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.

If a pneumothorax occurs suddenly or for no known reason, it is called a spontaneous pneumothorax. This condition most often strikes tall, thin men between the ages of 20 to 40. In addition, people with lung disorders, such as emphysema, cystic fibrosis, and tuberculosis, are at higher risk for spontaneous pneumothorax. Traumatic pneumothorax is the result of accident or injury due to medical procedures performed to the chest cavity, such as thoracentesis or mechanical ventilation. Tension pneumothorax is a serious and potentially life-threatening condition that may be caused by traumatic injury, chronic lung disease, or as a complication of a medical procedure. In this type of pneumothorax, air enters the chest cavity, but cannot escape. This greatly increased pressure in the pleural space causes the lung to collapse completely, compresses the heart, and pushes the heart and associated blood vessels toward the unaffected side.

Causes and symptoms

The symptoms of pneumothrax depend on how much air enters the chest, how much the lung collapses, and the extent of lung disease. Symptoms include the following, according to the cause of the pneumothorax:

• Spontaneous pneumothorax. Simple spontaneous pneumothorax is caused by a rupture of a small air sac or fluid-filled sac in the lung. It may be related to activity in otherwise healthy people or may occur during scuba diving or flying at high altitudes. Complicated spontaneous pneumothorax, also generally caused by rupture of a small sac in the lung, occurs in people with lung diseases. The symptoms of complicated spontaneous pneumothorax tend to be worse than those of simple pneumothorax, due to the underlying lung disease. Spontaneous pneumothorax is characterized by dull, sharp, or stabbing chest pain that begins suddenly and becomes worse with deep breathing or coughing. Other symptoms are shortness of breath, rapid breathing, abnormal breathing movement (that is, little chest wall movement when breathing), and cough.
• Tension pneumothorax. Following trauma, air may enter the chest cavity. A penetrating chest wound allows outside air to enter the chest, causing the lung to collapse. Certain medical procedures performed in the chest cavity, such as thoracentesis, also may cause a lung to collapse. Tension pneumothorax may be the immediate result of an injury; the delayed complication of a hidden injury, such as a fractured rib, that punctures the lung; or the result of lung damage from asthma, chronic bronchitis, or emphysema. Symptoms of tension pneumothorax tend to be severe with sudden onset. There is marked anxiety, distended neck veins, weak pulse, decreased breath sounds on the affected side, and a shift of the mediastinum to the opposite side.

Diagnosis

To diagnose pneumothorax, it is necessary for the health care provider to listen to the chest (auscultation) during a physical examination. By using a stethoscope, the physician may note that one part of the chest does not transmit the normal sounds of breathing. A chest x ray will show the air pocket and the collapsed lung. An electrocardiogram (ECG) will be performed to record the electrical impulses that control the heart's activity. Blood samples may be taken to check for the level of arterial blood gases.

Treatment

A small pneumothorax may resolve on its own, but most require medical treatment. The object of treatment is to remove air from the chest and allow the lung to re-expand. This is done by inserting a needle and syringe (if the pneumothorax is small) or chest tube through the chest wall. This allows the air to escape without allowing any air back in. The lung will then re-expand itself within a few days. Surgery may be needed for repeat occurrences.

Prognosis

Most people recover fully from spontaneous pneumothorax. Up to half of patients with spontaneous pneumothorax experience recurrence. Recovery from a collapsed lung generally takes one to two weeks. Tension pneumothorax can cause death rapidly due to inadequate heart output or insufficient blood oxygen (hypoxemia), and must be treated as a medical emergency.

Prevention

Preventive measures for a non-injury related pneumothorax include stopping smoking and seeking medical attention for respiratory problems. If the pneumothorax occurs in both lungs or more than once in the same lung, surgery may be needed to prevent it from occurring again.

Key terms

Electrocardiagram — A test that provides a typical record of normal heart action.

Mediastinum — The space between the right and left lung.

Pleural — Pleural refers to the pleura or membrane that enfolds the lungs.

Thoracentesis — Also called a pleural fluid tap, this procedure involves aspiration of fluid from the pleural space using a long, thin needle inserted between the ribs.

Resources

Organizations

American Association for Respiratory Care. 11030 Ables Lane, Dallas, Texas 75229. (972) 243-2272. http://www.aarc.org.

American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.

Other

"Spontaneous Pneumothorax." HealthAnswers.com. http://www.healthanswers.com.

---

pneumothorax /pneu·mo·tho·rax/ (-thor´aks) air or gas in the pleural space, usually as a result of trauma (traumatic or open p.) or some pathological process.

---

tension p.  pneumothorax in which the pressure within the pleural space is greater than atmospheric pressure; as a result, the mediastinum is displaced to one side, which interferes with breathing.

Tension pneumothorax.

---

pneu·mo·tho·rax (nm-thôrks)

n.

Accumulation of air or gas in the pleural cavity, occurring as a result of disease or injury or as a treatment of tuberculosis and other lung diseases.

---

pneumothorax

[no̅o̅′mōthôr′aks]

Etymology: Gk, pneuma, air, thorax, chest

the presence of air or gas in the pleural space, causing a lung to collapse. Pneumothorax may be the result of an open chest wound that permits the entrance of air, the rupture of an emphysematous vesicle on the surface of the lung, or a severe bout of coughing. It may also occur spontaneously without apparent cause.

observations The onset of pneumothorax is accompanied by a sudden sharp chest pain, followed by difficult, rapid breathing; decreased breath sounds and cessation of normal chest movements on the affected side; tachycardia; a weak pulse; hypotension; diaphoresis; an elevated temperature; pallor; dizziness; and anxiety.

interventions The patient is assured that the condition can be treated, is urged to remain still, and is placed in bed in Fowler's position. Oxygen is administered through a nasal cannula, unless contraindicated, and the air in the pleural space is immediately aspirated. A chest tube is inserted and attached to an underwater seal; a waterless, disposable system; or a mobile chest drain; the tube is not removed until air is no longer expelled through the seal and a radiographic examination shows that the lung is completely expanded. Pain may be controlled by administering appropriate analgesics, but the use of respiratory depressants is avoided. Intermittent positive-pressure breathing may be administered.

nursing considerations The patient is taught how to turn, cough, breathe deeply, and perform passive exercises and is told to avoid stretching, reaching, or making sudden movements. The patient is advised not to smoke but to drink fluids copiously, to exercise, to avoid fatigue and strenuous activity, and to report any symptoms of recurrence, such as chest pain, difficult breathing, fever, or respiratory infection.

---

pneumothorax (nōōˈ·mō·thōˑ·raks),

n an abnormal condition characterized by the buildup of air within the space between the lungs and the chest wall; as a result, the lung is unable to expand properly during respiration and eventually collapses because of the increased pressure. Symptoms include chest pain and shortness of breath; although rare, it is a potential complication of acupuncture treatments.

---

pneumothorax (noo´mōthôr´aks),

n 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. It is accompanied by sudden, severe pain and rapidly increasing dyspnea.

---

pneumothorax

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.

Pneumothorax. By permission from Ettinger SJ, Feldman E, Textbook of Veterinary Internal Medicine, Saunders, 2004

---

closed pneumothorax

air leaks from a discontinuity in the lung into the pleural cavity.

false pneumothorax

artifactual increased radiolucency of the thorax resembling free air in the pleural cavity.

iatrogenic pneumothorax

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 pneumothorax

caused by an open wound in the chest wall.

spontaneous pneumothorax

due to an unknown cause.

tension pneumothorax

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.

---

pneumothorax

Lung collapse Pulmology The presence of air in the pleural space, which may be 1º–seen in tall, thin, young ♂, characterized by subpleural apical blebs, 2º–asthma, COPD, PCP, trauma, TB, iatrogenic–due to thoracentesis, subclavian line placement, PEEP, bronchoscopy Clinical Pleural pain, dyspnea, ↓ breath sounds, percussion hyperresonance, ↓ tactile fremitus Management Small blebs may heal spontaneously, larger pneumothoraces require chest tube drainage, pleurodesis. See Spontaneous pneumothorax.