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Pneumothorax

A pneumothorax is the presence of air between the two layers of pleura, resulting in   collapse of the lung.

Normally, the pressure in the pleural space is lower than that inside the lungs. When there is air in the pleural space, the lung partially or completely collapses, leading to severe shortness of breath.

Occassionally pneumothorax occurs without any apparent cause which is called a primary spontaneous pneumothorax. Primary spontaneous pneumothorax usually occurs when a small weakened area of the lung (bulla) ruptures. The condition is most common in tall men younger than age 40 who smoke. Most people recover fully, however, primary spontaneous pneumothorax recurs in 30 to 50% of the cases.

A pneumothorax may also occur after a medical procedure that introduces air into the pleural space, such as thoracentesis or bronchoscopy. Ventilators can cause pressure damage to the lungs (barotrauma) that leads to a pneumothorax.

Symptoms vary depending on how much air enters the pleural space and how much of the lung collapses. Most often, sharp chest pain and shortness of breath - and occasionally - a dry cough begin suddenly. Pain may also be felt in the shoulder, neck, or abdomen. Symptoms tend to be less severe in a slowly developing pneumothorax.

A physical examination can usually confirm the diagnosis if the pneumothorax is large. Using a stethoscope, a doctor may note no normal sounds of breathing over a part of the chest, and when the chest is tapped (percussed) the chest produces a drum-like sound. A chest x-ray also shows the collapsed lung.

A small, primary spontaneous pneumothorax usually requires no treatment.

If the pneumothorax is large enough to make breathing difficult, aspiration may be necessary.

A recurring pneumothorax can cause considerable disability. People at high risk—for example divers and airplane pilots—after the first episode of pneumothorax may need surgery. Surgery involves repairing leaking areas of the lung, firmly attaching the inner layer of the pleura to the outer layer.

Surgery is often done by using a thoracoscope on patients who have a pneumothorax that will not heal or a pneumothorax that has occurred twice on the same side.