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This buildup of air puts pressure on the lung, so it cannot expand as much as it normally
does when you take a breath.
Causes
A collapsed lung may result from chest trauma, such as gunshot or knife wounds, rib
fracture, or after certain medical procedures.
In some cases, a collapsed lung occurs without any cause. This is called a spontaneous
pneumothorax. A small area in the lung that is filled with air, called a bleb, ruptures, and
the air leaks into the space around the lung.
Certain activities may lead to a collapsed lung. These include scuba diving, smoking
marijuana or cigarettes, high altitude hiking, and flying.
Lung diseases such as COPD, asthma, cystic fibrosis, tuberculosis, and whooping cough
also increase your risk for a collapsed lung.
Symptoms
Almost everyone who has a collapsed lung has the following symptoms:
• Chest tightness
• Easy fatigue
• Rapid heart rate
• Bluish color of the skin caused by lack of oxygen
• Nasal flaring
• Low blood pressure (hypotension)
There are decreased or no breath sounds on the affected side when heard through a
stethoscope.
Tests include:
Treatment
A small pneumothorax may go away on its own. You may only need oxygen and rest.
The health care provider may use a needle to pull the extra air out from around the lung
so it can expand more fully. You may be allowed to go home if you live near the hospital.
If you have a large pneumothorax, a chest tube will be placed between the ribs into the
space around the lungs to help drain the air and allows the lung to re-expand.
The chest tube can be left in place for several days. You must stay in the hospital while
the chest tube is in place.
Some patients with a collapsed lung need extra oxygen, which helps the air around the
lung be reabsorbed more quickly.
Lung surgery may be needed to treat your pneumothorax or to prevent future episodes.
The area where the leak occurred may be repaired. Sometimes, a special chemical is
placed into the area of the collapsed lung. This chemical causes a scar to form.
Outlook (Prognosis)
If you have a collapsed lung, you are more likely to have another one in the future if you:
How well a person does after having a collapsed lung depends on what caused it.
Possible Complications
Prevention
There is no known way to prevent a collapsed lung, but you can decrease your risk by not
smoking.
Alternative Names
Air around the lung; Air outside the lung; Pneumothorax; Spontaneous pneumothorax
pneumothorax
Definition
Pneumothorax is a collection of air or gas in the chest or pleural space that causes part or
all of a lung to collapse.
Description
Normally, the pressure in the lungs is greater than the pressure in the pleural space
surrounding the lungs. However, if air enters the pleural space, the pressure in the pleura
then becomes greater than the pressure in the lungs, causing the lung to collapse partially
or completely. Pneumothorax can be either spontaneous or due to trauma.
— Lorraine Steefel, RN
—
pneumothorax
Condition in which air accumulates in the pleural sac, causing it to expand and thus
compress the underlying lung, which may then collapse. (The pleural sac is a cavity
formed by the two pleural membranes that line the thoracic cavity and cover the lungs.)
Traumatic pneumothorax is the accumulation of air caused by penetrating wounds (knife
stabbing, gunshot) or other injuries to the chest wall, after which air is sucked through the
opening and into the pleural sac. Spontaneous pneumothorax is the passage of air into the
pleural sac from an abnormal connection created between the pleura and the bronchial
system as a result of tuberculosis or some other lung disease. The symptoms of
spontaneous pneumothorax are a sharp pain in one side of the chest and shortness of
breath.
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An accumulation of air or gas in the pleural cavity. The air enters by way of an external
wound, a lung perforation, a burrowing abscess, or rupture of a superficial lung cavity.
Pneumothorax is accompanied by sudden, severe pain and rapidly increasing dyspnea.
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Sports Science and Medicine:
pneumothorax
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The entrance of air into the pleural cavity, which may lead to lung collapse. It may result
from a perforation of the chest wall, but a spontaneous pneumothorax has an internal
cause, such as the rupture of the alveoli, which can occur if a diver ascends too rapidly
with air trapped in the lungs.
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Columbia Encyclopedia:
pneumothorax
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pneumothorax (nūmōthôr'ăks), collapse of a lung with escape of air into the pleural
cavity between the lung and the chest wall. The cause may be traumatic (e.g., gunshot or
stab wound), spontaneous (rupture due to disease or localized weakness of the lung
lining), or environmental (extreme change in atmospheric pressure). The only symptom
may be a sudden pain in the chest. Physical and radiological examination reveals
characteristic signs of lung collapse. Simple pneumothorax of only one lung generally
requires only rest; the break in the pleura usually heals quickly after collapse of the lung
has taken place. In tension pneumothorax (where there is high intrapleural pressure), or if
both lungs are collapsed, it is mandatory to remove the air from the pleural cavity
immediately. An artificial pneumothorax is one deliberately induced, as in the treatment
of tuberculosis of the lung before modern drugs became available, or in the diagnosis of
lung disease.
Veterinary Dictionary:
pneumothorax
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Entry of air into the pleural cavity in sufficient quantity to cause collapse of the lung and
consequent respiratory embarrassment. If it is unilateral there is a mediastinal shift with
displacement of the heart to the other side of the chest. Breath sounds are absent from the
affected side.
• closed p. — air leaks from a discontinuity in the lung into the pleural cavity.
• false p. — artifactual increased radiolucency of the thorax resembling free air in
the pleural cavity.
• iatrogenic p. — may occur following intrathoracic surgery or in association with
procedures which involve entry into the pleural cavity, such as thoracentesis or
placement of a chest drain.
• open p. — caused by an open wound in the chest wall.
• spontaneous p. — due to an unknown cause.
• tension p. — a particularly dangerous form of pneumothorax that occurs when air
escapes into the pleural cavity from a bronchus but cannot regain entry into the
bronchus. As a result, continuously increasing air pressure in the pleural cavity
causes progressive collapse of the lung tissue. If not relieved, it can lead to lung
collapse and mediastinal shift.
Wikipedia:
Pneumothorax
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This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be
challenged and removed. (March 2009)
"Collapsed lung" redirects here. For the band, see Collapsed Lung (band). For other
forms of lung collapse, see Atelectasis.
Pneumothorax
Classification and external resources
Contents [hide]
• 1 Etiology
• 2 Signs and symptoms
• 3 Diagnosis
• 4 Differential diagnosis
• 5 Pathophysiology
• 6 First aid
o 6.1 Chest wound
o 6.2 Blast injury or tension
o 6.3 Pre-hospital care
• 7 Clinical treatment
• 8 Spontaneous pneumothorax
o 8.1 Primary spontaneous pneumothorax
o 8.2 Secondary spontaneous pneumothorax
• 9 History
• 10 Image gallery
• 11 References
• 12 See also
Etiology
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-
filled pleural cavity (black) and ribs (white) can be seen. The heart can be seen in the
center.
The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the problem,
creating a hemopneumothorax.
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 in connective tissue, though not necessarily in elastin per se. Most
spontaneous pneumothorax result from "blebs", expanded alveoli just under the
superficial surface of the lung, that rupture allowing the escape of air into the pleural
cavity.
Pneumothorax can also occur as part of medical procedures, such as the insertion of a
central venous catheter into the subclavian vein. Other causes include mechanical
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 carinii pneumonia, lung abscess, and asthma[3].
Diagnosis
The absence of audible breath sounds through a stethoscope can indicate that the lung is
not unfolded in the pleural cavity. This accompanied by hyperresonance (higher pitched
sounds than normal) to percussion of the chest wall is suggestive of the diagnosis. The
"coin test" may be positive. Two coins when tapped on the affected side, produce a
tinkling resonant sound which is audible on auscultation.[4]
If the signs and symptoms are doubtful, an X-ray of the chest can be performed, but in
severe hypoxia, or evidence of tension pneumothorax emergency treatment has to be
administered first. An x-ray can illustrate the collapse of the lung as extra black space,
indicating the presence of air, will be seen in the x-ray around the lung. The lung shrivels
up away from the affected side and the mediastinum (trachea and other components) will
shift towards the affected side.[5]
In a supine chest X-ray the deep sulcus sign is diagnostic[6], which is characterized by a
low lateral costophrenic angle on the affected side.[7] In layman's terms, the place where
rib and diaphragm meet appears lower on an X-ray with a deep sulcus sign and suggests
the diagnosis of pneumothorax.
In Neonates the use of a transilluminator to suspected area will help visualize the air as
radiating rings from light source out.
Differential diagnosis
When presented with this clinical picture, other possible causes include:
• Acute Myocardial Infarction: presents with shortness of breath and chest pain,
though MI chest pain is characteristically crushing, central and radiating to the
jaw, left arm or stomach. Whilst not a lung condition, patients having an MI often
happen to also have lung disease.
• Emphysema: here, delicate functional lung tissue is lost and replaced with air
spaces, giving shortness of breath, and decreased air entry and increased
resonance on examination. However, it is usually a chronic condition, and signs
are diffuse (not localised as in pneumothorax).
Careful history taking and examination and a chest X-ray will allow accurate diagnosis.
Pathophysiology
Mechanics of a sucking chest wound. A. Air enters the chest through the opening in the
chest wall during inspiration (a). The lung collapses on the affected side (b), air passes
out of affected bronchus. Air enters the bronchus from the collapsed lung (c) and passes
to the intact lung. The mediastinum shifts toward the uninvolved side (d), and
hemothorax occurs (e). B. During expiration, air escapes through the wound (a). The
collapsed lung expands (b). Air passes from the uninvolved side to the lung on involved
side and out the trachea (c). The mediastinum shifts to the involved side (d), and
hemothorax occurs (e).
The lungs are located inside the chest cavity, which is a hollow space. Air is drawn into
the lungs by the diaphragm (a powerful abdominal muscle). The pleural cavity is the
region between the chest wall and the lungs. If air enters the pleural cavity, either from
the outside (open pneumothorax) or from the lung (closed pneumothorax), the lung
collapses and it becomes mechanically impossible for the injured person to breathe, even
with an open airway. If a piece of tissue forms a one-way valve that allows air to enter
the pleural cavity from the lung but not to escape, overpressure can build up with every
breath; this is known as tension pneumothorax. It may lead to severe shortness of breath
as well as circulatory collapse, both life-threatening conditions. This condition requires
urgent intervention.
First aid
Chest wound
Penetrating wounds (also known as 'sucking chest wounds') require immediate coverage
with an occlusive dressing, field dressing, or pressure bandage made air-tight with
petroleum jelly or clean plastic sheeting. The sterile inside of a plastic bandage packaging
is good for this purpose; however in an emergency situation any airtight material, even
the cellophane of a cigarette pack, can be used. A small opening, known as a flutter
valve, may be left open so the air can escape while the lung reinflates. Any patient with a
penetrating chest wound must be closely watched at all times and may develop a tension
pneumothorax or other immediately life-threatening respiratory emergency at any
moment. They cannot be left alone.
If the air in the pleural cavity is due to a tear in the lung tissue (in the case of a blast
injury or tension pneumothorax), it needs to be released. A thin needle can be used for
this purpose, to relieve the pressure and allow the lung to reinflate.
Pre-hospital care
Clinical treatment
Small pneumothoraces are often managed conservatively as they will resolve on their
own.[8] Repeat observation via chest X-rays and oxygen administered.[9]
Pneumothoraces which are too small to require tube thoracostomy and too large to leave
untreated, may be aspirated with a small catheter.
Larger pneumothoraces may require tube thoracostomy, also known as chest tube
placement. If a thorough anesthetizing of the parietal pleura and the intercostal muscles is
performed, the only major pain experienced should be either the injury that caused the
pneumothorax or the re-expanding of the lung. Proper anesthetizing will come about by
the following procedure: the needle should be inserted into the chest cavity and a
negative pressure created in the syringe. While air bubbles rise into the syringe, the
needle should be slowly pulled out of the cavity until the bubbles cease. The tip of the
syringe that contains the anesthetic is now in the intercostal muscles just next to the
parietal pleura. A proper and sizable injection should ensue (5 to 10 ml). This will allow
the patient to be fairly comfortable despite a hemostat or finger being inserted into the
chest cavity. A tube is then inserted through the chest wall into the pleural space and air
is extracted using a simple one way valve or vacuum and a water valve device. This
allows the lung to re-expand within the chest cavity. The rate of re-expansion will vary
widely. It is important not to connect the chest tube to suction right away, as rapid
expansion may lead to pulmonary edema. The pneumothorax is followed up with
repeated X-rays. If the pneumothorax has resolved and there is no further air leak, the
chest tube is removed. If, during the time that the tube is still in the chest, the lung
manages to sustain the re-expansion, but once suction is turned off, the lung collapses, a
Heimlich valve may be used. This flutter valve allows air and fluid in the pleural cavity
to escape the pleura into a drainage bag while not letting any air or fluid back in. This
method was developed by the military in order to get soldiers with lung injuries stable
and out of the battlefield faster. It is a rarely used medical device in the treatment of
patients these days, but may be used in order to allow the patient to leave the hospital.
It is critical that the chest tube be managed in such a way that it does not become kinked
or occluded with clot or other fibrinous material. Chest tube clogging can result in build
up of air in the pleural space. At the very least, this will lead to a recurrent pneumothorax.
In the worse case, the patient can have a tension pneumothorax if the air builds up under
pressure and impairs venous return to the heart. This can be fatal. The tubes have a
tendency to form clot from blood and other fibrinous material that can occlude them. To
keep them open they must be stripped, milked or even replaced if they totally occlude.
Smaller tubes are less traumatic, but more prone to clogging, although this can also occur
with larger tubes. One sign the chest tube is clogged is subcutaneous emphysema.
Another is a loss of respiratory variation in the fluid level at the water seal valve in the
drainage canister.
In the situation that the chest tube is not sufficient in healing of the lung (for example, a
continued air leak despite chest tube drainage), or if CT scans show the presence of large
"bullae" on the surface of the lung, thoracoscopic surgery, or video assisted thorascopic
surgery (VATS), may be done in order to staple the leak shut and to irritate the pleura to
promote adhesions between the lung and pleura (pleurodesis). Two or three small
incisions are made in the side of the chest and back, one for a small camera and the other
(s) for tools used to seal the lung and abrade or remove the pleura. When finished the
wound is covered with a steri-strip and bandaged up.
In case of penetrating wounds, these require attention, but generally only after the airway
has been secured and a chest drain inserted. Supportive therapy may include mechanical
ventilation.
Recurrent pneumothorax may require further corrective and/or preventive measures such
as pleurodesis. If the pneumothorax is the result of ruptured bullae, then bullectomy (the
removal or stapling of bullae or other faults in the lung) is preferred. Chemical
pleurodesis is the injection of a chemical irritant that triggers an inflammatory reaction,
leading to adhesion of the visceral pleura, which is in contact with the lung, to the parietal
pleura. Substances used for pleurodesis include talc, blood, tetracycline and bleomycin.
Mechanical pleurodesis is done by abrading the pleura and does not use chemicals. The
surgeon "roughens" up the inside chest wall ("parietal pleura") so the lung attaches to the
wall with scar tissue. This can also include a partial "parietal" pleurectomy, which is the
removal of the "parietal" pleura; "parietal" pleura is the serous membrane lining the inner
surface of the thoracic cage and facing the "visceral" pleura, which lies all over the lung
surface. Both operations can be performed using keyhole surgery (VATS) to minimise
discomfort to the patient. Sometimes pneumothorax occurs bilaterally in sequence or,
more rarely, simultaneously; that is often associated to bilateral apical blebs and
obviously requires bilateral treatment [10].[11]
Spontaneous pneumothorax
A primary spontaneous pneumothorax may occur without either trauma to the chest or
any kind of blast injury. This type of pneumothorax is caused when a bleb (an
imperfection in the lining of the lung) bursts causing the lung to deflate. The lung is
reinflated by the surgical insertion of a chest tube. A minority of patients will suffer a
second instance. In this case, thoracic surgeons often recommend thorascopic pleurodesis
to improve the contact between the lung and the pleura. If multiple and/or bilateral
occurrences continue, surgeons may opt for a far more invasive bullectomy and
pleurectomy 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 is most 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, but because the genetic
predisposition toward those traits often coincides with a genetic predisposition toward
high volume lungs with large, burstable blebs. A small portion of primary spontaneous
pneumothoraxes occur in persons outside the typical range of age and body type.
• Tuberculosis
• Pneumonia
• Asthma
• Cystic fibrosis
• Lung cancer
• Interstitial lung disease
• Marfan syndrome
• Lymphangioleiomyomatosis (LAM)[13]
History
Jean Marc Gaspard Itard, a student of René Laennec, first recognised pneumothorax in
1803, and Laennec himself described the full clinical picture in 1819.[14]
Image gallery
References
See also
• Tension pneumothorax
• Pleural effusion
• Hydrothorax
• Pulmonary contusion
• Traumatic aortic rupture
• Pneumohemothorax
[show]
v•d•e
Pathology of respiratory system (J, 460-519), respiratory diseases
sinuses: Sinusitis
nose: Rhinitis (Vasomotor rhinitis, Atrophic rhinitis, Hay fever) · Nasal polyp ·
HeadRhinorrhea · nasal septum (Nasal septum deviation, Nasal septum perforation,
Nasal septal hematoma)
Retropharyngeal abscess
Pleuritis/pleurisy
Fibrothorax
Mediastinal
Mediastinitis · Mediastinal emphysema
disease
[show]
v•d•e
Certain conditions originating in the perinatal period / fetal disease (P, 760-
779)
Intrauterine hypoxia · Infant respiratory distress syndrome · Transient
tachypnea of the newborn · Meconium aspiration syndrome · pleural
Respiratory
disease (Pneumothorax, Pneumomediastinum) · Wilson-Mikity
syndrome · Bronchopulmonary dysplasia
Digestive
Ileus · Necrotizing enterocolitis · Meconium peritonitis
system
Integument and
temperature Erythema toxicum
regulation
[show]
v•d•e
Injuries, other than fractures, dislocations, sprains and strains (S00-T14, 850-
929)
[show]
v•d•e
Chest trauma
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