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Pneumothorax

What is Pneumothorax?
Pneumothorax is the abnormal collection of air between the lung and the thoracic wall.

Pneumothorax - Erkan Yildirim, MD.

Why does Pneumothorax occur?

  • Pneumothorax may occur due to a number of reasons. Generally it occurs spontaneously.
  • Blebs for on the outer surface of the lung in patients with asthma or emphysema. Bleb is a small collection of air on the lung surface. If blebs rupture air leaks into the pleural cavity and this results in pneumothorax.
  • Young males with asthenic body build are especially in the risk group for spontaneous pneumothorax. Spontaneous pneumothorax may occur as a complication of emphysema, asthma, cystic fibrosis or tuberculosis.
  • If an abnormal passageway forms between the large airways in the lungs (the bronchi) and the space between the outer membranes of the lungs (the pleural cavity), pneumothorax occurs. This condition is called bronchopleural fistula.
  • When blebs rupture into the pleural cavity pneumothorax occurs.
  • If the chest is ruptured by an external factor and as a result a  passageway develops between the pleural cavity and the atmosphere, pneumothorax occurs.

How does Pneumothorax progress?

  • Depending on which side of the chest air leaks into, the lung on that side can not expand sufficiently and they start to collapse.
  • The collapsing lung slowly can not carry out its respiratory function.
  • Depending on the progress pace and severity of the condition symptoms can be light to life-threatening.

Symptoms of Pneumothorax

  • Sudden and severe pain in the chest, difficulty in breathing and coughing are the earliest symptoms.
  • The pain might spread to the shoulder or stomach area. However generally it is contained in the chest.
  • Symptoms may be minor if the condition progresses slowly and the amount of air leaked in is small.

How is Pneumothorax treated?

  • If the condition is minor, no special treatment is necessary. The small amount of air leaked into the pleural cavity is expelled from the body naturally.
  • If the condition is more serious with substantial amount of air leaked in, it must be removed by a catheter (chest tube).
  • Meanwhile the cause of the condition must also be addressed.
  • The condition may recur in patients who have experienced pneumothorax. If it does, generally surgical treatment is necessary. The surgery methods are open or closed (endoscopic) surgery.

The treatment aims to:

  • Removing the air that leaked into the pleural cavity and treating pneumothorax.
  • Controlling air leakage.
  • Minimizing recurrence risk.

Methods used in Pneumothorax Treatment

  • Observation
  • Needle Aspiration
  • Tube Thoracostamy
  • Thoracostomy
  • Thoracoscopic Surgery

Observation: Normally, pleura absorbs air corresponding to 1.25% of the volume of one lung. So if 10% pneumothorax is present, air is absorbed in 8 days. In this method the patient rests and given oxygen from the nostrils until the leaked air is absorbed. Unless the lung collapse is more than 15% and the patient suffers from dyspnoea, this method is preferred.

Needle Aspiration: In this treatment 16-18 gauge cannula and 3-way tap is used to drain the leaked air. This method may be preferred if the lung collapse is more than 15%.

Tube Thoracostomy: This is the most widely used method in treating  pneumothorax in medium to severe cases. Tube thoracostomy is used if symptoms are present, and if the first two treatment methods were conducted and they did not suffice.  In this method a sterile tube is inserted into the pleural cavity through the thoracic wall under local anesthesia. The tube is designed to drain the air out but with its air lock mechanism it does not allow air to leak from the atmosphere into the body. With this method air leaked into the pleural cavity is discharged quickly, treating the collapsed lung. Following tube thoracostomy lungs heal fast and the air leakage stops in less than 48 hours.

Thoracostomy Tube

Surgical Thoracotomy (Open Surgery / VATS Closed Surgery) – Pneumothorax cases requiring surgical treatment:

  • Prolonged air leakage (longer than 7 days)
  • Pneumothorax recurrance
  • Two-sided pneumothorax
  • If the patient had pneumothorax in the past, first occurrence in the other lung
  • First attack in patients with pneumothorax
  • First attack in those patients under occupational risks
  • Pilots
  • Divers

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