Pneumothorax: what it is, hypertensive, spontaneous, open

A strong and sharp pain in the chest followed by difficulty in breathing.

These can be signs of a collapsed lung, the pneumothorax, which is a disease that can cause serious problems.

Keep reading to learn more about it!

What is pneumothorax?

Pneumothorax, or pulmonary collapse, is a condition characterized by air entering the pleural cavity, the space between the lungs and the chest wall.

This air can come out spontaneously from the lungs or through wounds, as well as it can enter through wounds.

The lungs are usually in contact with the chest walls, but not glued. What keeps them in their position is the vacuum.

When air escapes into the pleural cavity, in addition to eliminating the vacuum, it can also increase the pressure in the region, preventing the lung from filling completely.

In severe cases, much of the space can be taken up by air, which prevents normal filling of the lungs.

It is especially common in very tall, thin men. The condition can cause a lot of pain and difficulty in breathing, and its severity is high if the patient has any extra lung disease.

Other lung diseases also increase the chances of pneumothorax appearing.

Read more: Pneumonia or tuberculosis? Learn how to differentiate diseases

The main cause of the condition is the appearance and subsequent rupture of air bubbles below the pleura , the lining layer of the lungs. These bubbles are called blebs .

The pneumothorax code  in the ICD-10 is J93 .

What are the types of pneumothorax?

There are a few different types of pneumothorax and they can all be divided into primary and secondary. If there is a lung condition that leads to pneumothorax, it is the secondary, but when there is no disease causing the condition, it is the primary.

The different types are:

Spontaneous

Spontaneous pneumothorax appears without external influence. It can happen due to a present disease, such as cancer , asthma or tuberculosis (which characterizes it as spontaneous secondary) or without evident disease (primary).

The blebs , air bubbles within the lung protective layer, are found in most cases of spontaneous disease are due to other conditions or no apparent reason.

Acquired

The acquired pneumothorax, on the other hand, is caused by external interference to the patient.

Some medical procedures, such as punctures of central veins, biopsies, laparoscopic surgeries, in addition to heavy blows or deep cuts can cause air to enter the cavity where the lungs are located.

Open pneumothorax

An open pneumothorax is the result of trauma that causes an opening in the chest wall. It is a type of pneumothorax acquired since it is usually caused by injuries.

When a cut is made in the chest and is open, the vacuum that holds the lungs close to the chest walls ceases to exist and lung collapse occurs, allowing air to enter the cavity. Closing the wound is essential to reverse the situation.

Hypertensive pneumothorax

Hypertensive pneumothorax is a medical emergency. It can arise from the evolution of either of the two types of pneumothorax already described. It happens when the pressure inside the pleural cavity becomes too high compared to the external pressure.

This can cause the vena cava to be clamped and blocked, which reduces the flow of venous blood to the heart.

The treatment must be done immediately since the clamping can block blood flow. Death is possible even if the flow is not completely blocked.

What causes pneumothorax?

Pneumothorax happens when air enters the pleural cavity. It is not an uncommon condition and it usually happens spontaneously with people who are at risk, such as those who have lung disease or are smokers. The disease requires immediate treatment in hospital. The main causes are:

Blebs e bullae

The main causes of spontaneous pneumothorax are blebs and bullae .

Blebs are small accumulations of air in the pleura , the protective layer that covers the chest cavity. When these accumulations rupture, the air escapes, which eliminates the vacuum inside the cavity.

This vacuum is what keeps the lungs close to the chest wall. With this, there is space for the air to prevent the lung from expanding completely. Thus, it collapses.

Bullae are similar. The main difference is that they are much larger, to the point of forming bubbles in the lung tissue.

When they break, the amount of air that spreads in the cavity is greater and, consequently, the collapse is usually more serious.

Air buildups can be present in anyone, but they are more likely to form and burst in people who smoke or have lung disease.

Traumas

Trauma is a frequent cause of pneumothorax. A strong impact on the chest can cause the lung, blebs or bullae to rupture, as well as having the ability to simply displace the lung.

If the impact is strong, it is possible that there is a fracture of the ribs, which can also do the same thing: pierce the pleura and lungs.

Another type of trauma that can also cause pneumothorax is cuts and perforations.

A puncture in the chest – caused by knives, gunshots or anything else that can break body tissue – is able to detach the lungs from the chest wall while allowing air to escape from the lungs or enter through the cut.

Groups and risk factors

The main risk factors are those that facilitate the formation of blebs or bullae, and attitudes that promote their disruption. In addition, the possibility of trauma also increases the risk of pneumothorax.

Some groups with greater susceptibility to the formation and rupture of air pockets in the pleura are:

Men

Males have more incidences of pneumothorax than females. It is one of the main risk factors for the condition when added to the high height and reduced weight.

Young adults

The disease usually manifests itself in early adulthood. The age group with the highest number of pneumothorax cases is just over 20 years of age.

Height and thinness

Very tall, thin people are more likely to develop spontaneous pneumothorax. The relationship between the two factors exists, it is not just being thin or being tall, but a combination of both.

Body Mass Index ( BMI ), which is measured by dividing weight by height squared (kg / height²), low is an indicator of risk for the disease.

This is believed to happen because of greater strain pressure in these people, which creates a negative pressure in the elevated lung cavity in relation to others.

This negative pressure, that is, the vacuum that keeps the lungs glued to the chest wall, makes blebs and bullae form more easily in the pleura, which in turn facilitates the formation of pneumothorax.

Lung diseases

Lung diseases that can be variable, such as bullous emphysema, asthma, obstructive pulmonary disease ( COPD ) and even lung cancer , increase the chances of a lung collapse.

Smokers

Smokers have a high chance and it is a factor strongly associated with pneumothorax. There is also a relationship with quantity. The more cigarettes a day, the greater the chances of developing pneumothorax.

Read more: Smoking is the biggest cancer risk factor in men

Family history

Family history is an indication of the possibility of the disease. If your parents have already had a lung collapse, your chances are greater, as it is possible that genetics will increase the chances of blebs and bullae forming.

Anterior pneumothorax

The recurrence of the disease is common. People who have had pneumothorax once in their life are very likely to develop the condition again.

Mountaineering

The higher we are, the lower the atmospheric pressure. Mountain climbing can bring about pressure changes that are capable of causing blebs and bullae to rupture.

Therefore, mountaineering can cause pneumothorax in those who are at risk factors.

Air travel

Like mountain climbing, air travel changes atmospheric pressure, since the higher it is, the lower the pressure. This can also increase the risk of pneumothorax in people who have had the condition before.

Dive

Dips increase the body’s external pressure, which also affects the lungs. People who are in the risk groups are more likely to develop pneumothorax in this situation, especially if the patient has previously had the disease.

The danger is time to get out of the water, because when it comes back to the surface very fast, there is a very sudden pressure change, which can burst or form blebs and bullae.

Symptoms

Pneumothorax symptoms are most severe when the amount of air in the chest cavity is greater and, therefore, can vary widely. In addition, other lung diseases can also make them more intense.

The main symptoms of the disease are chest pain and shortness of breath, but   tiredness , agitation and rapid heartbeat may appear.

Chest pain

Pain in the chest is acute, intense and sudden, and happens when the lung collapses and air enters the pleural cavity.

It is the main symptom of the disease and is present in up to 90% of patients.

This pain remains with the patient until the condition is treated or, in less severe cases, the disease resolves spontaneously.

Difficulty breathing

Breathing difficulty is associated with the lung’s inability to be completely filled with air.

In the mildest cases, it may appear as a slight shortness of breath, however, in the most intense, in which a large part of the pleural cavity is filled with air, the patient may have great difficulties in breathing and oxygenation.

Tiredness

With the reduction of the flow of oxygen in the blood, due to the decrease of the pulmonary capacity during the pneumothorax, the patient can appear tired and with difficulties to make efforts.

Acceleration of heart rate

A pneumothorax patient’s heart tends to race because of pain and a lack of oxygen.

Cyanosis

When the disease is very severe, the patient may experience a lack of oxygen as the lung is unable to fill with air. The extremities – fingers, lips, nails for example – may turn bluish, indicating a lack of oxygen, which characterizes cyanosis.

How is the diagnosis made?

The diagnosis of pneumothorax is made through physical examination and confirmed by imaging tests. The doctors responsible for treating the condition are the general practitioner and the pulmonologist .

Among the exams that can assist the professional are:

X ray

The X-ray examination creates an image of the inside of the body and it is possible to observe the region of the chest where the lung should be, but which have air in place.

In addition, through X-ray examination it is possible to identify some blebs and bullae before they break.

When this test shows the empty space between the lungs and the chest wall, the diagnosis of pneumothorax can be confirmed.

Computed tomography

Computed tomography is an examination that also uses X-rays to create an image. The difference is that it is able to create a 3D image from several X-ray captures in a very short time.

Because it is much more detailed, computed tomography is often used in cases that require more details of the condition, such as to check for other blebs or bullae, or even other pneumothoraxes that are too small to appear on the X-ray exam.

The detail provided by computed tomography also allows the prevention and preparation for the rupture of blebs and bullae.

Pneumothorax is curable?

-Yeah . Pneumothorax cures when air in the pleural cavity is removed, which causes the lung to occupy its space properly again and be able to be completely filled with air.

What is the treatment?

Treatment for pneumothorax is very varied, depending on the severity and causes of the condition. Remember that in any case, it is important to go to the doctor to deal with the pneumothorax.

It is possible to treat the disease in the following ways:

Rest and observation

When the condition is spontaneous, the collapse is small and there are no other lung diseases, spontaneous recovery is possible.

In these cases, the patient must stay in the hospital for 4 to 6 hours, under observation, at rest and with the administration of analgesic drugs, which relieve pain.

The purpose of observation is to ensure that the pneumothorax will not expand. After the end of this period, other imaging tests should be done to check the disease’s stability.

If she is stable, the patient can go home, having to return the next day to verify that there was no change in the condition.

The patient must also return immediately if the symptoms become more intense.

When there is medical suspicion that the condition may worsen, the patient can stay in the hospital for up to 24 hours before being released, if he is stable.

The air in the pleural cavity, when the pneumothorax is small, is usually spontaneously reabsorbed in a short time.

Thoracic drainage

A chest drain consists of the insertion of a tube in the patient’s chest. Through this tube, the air inside the cavity is drained, making room for the lung to expand properly.

This treatment is used in the most severe cases of the disease, where the amount of air in the cavity is large, or in those where the patient is not stable (breathing and weak heartbeat, even with a small pneumothorax).

This is also the treatment method indicated when the condition is created secondary to other illnesses or traumas.

Drainage treatment is continued until the lung is in its proper place again, with the elimination of the pneumothorax. Other drainages can be done in case of recurrences.

Drainage is effective even in severe situations in which the vena cava may be obstructed by air pressure in the pleural cavity.

In this case, it is extremely important that treatment is carried out on an emergency basis, to avoid complications and death.

Surgery (pleurectomia)

Pleurectomy is a surgery that removes the pleura , the layer that lines the chest cavity. It is quite invasive and, therefore, it is not usually performed unless relapses are very frequent.

This surgery can be total or partial and aims to adhere the lung to the chest wall, since without the pleura, the healing process promotes adherence.

Thus, without pleura, there is no way to build up, and air and lungs are stuck to the chest wall, preventing new pneumothorax.

Physiotherapy

Physiotherapy is a treatment option for pneumothorax. It is effective only after excess air and possible liquids are drained, or when the collapse is very small. In this case, physiotherapy helps the body to absorb what is left over more quickly, through breathing exercises.

For this, the professional must accompany the patient and indicate specific exercises.

Medicines

The only medications used for pneumothorax are those needed to relieve the pain from the condition until it resolves. Some of them are:

  • Dipyrone monohydrate ( Novalgine );
  • Paracetamol (Tylenol).

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Pneumothorax relapse is common, especially for those who have other risk factors for the condition.

Therefore, even after the condition is resolved, it is important to carry out frequent medical follow-up to find possible blebs or bullae that can develop into pneumothorax.

Physical exercise should be avoided in the first month after the completion of treatment and if symptoms appear again, it is essential that the patient seek medical attention.

Prognosis

Although the disease is extremely uncomfortable and in some cases very dangerous, the treatment is relatively simple and quite effective.

As the recurrence of the disease is common, it is important that the patient undergo medical follow-up and follow medical instructions to prevent another pneumothorax from forming.

The prognosis of the disease is mostly positive and it is even possible to return to doing aerobic physical exercises after medical release.

However, it is very important that periodic X-ray examinations are performed to check for the possible presence of other blebs and bullae.

Complications

There are some possible complications due to pneumothorax. Are they:

Hypertensive pneumothorax

Despite being classified as a type of pneumothorax, this version of the condition is a complication of it.

When the pressure inside the pleural cavity becomes too high because of the air inside, the vena cava, which carries blood without oxygen to the heart, can be clamped and blocked.

This causes the blood flow to be reduced and the patient may die.

Pulmonary reexpansion edema

The pulmonary edema re-expansion of is rare, but possible after the re-expansion of the collapsed lungs.

After removing the air from the pneumothorax, when the lungs expand too quickly, it is possible for the organs to release fluid that can accumulate and cause serious breathing problems.

How to prevent pneumothorax?

It is difficult to prevent pneumothorax, especially spontaneous ones, since rarely is anyone paying attention to the presence of blebs or bullae in the pleura without a reason for exams, as they do not cause symptoms.

However, it is possible to reduce the chances of the condition appearing or terminating:

Do not smoke

Smoking considerably increases the chances of developing pneumothorax. Not smoking is one of the best ways to prevent the disease.

Follow medical guidelines

As there are many chances of recurrence, those who have had pneumothorax before can try to avoid them.

Following the doctor’s directions is extremely important. Failure to exercise in the month following recovery, for example, can prevent a new pneumothorax.

Medical follow-up

Medical follow-up is important to discover blebs and bullae before they become pneumothorax, which can allow the doctor to remove air from the blisters and avoid the condition.

Pleurectomia

In the case of patients with many relapses, removal of the pleura may prevent the pneumothorax from returning in the future.


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