Pneumothorax: An Overview of Symptoms, Causes, and Treatment

It is the entry of air into the pleural cavity either caused directly from inside the lung or from the outside (by perforation).

The pleural cavity is the space between the lung and the rib cage. Under normal conditions there is a minimal amount of fluid in this space, called the pleural space. The entry of air into the pleural cavity causes the collapse of the lung to a greater or lesser degree.

How is it produced?

According to the production mechanism:

• Traumatic: due to trauma, either open (with a penetrating wound from the outside) or closed (due to a broken rib that favors the passage of air from the lungs to the pleural cavity). These are classified as iatrogenic (due to a diagnostic and / or therapeutic maneuver) or non-iatrogenic.
• Spontaneous: due to the rupture of pulmonary cysts or bullae located on the lung surface. They can be primary (without underlying lung disease) or secondary (with lung disease such as emphysema).

Symptoms

It is accompanied by chest pain that increases with inspiration, of sudden onset accompanied by respiratory distress with rapid and superficial respiratory movements, with sweating, paleness, hypotension and tachycardia.

Diagnosis

It is obtained by means of a chest X-ray, which must always be performed in an upright position. In doubtful cases, it will be carried out in forced inspiration and expiration.

Treatment

The goal is to re-expand the collapsed lung and prevent future recurrences.

If the pneumothorax is small (<20-30% of the pleural space) and it is a first episode, rest is the indicated treatment, since air can be spontaneously reabsorbed. Otherwise, the placement of a drainage tube connected to an aspirator will be necessary to cure the pneumothorax.

Pleurodesis (bulla surgery) occurs in severe cases such as, for example, involving both lungs.

There is a 20 to 50% chance of a recurrence of a pneumothorax after a first episode. The prevention of recurrences is aimed at chemically sealing the junction between the parietal pleura (the membrane that lines the inside of the rib cage) and the visceral pleura (the membrane that surrounds the lung).