Pneumothorax

Pneumothorax, often referred to as a "collapsed lung," is an abnormal collection of air in the pleural space between the lung and the chest wall. This condition can lead to impaired breathing and, if severe, life-threatening complications.

Signs and Symptoms

Primary spontaneous pneumothorax (PSP) typically occurs in young adults without underlying lung issues and presents with sudden, sharp, one-sided chest pain and mild breathlessness. In newborns, symptoms include tachypnea, cyanosis, and grunting. People with PSP might not seek immediate medical attention.

Secondary spontaneous pneumothorax (SSP), occurring in individuals with significant lung diseases such as COPD, asthma, or tuberculosis, manifests more severely with symptoms like hypoxaemia, hypercapnia, and cyanosis.

Traumatic pneumothorax, often resulting from chest injuries like stab or gunshot wounds, can occur in up to half of chest trauma cases. Physical examination may reveal diminished breath sounds, hyperresonant percussion, and decreased tactile fremitus.

Tension Pneumothorax

Tension pneumothorax is a very important condition characterised by significant respiratory and circulatory impairment due to a one-way valve mechanism allowing air to enter but not exit the pleural space. Symptoms include severe chest pain, respiratory distress, rapid heart rate, and low blood pressure. It is a medical emergency requiring immediate intervention.

Causes

Primary spontaneous pneumothorax occurs without apparent cause, predominantly in males, smokers, and those with a family history. Secondary spontaneous pneumothorax is linked to lung diseases such as COPD, cystic fibrosis, and tuberculosis. Traumatic pneumothorax results from chest injuries or medical procedures like central venous catheter insertion. Newborns are at higher risk due to factors like prematurity and low birth weight.

Diagnosis

Diagnosis often requires medical imaging since symptoms can be non-specific. Chest X-rays are the primary diagnostic tool, revealing the presence and size of the pneumothorax.

In some cases, a CT scan is performed to distinguish between pneumothorax and other conditions like bullae. Ultrasound is increasingly used, especially in trauma situations, for rapid and accurate diagnosis.

Treatment

The treatment approach depends on the severity, symptoms, and underlying causes. In mild cases with small pneumothoraces, conservative management with observation may suffice. For larger pneumothoraces or those causing breathlessness, needle aspiration or chest tube insertion may be necessary.

Tension pneumothorax requires urgent needle decompression followed by chest tube placement. In recurrent or persistent cases, surgical interventions such as pleurodesis or thoracoscopy may be considered to prevent recurrence. Chest tubes are often used in traumatic pneumothorax to prevent tension pneumothorax, especially in mechanically ventilated patients.

Prevention

Preventive measures include smoking cessation and, in recurrent cases, surgical procedures like pleurodesis to eliminate the pleural space. Air travel and underwater diving are generally discouraged until complete recovery and clearance from a medical professional.

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Self-assessment MCQs (single best answer)

What is the primary diagnostic tool for diagnosing pneumothorax?

Which of the following symptoms is NOT typically associated with primary spontaneous pneumothorax (PSP)?

What is the immediate treatment required for tension pneumothorax?

Which of the following is a risk factor for primary spontaneous pneumothorax?

Which imaging technique is increasingly used for rapid and accurate diagnosis of pneumothorax, especially in trauma situations?

What is the preferred treatment for a large pneumothorax causing breathlessness?

Which symptom is characteristic of tension pneumothorax?

Which of the following is a preventive measure for recurrent pneumothorax?

For which condition might a CT scan be performed to distinguish it from pneumothorax?

Which of the following is a common cause of secondary spontaneous pneumothorax (SSP)?