Pneumothorax is due to air in the pleural cavity, causing pain in the chest or side and shortness of breath. It can be mild or a medical emergency that requires immediate attention. Learn how to detect it and how it is treated.
It has two parts, the visceral pleura (in contact with the lung) and the parietal pleura (in contact with the chest wall). Under normal conditions, the pleural cavity is a virtual cavity with no real space in it; Between the two pleura, there is a small amount of fluid so that they can slide over each other.
In pneumothorax (or lung collapse), what happens is that air enters the space between the two pleurae. This causes the lung on the affected side to collapse to a greater or lesser extent because that air that should not be in that pleural space pushes the lung and, also, affects the pressures that are in normal conditions within the thorax (the pressure of the pleural space is usually negative, and in pneumothorax, this pressure becomes less harmful, or even positive).
Pneumothorax can appear spontaneously without a clear cause for it or by trauma that allows air to enter the pleural cavity, medical procedures, or derived from an undetected pulmonary pathology. The pneumothorax primary spontaneous occurs mainly in men between 20 and 40 years, especially if they are smokers, tall and thin. It is estimated that there may be between 8 and 28 cases per 100,000 men a year, and only 1-10 cases in every 100,000 women a year, according to data from SEPAR (Spanish Society of Pulmonology and Thoracic Surgery).
Can having a pneumothorax be serious?
Pneumothorax can be a dire situation if air enters but does not leave the pleural cavity. It is the tension pneumothorax, which puts the life of the person who suffers it at risk because there is a complete collapse of the lung and can even cause a heart collapse. For this reason, the diagnosis and treatment of pneumothorax are essential, which must always be done in a hospital setting and will require admission of the patient.
Due to its symptoms rependitial pain in the chest and a feeling of suffocation– pneumothorax can be confused with a heart attack or other diseases that cause pain in the chest. Even so, in most cases, the pain at the tip of the finger on one side can be simple muscle pain. With an X-ray and an electrocardiogram (sometimes accompanied by an analysis), most chest pain can usually be resolved as something that requires specific treatment or as a harmless but annoying pain.
Causes of pneumothorax
The pneumothorax may be secondary to trauma or injury to the chest or spontaneous (without there being any prior trauma).
The spontaneous pneumothorax, in turn, can be primary or secondary. The pneumothorax direct spontaneous is one that appears without having any previous lung disease, the less apparent. It is more common in young men, usually tall and thin (they have larger and longer lungs). Due to the rupture of small bullae below the pleura, especially in the area of the pulmonary apexes. It is much more frequent than secondary.
The pneumothorax secondary spontaneously usually occurs in older people and occurs without prior trauma, but there is indeed a prior lung disease in these cases. The most common cause is an emphysema-type chronic obstructive pulmonary disease. In this situation, there can be huge bullae in the lungs that, when ruptured, can lead to pneumothorax.
Other lung diseases in which a secondary spontaneous pneumothorax may appear are pulmonary asthma, cystic fibrosis, P. jirovecii pneumonia (typical of highly immunosuppressed patients, such as those with AIDS), various interstitial pneumonitis, associated or not with diseases rheumatological, fungal pneumonitis, radiation pneumonitis, lung tumor diseases, hydatid cysts … In short, a multitude of lung diseases can favor the appearance of a pneumothorax.
A peculiar case is a catamenial pneumothorax associated with menstruation in women with endometriosis, but it is rare. Also, diving or mountaineering at great heights can cause pressure changes to favor the small bullae’s rupture under the pleura.
Causes of traumatic pneumothorax
The traumatic pneumothorax due to trauma, contusion, or penetrating injury can be open or closed. One could distinguish between this iatrogenic pneumothorax, which is caused by a diagnostic or therapeutic procedure in the health field. Techniques that a pneumothorax can complicate are bronchoscopy with transbronchial biopsy, thoracentesis, pleural biopsy, cannulation of a subclavian or jugular central line, fine needle aspiration (FNA), or core needle biopsy ( BAG) of the lung. Pneumothorax barotrauma can occur in patients who are intubated and excess pressure in the airway.
The non – iatrogenic traumatic pneumothorax has its typical example penetrating chest wounds, for example, by a knife or stabbing or gunshot wounds in the chest. A broken rib can also tear the pleura and lead to a pneumothorax. The wound does not have to be obvious. Thus, chest contusions can also produce a pneumothorax with no apparent external injury.