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Pneumothorax

  • Lungs and bronchial tree

Definition

A pneumothorax is an abnormal collection of air in the space between the lung and the inside lining of the chest wall.

What is going on in the body?

Air can collect between the lung and chest wall can occur for different reasons. The main concern is that this abnormal air can compress the lung and cause breathing problems. In severe cases, a pneumothorax can cause death if it is not treated quickly.

Risks

What are the causes and risks of the condition?

A pneumothorax may be caused by:
  • injury or trauma to the chest, often from a motor vehicle crash
  • an inadvertent puncture of the lung during surgery
  • lung diseases, such as emphysema, chronic bronchitis or asthma
  • a severe bacterial infection such as pneumonia or tuberculosis
  • a tumor or cancer, such as lung cancer
  • rare inherited conditions
In some cases, the condition occurs for no apparent reason in otherwise healthy people. This is known as "spontaneous" pneumothorax.

Prevention

What can be done to prevent the condition?

Avoidance of smoking and smokeless tobacco can prevent most cases due to emphysema and lung cancer. Most other cases cannot be prevented.

Diagnosed

How is the condition diagnosed?

The history and physical examination alone can sometimes make the diagnosis. A chest x-ray confirms the diagnosis by showing the abnormal air collection. It may also help determine the cause.

Long Term Effects

What are the long-term effects of the condition?

The collection of air may be treated or resolve on its own and cause no long-term effects. However, larger collections of air can cause collapse of the lungs and affect the heart. Severe breathing problems, low blood pressure, and, possibly, even death may occur. The underlying cause, especially if it is a life-threatening one such as lung cancer, may dictate the long-term outcome.

Other Risks

What are the risks to others?

This condition is not contagious and does not cause any risks to others. If the underlying problem is an infection such as tuberculosis or pneumonia, this infection can be contagious.

Treatments

What are the treatments for the condition?

People with a pneumothorax are usually admitted to the hospital for monitoring and treatment. The underlying cause is treated, if possible. A special needle or tube can be inserted between the ribs and into the chest. This allows the abnormal air to escape from the chest. The lung is then able to expand fully and symptoms usually go away. A tube may be left inside the chest for a few days until the person is stable. Surgery or other special procedures may be needed for repeated episodes of the condition.

Side Effects

What are the side effects of the treatments?

A tube inserted into the chest can cause bleeding, lung damage, and infection. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the condition?

The person usually gets better and can return to normal activities.

Monitor

How is the condition monitored?

Symptoms and repeat examinations are done. Blood tests to measure oxygen levels, known as arterial blood gases, and chest x-rays may also be used to monitor the condition.

Sources

Cecil's Textbook of Medicine, 1996, Bennett et al.

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