Pleura Pneumothorax Disease and Treatment of Lung Collapse

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A pneumothorax is a pocket of air between the two layers of pleura. Spontaneous pneumothorax is also known as collapse of a lung. This most commonly occurs in the second and third decade of life and presents itself with the sudden development of pain in the chest and breathlessness. The collapse, occurs because of a sudden leak of air from the lung into the chest cavity. The lung is ordinarily maintained in an expanded state by the rigid bony thorax, but if air leaks out into the space between the thorax and the lung, the lung collapses. This condition is rarely very serious but the patient needs to be observed to be sure that the air leak does not become greater with further lung collapse.

Essentials of Diagnosis (Spontaneous Pneumothorax)

Sudden onset of chest pain referred to the shoulder or arm on the involved side, associated dyspnoea.
Hyper resonance, decreased chest motion, decreased breath and voice sounds on involved side, mediastinal shift away from involved side.
Chest X-ray revealing retraction of the lung from the purictal pleura is diagnostic.

General Considerations:
The cause of spontaneous pneumothorax is unknown in 90 per cent of cases, but it may be secondary to pulmonary disease. The idopathicform typically occurs in healthy young males with no demonstrable pulmonary disease other than the subplural blebs usually found on thoracotomy or (rarely) autopsy.

Entry of air into the plural space from a vent in the visceral pleura causes partial to complete collapse of the underlying lung. Collapse usually is self limited by rapid sealing of the tear. Occasionally a "valve effect" occurs with progressive entry of air on inspiration and failure of exit on expiration and with increasing intraplural pressure (tension pneumothorax).

This has a profound effect on cardiorespiratory dynamics and may be fatal if not treated promptly Tension Pneumothorax is a true emergency. Traumatic Pneumothorax is an emergency. Open chest wounds (sucking wounds) must be made airtight by any available means (e.g.; bandage, handkerchief, shirt, or other material) and closed surgically as soon as possible, Traumatic Pneumothorax due to lung puncture of laceration (Fractured rib, bullet etc.) is managed like spontaneous pneumothorax surgery is frequently required.

Symptoms and Diagnosis:
Symptoms vary greatly depending on how much air enters the plural space and how much of the lung collapses. They range from a little shortness of breath or chest pain to severe shortness of breath shock and life threatening cardiac arrest. Most often sharp chest pain and shortness of breath and occasionally a dry hacking cough begin suddenly. Pain may be felt in the shoulder, neck or abdomen. Symptoms tend to be less severe in a slowly developing pneumothorax than in a rapidly developing one.

Except with a very large pneumothorax or. a tension pneumothorax, symptoms usually subsides as the body adopts to the lung collapse and the lung slowly begins to reinflate. A physical examination can usually confirm the diagnosis. Using a stethoscope, a doctor may note that one part of the chest does not transmit the normal sounds of breathing. The trachea, the large airway that passes through the front of the neck, may be pushed to one side because of a collapsed lung. A chest X-ray shows the air pocket and the collapsed lung.

Treatment:
A small pneumothorax usually requires no treatment. It usually does not cause serious breathing problems and the air is absorbed in few days. The full absorption of a larger pneumothorax may take 2 to 4 weeks, however, the air can be removed more quickly by inserting a chest tube into the pneumothorax. A chest tube is needed if the pneumothorax is large enough to impair breathing. The tubes connected to a watersealed drainage system or a one-way valve that allows the air to exit without allowing any air to get back in. A suction pump may have to be attached to the tube if air keeps leaking in from an abnormal connection (fistula) between an airway and the pleural space. Occasionally, surgery is necessary. Often the surgery is performed using a thoracoscope inserted through the chest wall and into the pleural space.

A recurring pneumothorax can cause considerable disability. For people at highrisk - for example, divers and air plane pilots - surgery is considered after the first episode of penumothcarax. For people who have a peiicumo-14i,4r that won't heal neumothorax that occurs thrice on the same side, surgery is performed to eliminate the course of the problem.

In a complicated spontaneous penumothorax with a persistent air leak into the plural space or with a recurring penumothorax, the underlying lungs disease may make surgery hazerdous. Often, the plural space can be sealed by giving doxycycline through a chest tube that's draining air from the space. In tension pneumothorax, emergency removal of the air may prevent death. Air is immediately suctioned out, using a large syringe attached to a needle inserted into the chest. Then, a tube is inserted separately to drain out the air continuously.

Prognosis:
The outlook is very good in idiopathic cases but is more serious in secondary cases because of the danger of infection of the plural space. Recurrence occurs in 15-90 per cent, usually on the same side. Empyema may occur where underlying disease, specially tuberculosis is present. Failure of lung to expand, with fibrothorax, is rare in idiopathic type.

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