a tension pneumotho rax, the heart is pushed toward the unaffected lung. This can interfere with the return of blood to the heart and lead to a sudden loss of heart function. Cardi ac arrest is fatal if not treated immediately.

Shock. This critical condition occurs when blood pressure drops so low that the body's vital organs are deprived of oxygen and nutrients. Shock is a major medic al emergency and requires immediate care. Treatments and drugs The goal in treating a pneumothorax is to relieve the pressure on the lung, allo wing it to re-expand, and to prevent recurrences. The best method for achieving this depends on the severity of the lung collapse and sometimes on your overall health:

Observation. If your lung is less than 20 percent to 25 percent collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the air is completely absorbed and your lung has re-expanded. Because it may take w eeks for a pneumothorax to heal on its own, however, a needle or chest tube may be used to remove the air, even when the pneumothorax is small and nonthreatenin g. Needle or chest tube insertion. When your lung has collapsed more than 25 per cent, your doctor is likely to remove the air by inserting a needle or hollow tu be (chest tube) into the pleural space. Chest tubes often are attached to a suct ion device that continuously removes air from the chest cavity and may be left i n place for several hours to several days. Other pneumothorax treatments. If you have had more than one pneumothorax, you may have treatments to prevent further recurrences. The most common is a surgical procedure called video-assisted thor acoscopy, which uses small incisions and a tiny video camera to guide the surger y. This technique leads to less pain and a shorter recovery time than other type s of surgery do because the chest cavity can be accessed without breaking any ri bs. Nursing care Open the airway by suctioning and endotracheal intubation Control hemorrhage Pro vide care of chest tube Do ECG daily Check vital signs frequently

Prevention Although it's often not possible to prevent a pneumothorax, stopping smoking is the best way to reduce your risk of a first pneumothorax and avoid a recurrence.