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Dictionary The Respiratory System

Spontaneous Pneumothorax

Synonyms :  

Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs,

    Pneumothorax is abnormal presence of air in the pleural space caused by a rupture in the parietal pleura and chest wall after chest wall trauma (traumatic pneumothorax) or visceral pleura which surrounds the lungs which occurs without injury (spontaneous pneumothorax). The major consequence is loss of negative pressure of the pleural space and atelectasis (collapse) of the lung which is out of function. 

    The main causes of spontaneous pneumothorax are:

           rupture of a subpleural emphysematous bulla, or of the pulmonary end of a pleural adhesion during breathing

           rupture of a subpleural tuberculous focus (cavity) into the pleural space, which can occur in advanced secondary tuberculosis

           rupture of an acquired small, usually apical, bulla when there is no history of emphysema (the most common case); the mechanism of bulla formation is unclear but may be related to smoking-induced inflammation in the lungs 

    Spontaneous pneumothorax commonly develops in young and otherwise healthy adults with no history of lung disease. 

    There are three types of spontaneous pneumothorax:

           Closed. The communication between the pleural cavity and lung seals off as the lung deflates and does not reopen. The air is gradually absorbed and the lung re-expands.

           Open. The communication is generally with a bronchus (bronchopleural fistula) and does not seal off when the lung collapses. The term “open?is also applied to a pneumothorax resulting from a penetrating wound of the chest wall. The air enters the pleural cavity with every inspiration but it is readily squeezed out during expiration.

           Tension (valvular). The communication between the pleural cavity and lung persists but is small and acts as a one-way valve which allows air to enter the pleural cavity during inspiration but prevents it from escaping. This type of pneumothorax gradually worsens as more air is accumulated and pressure in the pleural cavity rises well above atmospheric pressure. In these circumstances significant pressure is exerted on the other lung and the heart.

Clinical features:  < BACK TO TOP >

           The onset is usually sudden, and usually without exertion.

           The patient complains of pain that can be minimal or severe or a feeling of tightness on the affected side of the chest that may be aggravated by deep breathing (acute dyspnoea).

           The patient may become increasingly breathless and in severe cases cyanosed, depending on the type/severity of pneumothorax.

           In closed pneumothorax symptoms gradually abate over a course of a few days.

           In open pneumothorax symptoms are persistent with pleurisy and empyema as a common complication due to introduction of bacteria into the pleural cavity.

           Tension pneumothorax is characterised by progressively worsening dyspnoea ending in cyanosis and even respiratory failure/death. 

Diagnosis:  < BACK TO TOP >

           Breathing sounds can’t be heard over the area of pneumothorax, percussion will return hyper-resonant sound of empty space filled with air.

           X-ray will show accumulated air with compression of the lung (atelectasis); in tension pneumothorax mediastinum appear shifted to the other side and the heart is displaced.

Management  < BACK TO TOP >

           Often closed pneumothorax doesn’t require any treatment apart from observation; in few days air will be absorbed and the lung will re-expand.

           Open pneumothorax requires closure of the communication with the pleural space (e.g., surgical closure of the chest wound or surgery to locate and close the bronchopleural fistula).

           Tension pneumothorax is a medical emergency and requires prompt surgery. In the meantime, patient’s sufferings can be alleviated by converting tension into open pneumothorax (which is less dangerous) by puncturing the chest with a wide needle which should be secured in place.

           A tube is placed into the pleural space and connected to a water-seal drainage and suction until the damaged pleura is healed.

           It is wise to administer antibiotic cover assuming that bacteria already managed to enter the pleural cavity, and pleurisy/empyema is a strong possibility.

Prognosis  < BACK TO TOP >

    -

Nutrition < BACK TO TOP >

Nutrition that alleviate or prevent Spontaneous Pneumothorax :-
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Herbs < BACK TO TOP >

Herbs that alleviate or prevent Spontaneous Pneumothorax :-
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