A B C D E F G H I J K L M N O P R S T U V W

PNEUMOTHORAX

What is a Pneumothorax ?

This condition comes about as a result of an escape of air into the space between the linings of the lungs, called the pleura. Each lung is completely surrounded by two thin layers of lining called the pleura. Normally there is no air between the layers, and each glides freely over the other, as the lung expands and shrinks with each breath in and out. The purpose of the pleura is to protect the lungs and to allow them to move smoothly with breathing. The lungs are also protected by the rib cage and the muscles between the ribs. In pneumothorax this process is interrupted by air escaping into the space between the pleura, causing pressure on the lung. Now the air is trapped between the rib cage and the lung and forces the lung (which is like a sponge), to collapse. There are two types of pneumothorax: spontaneous and traumatic. The spontaneous type as the name suggests occurs unexpectedly. The traumatic variety, also as suggested by the name, occurs when the chest is damaged. This often happens in road traffic accidents, or some kind of crushing injury. Tension pneumothorax is when a pneumothorax develops very quickly under a lot of pressure. This causes the lung to get squashed tightly (i.e. it collapses). This is rare, but very dangerous. In tension pneumothorax, each breath increases the amount of air trapped in the space between the lung and chest wall (pleural space). This reduces the amount of lung space available for breathing. Both lungs become more and more squashed by the very act of breathing, and it is a medical emergency, which must be relieved within minutes, otherwise it will prove fatal.

How does a Pneumothorax occur ?

Spontaneous pneumothorax is the commonest type, and there is usually no obvious reason for it. Sometimes a weakness in the wall of the lungs or the pleura can be found, through which air escaped to cause the pneumothorax. With trauma, a sharp piece of bone from a broken rib, or even a whole segment of the chest wall, can tear a hole in the pleura. Tension pneumothorax occurs as a complication of either of these two types. The symptoms of pneumothorax are mainly pain often sharp and severe and shortness of breath.

Why does a Pneumothorax occur ?

Pneumothorax happens most often to young men who are often tall and thin, between the ages of 15 and 40 years. Another common time is after the age of 50 years in patients with chronic bronchitis and emphysema, when bubbles due to weaknesses on the surface of the lung, called bullae, sometimes burst to cause pneumothorax. It can also occur because of bullae caused by other lung conditions such as asthma and cystic fibrosis.

Treatment Involved for a Pneumothorax

A chest x-ray will be needed to confirm the diagnosis. Treatment depends on how big the pneumothorax is. If it is not too large and the pain and shortness of breath are not too severe, then no treatment may be necessary. The damaged lung will return to normal over a period of a few days. If large or if the pneumothorax is causing breathing difficulty, then a chest drain operation will probably be needed. This is a tube, inserted through the chest wall into the air space of the pneumothorax, which lets the air drain out of the chest through an underwater seal. Initially, air is drawn off, or 'aspirated' by careful suction. Having a chest drain put in is not a pleasant experience: good pain relief will be needed and given, during and after the operation. This is done under local anaesthetic. A tension pneumothorax must be relieved as a matter of urgency, by putting a large needle through the chest wall to relieve the pressure on the lungs.

During Treatment for a Pneumothorax

If a chest drain has been inserted, it is important to know that the drain is working to reduce the amount of air trapped outside the lung. This can be checked by watching the underwater seal bubble as air is pushed out of the space. The water level will rise and fall with each breath. If these things do not happen the tube may be blocked, and need attention. Complications of treatment include bleeding into the air space infection, and a persistent cough with phlegm.

After Treatment for a Pneumothorax

Normally, a pneumothorax does not recur, but sometimes this does happen. Under these circumstances an operation may be required. The purpose of the operation is to obliterate the space between the two layers of the pleura, so that air cannot escape in future. This may be done using a simple substance, such as talcum powder. When placed in the space between the pleura this causes such inflammation that the two layers stick together, preventing any further leak of air. Alternatively, part of the outer pleural layer may be removed, causing the inner layer to stick to the inside of the chest wall.

If a Pneumothorax is Left Untreated

This depends on the size of the pneumothorax. A small one would cause pain and breathlessness for a few days, but slowly recover. A large pneumothorax would cause serious distress, and possibly collapse and death. Tension pneumothorax is rare, but can lead to death within a few minutes if not relieved.

Effects on Family of a Pneumothorax

There are certain rare conditions that run in families which may be associated with pneumothorax. The most important of these are neurofibromatosis, cystic fibrosis and Marfan's syndrome. Self-help groups exist for all these conditions.