| Pneumothorax Classification and external resources |
|
 |
|
|---|---|
| Chest X-ray of Left-sided Tension Pneumothorax | |
| ICD-10 | J93., P25.1, S27.0 |
| ICD-9 | 512, 860 |
| DiseasesDB | 10195 |
| MedlinePlus | 000087 |
| eMedicine | emerg/469 |
| MeSH | D011030 |
In medicine (pulmonology), a pneumothorax, or collapsed lung, is a potential medical emergency caused by accumulation of air or gas in the pleural cavity, occurring as a result of disease or injury, or spontaneously. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the In Medicine, pulmonology (aka pneumology) is the specialty that deals with Diseases of the Lungs and the Respiratory tract. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health
Contents |
Etiology
It is most commonly due to:
- Spontaneously (most commonly in tall slim young males and in Marfan syndrome)
- A penetrating chest wound
- Barotrauma to the lungs[1][2]
It may also be due to:
- Chronic lung pathologies including emphysema, asthma
- Acute infections
- Acupuncture
- Chronic infections, such as tuberculosis
- Cancer
- Rare diseases that are unique to women such as Catamenial pneumothorax (due to endometriosis in the chest cavity) and lymphangioleiomyomatosis (LAM). Marfan syndrome (or Marfan's syndrome is a genetic disorder of the Connective tissue. Barotrauma is physical damage to body tissues caused by a difference in Pressure between an air space inside or beside the body and the surrounding Gas or Liquid Emphysema is a chronic obstructive Pulmonary disease ( COPD) formerly termed a chronic obstructive Lung disease (COLD Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Catamenial pneumothorax is a condition of collapsed lung occurring in conjunction with Menstrual periods (catamenial refers to Menstruation) believed to Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus
Pneumothoraces are divided into tension and non-tension pneumathoraces. A tension pneumothorax is a medical emergency as air accumulates in the pleural space with each breath. A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple Pneumothorax, associated with the formation A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health The increase in intrathoracic pressure results in massive shifts of the mediastinum away from the affected lung compressing intrathoracic vessels. A non-tension pneumothorax by contrast is a less severe pathology because there is no ongoing accumulation of air and hence no increasing pressure on the organs within the chest.
The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the problem, creating a hemopneumothorax. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells €”such as nutrients and oxygen—and transports Waste products The thoracic cavity (or chest cavity) is the chamber of the human body (and other animal bodies that is protected by the Thoracic wall ( Thoracic cage A hemothorax (or haemothorax) is a condition that results from blood accumulating in the Pleural cavity. Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions Pneumothorax, or air in the Chest cavity, and
Signs and symptoms
Sudden shortness of breath, dry coughs, cyanosis (turning blue) and pain felt in the chest, back and/or arms are the main symptoms. Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from Cyanosis is a blue coloration of the Skin and mucous membranes due to the presence of deoxygenated Hemoglobin in Blood vessels near the skin surface In penetrating chest wounds, the sound of air flowing through the puncture hole may indicate pneumothorax, hence the term "sucking" chest wound. The flopping sound of the punctured lung is also occasionally heard. Subcutaneous emphysema is another symptom. Subcutaneous emphysema, sometimes abbreviated SCE or SE and also called tissue emphysema, and sometimes referred to as Sub Q air by paramedics and
If untreated, hypoxia may lead to loss of consciousness and coma. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. In addition, shifting of the mediastinum away from the site of the injury can obstruct the superior and inferior vena cava resulting in reduced cardiac preload and decreased cardiac output. The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. The superior vena cava is a large yet short Vein that carries deoxygenated Blood from the upper half of the body to the Heart 's Right atrium The inferior vena cava (or IVC is the large Vein that carries de-oxygenated Blood from the lower half of the body into the Heart. In cardiac Physiology, preload is the pressure stretching the ventricle of the Heart, after Atrial contraction and subsequent Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute Untreated, a severe pneumothorax can lead to death within several minutes.
Spontaneous pneumothoraces are reported in young people with a tall stature. As men are generally taller than women, there is a preponderance among males. The reason for this association, while unknown, is hypothesized to be the presence of subtle abnormalities in connective tissue. Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, Muscle, and Nervous tissue) Some spontaneous pneumothoraces however, are results of "blebs", blister like structures on the 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 (an intravenous catheter) in the subclavian vein or jugular vein. In Medicine, a central venous catheter ( CVC or central venous line or central venous access catheter) is a Catheter placed into a Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. In Human anatomy, the subclavian veins are two large Veins one on either side of the body The jugular veins are Veins that bring deoxygenated blood from the Head back to the heart via the Superior vena cava. While rare, it is considered a serious complication and needs immediate treatment. Other causes include mechanical ventilation, emphysema and rarely other lung diseases (pneumonia). In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own Emphysema is a chronic obstructive Pulmonary disease ( COPD) formerly termed a chronic obstructive Lung disease (COLD Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal
Diagnosis
The absence of audible breath sounds through a stethoscope can indicate that the lung is not unfolded in the pleural cavity. The stethoscope (from Greek στηθοσκόπιο, of στήθος stéthos - chest and σκοπή skopé - examination) is an acoustic 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. A coin test is a medical Diagnostic test used to test for a punctured lung Two coins when tapped on the affected side, produce a tinkling resonant sound which is audible on auscultation. [3]
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. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple Pneumothorax, associated with the formation
In a supine chest X-ray the deep sulcus sign is diagnostic[4], which is characterized by a low lateral costophrenic angle on the affected side. The supine position is a position of the body; lying down with the Face up as opposed to the Prone position, which is face down In Radiology, the deep sulcus sign on a supine chest radiograph or X-ray, is an indication of a Pneumothorax. [5] 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 Vertebrate Anatomy, ribs ( Latin costae) are the long curved Bones which form the ribcage. For other types of diaphragm see Diaphragm. In the Anatomy of Mammals the thoracic diaphragm is a sheet of Muscle
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. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply 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. Emphysema is a chronic obstructive Pulmonary disease ( COPD) formerly termed a chronic obstructive Lung disease (COLD 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. A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used
Pathophysiology
The lungs are located inside the chest cavity, which is a hollow space. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Air is drawn into the lungs by the diaphragm (a powerful abdominal muscle). In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the 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. The airways are those parts of the Respiratory system through which air flows to get from the external environment to the Alveoli. 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. A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple Pneumothorax, associated with the formation 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. An occlusive dressing is an air- and water-tight trauma dressing used in First aid. A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to the body 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.
Blast injury or tension
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 tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple Pneumothorax, associated with the formation A thin needle can be used for this purpose, to relieve the pressure and allow the lung to reinflate.
Pre-hospital care
Many paramedics can perform needle thoracocentesis to relieve intrathoracic pressure. A paramedic is a medical professional usually a member of the emergency medical service, who primarily provides Pre-hospital advanced medical and Thoracentesis (also known as thoracocentesis or pleural tap) is an invasive procedure to remove fluid or air from the pleural space Intubation may be required, even of a conscious patient, if the situation deteriorates. In Medicine, intubation refers to the placement of a tube into an external or internal orifice of the body Advanced medical care and immediate evacuation are strongly indicated. The casualty movement is the procedures used to move a casualty from the initial location (street home workplace wilderness battlefield to the Ambulance.
An untreated pneumothorax is an absolute contraindication of evacuation or transportation by flight. In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug,
Clinical treatment
Small pneumothoraces often are managed with no treatment other than repeat observation via Chest X-rays, but most patients admitted will have oxygen administered since this has been shown to speed resolution of the pneumothorax. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. [6]
Pneumothoraces which are too small to require tube thoracostomy and too large to leave untreated, have been aspirated with a needle to remove the pressure, although this technique is usually reserved for tension pneumothoraces.
Larger pneumothoraces may require tube thoracostomy, also known as chest tube placement. A chest tube ( chest drain or tube thoracostomy) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. A chest tube ( chest drain or tube thoracostomy) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. 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. A proper and sizable injection should ensue. 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 into the chest wall outside the lung and air is extracted using a simple one way valve or vacuum and a water valve device, depending on severity. A flutter valve (also known as the Heimlich valve after its inventor Henry Heimlich) is a one way Valve used in respiratory medicine to prevent air This allows the lung to re-expand within the chest cavity. This re-expansion usually lasts for approximately 15–30 seconds depending on the size of the pneumothorax and feels as if your breath has been taken away. This response is normal and should pass fairly quickly. The pneumothorax is followed up with repeated X-rays. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. If the pneumothorax has resolved and there is no further air leak, the chest tube removed. If, during the time that the tube is still in the chest, the lung manages to sustain the re-expansion once suction is turned off, but the lung still diminishes if actually clamped off, a Heimlich valve may be used. A flutter valve (also known as the Heimlich valve after its inventor Henry Heimlich) is a one way Valve used in respiratory medicine to prevent air 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 battle field 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.
In the situation that the chest tube does not seem to be helping the healing of the lung or if CAT scans show the presence of "blebs" on the surface of the lung orthoscopic surgery may be done in order to staple the lung closed. Two small incisions are made in the back, one for a small camera and one for the tool used to seal the lung. 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. A chest tube ( chest drain or tube thoracostomy) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. Supportive therapy may include mechanical ventilation. In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own
Recurrent pneumothorax may require further corrective and/or preventive measures such as pleurodesis. Pleurodesis is the artificial obliteration of the pleural space. If the pneumothorax is the result of 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 lung to the parietal pleura. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Substances used for pleurodesis include talc, blood, tetracycline and bleomycin. Talc (derived from the Persian via Arabic talq) is a Mineral composed of Hydrated Magnesium Silicate with This article deals with the specific antibiotic called tetracycline Bleomycin is a Glycopeptide antibiotic produced by the Bacterium Streptomyces verticillus. Mechanical pleurodesis does not use chemicals. The surgeon "roughs" up the inside chest wall ("parietal pleura") so the lung attaches to the wall with scar tissue. This can also include a "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 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 [1]. [7]
Spontaneous Pneumothorax
Spontaneous Pneumothorax can be classified as primary spontaneous pneumothorax and secondary spontaneous pneumothorax. In primary spontaneous pneumothorax, it is usually characterized by a rupture of a bleb in the lung while secondary spontaneous pneumothorax mostly occurs due to chronic obstructive pulmonary disease (COPD). For the protrusion of cell membrane present during Apoptosis and Cell motility, please see Bleb (cell biology.
Primary 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. If a patient suffers two or more instances of a spontaneous pneumothorax, surgeons often recommend a bullectomy and pleurectomy. Primary spontaneous pneumothorax is most evident in people without any previous history of lung disease and in tall, thin men who are 20–40 years old; however it can often occur in teenagers and young adults.
Secondary spontaneous pneumothorax
A known lung disease is present in secondary spontaneous pneumothorax. [8] The most common cause is chronic obstructive pulmonary disease (COPD). However, there are several diseases that may lead to spontaneous pneumothorax:
- COPD
- Tuberculosis
- Pneumonia
- Asthma
- Cystic fibrosis
- Lung cancer
- Interstitial lung disease
- Marfan syndrome
- Lymphangioleiomyomatosis (LAM)[9]
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. Chronic obstructive pulmonary disease ( COPD) is a Disease of the lungs in which the Airways become narrowed Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. Interstitial lung disease (ILD, also known as diffuse parenchymal lung disease (DPLD, refers to a group of Lung diseases affecting the Interstitium Marfan syndrome (or Marfan's syndrome is a genetic disorder of the Connective tissue. Lymphangioleiomyomatosis (LAM is the result of disorderly smooth muscle proliferation throughout the Bronchioles, Alveolar septa, Perivascular spaces, Jean Marc Gaspard Itard ( April 24 1774 – July 5, 1838) was a French Physician born in Provence. René-Théophile-Hyacinthe Laennec ( February 17, 1781 - August 13, 1826) was a French Physician and inventor of the Stethoscope 1803 ( MDCCCIII) was a Common year starting on Saturday (link will display the full calendar of the Gregorian calendar (or a Year 1819 ( MDCCCXIX) was a Common year starting on Friday (link will display the full calendar in the Gregorian Calendar (or a Common year [10]
Prior to the advent of anti-tuberculous medications, iatrogenic pneumothoraces were intentionally given to tuberculosis patients in an effort to collapse a lobe, or entire lung around a cavitating lesion. This was known as 'resting the lung'.
References
- ^ Broome JR, Smith DJ (November 1992). "Pneumothorax as a complication of recompression therapy for cerebral arterial gas embolism". Undersea Biomed Res 19 (6): 447–55. PMID 1304671.
- ^ Chen CW, Perng WC, Li MH, Yan HC, Wu CP (December 2006). "Hemorrhage from an enlarged emphysematous bulla during commercial air travel". Aviat Space Environ Med 77 (12): 1275–7. PMID 17183925.
- ^ Wallach SL (2000). "Spontaneous pneumothorax". N. Engl. J. Med. 343 (4): 300; author reply 300–1. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10928880.
- ^ Kong A (2003). "The deep sulcus sign". Radiology 228 (2): 415-6. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12893899.
- ^ Gordon R (1980). "The deep sulcus sign". Radiology 136 (1): 25-7. PMID 7384513.
- ^ Andrew K Chang, MD. eMedicine.com: Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum.
- ^ Eur J Cardiothorac Surg. 2000 Nov;18(5):608-10.
- ^ Spontaneous Pneumothorax Fact Sheet - American Lung Association site
- ^ McCormack FX (2006). "Lymphangioleiomyomatosis". MedGenMed : Medscape general medicine 8 (1): 15. PMID 16915145. Full text at PMC: 1682009
- ^ Laennec RTH. PubMed Central is a free digital database of full-text Scientific literature in biomedical and life sciences Traité de l'auscultation médiate et des maladies des poumons et du coeur. Part II. Paris, 1819.
See also
- Emergency medicine
- Tension pneumothorax
- Pleural effusion
- Hydrothorax
- Pulmonary contusion
- Traumatic aortic rupture
- Sucking chest wound:
External links
- A chest X-ray with a deep sulcus sign - learningradiology. Emergency Medicine is a speciality of Medicine that focuses on the Diagnosis and treatment of acute illnesses and injuries that require immediate medical attention A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple Pneumothorax, associated with the formation Pleural effusion is excess fluid that accumulates in the Pleural cavity, the fluid-filled space that surrounds the Lungs Excessive amounts of such fluid can impair A hydrothorax is a condition that results from serous fluid accumulating in the Pleural cavity. A pulmonary contusion (or lung contusion) is a contusion ( Bruise) of the Lung, caused by Chest trauma. Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the Aorta, the largest Artery in the An occlusive dressing is an air- and water-tight trauma dressing used in First aid. Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions Pneumothorax, or air in the Chest cavity, and com
- Blebinfo - Help, information, Forums and research on spontaneous pneumothorax
- Pneumothorax.org - Pneumothorax news, information and forums
- The Spontaneous Pneumothorax Patient Network - Info, Research & Support
- Music as a cause of primary spontaneous pneumothorax. An article from the journal Thorax detailing links between exposure to loud music and pneumothorax.
- Sucking chest wound:
Dictionary
pneumothorax
-noun
- (medicine) A progressing medical emergency in which air has entered the pleural cavity.
Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic