A Family Doctor's Tale - PNEUMOTHORAX

DOC I HAVE PNEUMOTHORAX

Pneumothorax is always a emergency.

It is due to the loss of air from the air sac of the lungs leading to pressure on the lung space in the pleural cavity.

The cause may be spontaneous or due to trauma.

It will definitely lead to loss of air in one part of the lungs.

The patient is hospitalized and air is pumped out of the pleural cavity using a one way valve tubing until the leak has been sealed either spontaneously or by surgical methods.

Chest X-ray monitoring may be needed.

Recurrence can be common in spontaneous pneumothorax.


Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.

Types of pneumothorax:


1.Tension pneumothorax:

This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.

2.Non-tension pneumothorax:


A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.

3.Hemopneumothorax:


When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.



It is most commonly due to:

A.Spontaneous pneumothorax


This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:

1.tall young males and in Marfan syndrome

2.Tuberculosis

3.Bronchial obstruction

4.Cancer

B.Non-spontaneous pneumothorax


1.penetrating chest wound

2.surgical trauma

3.pleural effusion tap



Symptoms:


1.Sudden onset of chest pain, back

2.shortness of breath,

3.dry coughs,

4.cyanosis (turning blue)

5.coma

Signs:


1.Pale or cyanotic

2.Percussion show resonance at normal lung while none at the pneumothorax lung area

3.Auscultation  reveals breath sounds on the normal side but none at the pneumothoracic lung

4.There may be a characteristic clicking sound with respiration.

5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .

6.The flopping sound of the punctured lung can sometimes be heard

Diagnosis of Pneumothorax is made by:


Physical examination:
a. absence of audible breath sounds through a stethoscope
b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.
c.Two coins when tapped on the affected side results in a tinkling resonant sound

Chest X-ray  reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.
Medistinal shifts can be seen on inspiratory and expiratory films

CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.

Complication of Pneumothorax:


Respiratory failure with circulatory collapse

Treatment of Pneumothorax:


All pneumothorax patients are to be admitted to hospital for treatment.

1. Small spontaneous pneumothorax


A small spontaneous pneumothorax can be left alone to reabsorb on its own.
The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.

2.Tension Pneumothorax


Tension Pneumothorax is a medical emergency.
Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.

Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.

The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.

The lung should re-expand in the thoracic cavity and the result is monitored by frequent x-rays

Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.

Penetrating wounds:


A chest drain is inserted first before any treatment of the wounds is done.

Supportive treatment:


1.Oxygen therapy
2.Rest
3.Antibiotics for infections
4.Painkillers for pain

Recurrent pneumothorax


1.pleurodesis may be required in recurrent pneumothorax.
2.bullectomy (the removal or stapling of bullae).
3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.
4.Mechanical pleurodesis  The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues
5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery

Prognosis of Pneumothorax is usually good following treatment.

However treatment always need to address the cause of the underlying diseases causing the pneumothorax.