A pneumothorax is a collapsed lung. A pneumothorax occurs when air leaks into the space between the lung and chest wall; may be partial or complete.
Pneumothorax may result from a blind or penetrating chest injury, some medical procedures, or damage from underlying lung disease. Or, it could appear without obvious reason.
Symptoms often include sudden chest pain and shortness of breath. In some cases, a collapsed lung can be a life-threatening event.
Treatment of pneumothorax usually involves inserting a needle or chest tube into the lung cavity to remove excess air. However, a small pneumothorax can heal on its own.
Causes
Injury: Any sharp or penetrating injury can cause lung collapse. Some injuries may occur during physical attacks or vehicle accidents, while others may occur accidentally during medical procedures involving the accidental insertion of a needle into the lung.
Lung diseases: Damaged lung tissue is more likely to collapse. Lung injury can be due to many underlying diseases, including chronic obstructive pulmonary disease (COPD), cystic fibrosis, and pneumonia.
Torn/ruptured air bubbles: Small air bubbles (bulla and/or bleb) may develop on the lungs. These bubbles sometimes rupture – causing air to infiltrate the lungs.
Artificial respiration: A severe type of pneumothorax may occur in people who need mechanical assistance to breathe. The lung may collapse completely.
Risk factors
In general, men have a higher risk of pneumothorax. The type of pneumothorax caused by ruptured air bubbles tends to occur in people aged 20-40 years, especially if the person is very long and weak (astenic body posture).
Risk factors for pneumothorax include
Smoking: The risk increases, even if there is no emphysema, with increasing duration and number of cigarettes.
Genetics: Some types of pneumothorax are more common in families.
Lung diseases: It is common to have an underlying lung disease (especially chronic obstructive pulmonary disease (COPD).
Mechanical ventilation: There is a higher risk of pneumothorax.
Previous pneumothorax: A person who has had a pneumothorax has a higher risk of new pneumothorax.
Complications
Many people who have had a pneumothorax are at high risk of recurrent pneumothorax in the first years.
Sometimes air leakage may persist (more than 1 week) and if the rupture in the lung does not close; surgery may be required to close the air leak.
Treatment
In the treatment of a pneumothorax, the aim is to relieve pressure on the lung and to re-inflate the lung.
Depending on the cause of the pneumothorax, a second goal may be to prevent recurrences. The treatment approach may vary according to the patient.
Treatment options; observation, needle aspiration, chest tube placement, non-surgical repair or surgery.
Observation
If only a small part of the lung extinguishes, a series of chest x-rays can be monitored until excess air is completely absorbed and the lung re-expands. This may take several weeks.
Needle aspiration or chest tube placement.
If a larger area of the lung is extinguished, a needle or chest tube is used to remove excess air.
Needle aspiration, the catheter may remain for several hours to ensure re-inflating the lung and non-recurrence of the pneumothorax.
Chest tube insertion: A flexible chest tube is inserted into the air-filled cavity and can be fitted to a unidirectional valve device that continuously evacuates air from the chest cavity until the lung is re-inflated and healed.
Non-surgical repair
If the chest tube does not re-expand the lung, non-surgical options for closing the air leak may include:
Using a substance to irritate the membranes around the lung (pleurodesis) will adhere to each other and stop air leakage. This can be done through the chest tube and, if desired, also during surgery.
Taking blood from your arm and applying a chest tube to the lung (autologous band of blood) closes the air leak to form a fibrinous patch.
The bronchoscope can be fitted with a one-way valve in the bronchus. The valve allows the lung to re-expand and air to escape.
Surgical:
– VATS closed surgery: First detect the air leakage location. The area is removed by a stapler (wedge resection) or manually sutured with insoluble sutures using the surgical technique.
– Air leakage is completely prevented by covering the wound, staple or suture lines with either “tissue adhesive = fibrin glue” or the outer membrane of the lung (parietal pleura).
– Irritation (abrasion) to the lung membranes.
– The lung membranes are glued together with the patient’s own blood or using tetracycline (pleurodesis).
– Informing the patient consciously about breathing exercises and having these exercises done with physiotherapists is very important.
