Pneumothorax refers to an accumulation of air in the pleural space. This is located between the lung and the inner chest wall.
If the pleural cavity fills with air – it can be removed from the inside z.B. leak from a spontaneously burst alveolus or flow in from the outside through an injury – this impairs lung function. The more air that enters the pleural space, the more difficult it is to breathe; in the worst case, the air influx can cause the lung in the affected area to collapse completely. Those affected often feel a stabbing pain and shortness of breath. The most common causes are pre-existing lung diseases such as COPD (common in smokers), an asthma attack, or a tumor. While smaller accumulations of air in the pleural space heal on their own, larger ones are drained to remove the air to the outside of the body.
How frequently a pneumothorax occurs?
Both primary and secondary spontaneous pneumothorax affect men at least twice as often as women. Per year is with zirka with 8 to 18 male patients per 100.000 to be expected.
Causes of pneumothorax
In pneumothorax, air enters the pleural space. This pleural space is located between the inside of the chest and the lungs. Chest and lungs are separated by 2 thin layers. One is the outer skin of the lung (pleura), the other is the pleura lining the inside of the chest wall.
Both layers lie on top of each other, they can be displaced against each other, but they cannot separate from each other due to the negative pressure prevailing there. The whole structure can be imagined like 2 glass plates, which stick together by a drop of water and cannot be detached from each other. If air enters this pleural space through an injury, both layers detach from each other. As a result, the lung loses its external tension at the affected location and collapses in on itself. As a result, the lung can no longer expand completely, and breathing is disturbed.
The air can enter the pleural space either spontaneously, or due to an injury, but also as a complication of a medical treatment to get there.
- Pneumothorax without foreign influence: The so-called spontaneous pneumothorax can occur without any apparent cause. If healthy people are affected, one speaks of a primary spontaneous pneumothorax. Most affected are young, slim, tall men between the ages of 15 and 35, often smokers.
Secondary spontaneous pneumothorax, on the other hand, occurs in people with pre-existing damage to the lungs. This can be caused, for example, by emphysema (chronic lung disease), obstructive pulmonary disease (COPD, often seen in smokers), an asthma attack, scar tissue in the lungs or a tumor.
- Pneumothorax due to the action of force: The cause of this pneumothorax is a direct or indirect violent impact on the thorax. Either due to an accident (bruise, brawl…) or due to an open injury of the lung for example by a stab or gunshot wound.
- Medical intervention: This pneumothorax occurs in the course of a medical intervention. For example, during a thoracentesis, insertion of a catheter or surgery.
Symptoms of a pneumothorax
A pneumothorax may present with the following symptoms:
- Sudden stabbing pain in the lungs
- Shortness of breath, at first only during exertion, later also at rest
- Rapid, shallow breathing
- bluish discoloration of the skin due to a lack of oxygen from blood
The accumulated air in the pleural space, which hinders the expansion of the lungs, leads to difficult breathing. If more and more air flows into the pleural space, the resulting overpressure can affect the heart and surrounding vessels. Therefore, in case of shortness of breath and stabbing pain in the lung area, call the rescue immediately.
Diagnosis of a pneumothorax
The cause of pneumothrorax can be an accident, it can occur spontaneously without pre-existing disease or with pre-existing damage to the lungs. In any case, the affected person feels more or less severe shortness of breath. You should be informed about the occurrence of the pain and shortness of breath, as well as a possible trigger, e.g., a pneumothorax.B. an accident you should inform the doctor.
How is examined?
- Breath sound and knock sound: The physician listens to the chest for examination. In the case of a pneumothorax, the breathing sound is weakened. The tapping sound of the lungs should sound hollow in the affected area. Based on this physical examination and the description of the affected person, the doctor can make a tentative diagnosis. He also takes an X-ray to confirm the diagnosis.
- Imaging test: In the chest X-ray, the doctor can see whether air has entered the pleural space and, if so, how much has collected there. In addition, the doctor may order a computed tomography (CT) scan. In this case, accompanying injuries in the surrounding tissue are also visible.
- Blood test: An examination of the blood shows changes in the amount of gases it contains. The level of carbon dioxide as well as oxygen is significantly reduced.
Therapy for pneumothorax
If the pleural space fills with air, it impairs lung function. The more air enters, the more difficult it is to breathe. In order to monitor the affected person and to be able to initiate the correct therapeutic measures, the treatment is not carried out by the general practitioner but in a clinic.
Treatment depends on the size of the pneumothorax:
- Small pneumothorax (rule of thumb: smaller than 3 cm in the X-ray): if only a little air flows into the pleural space through a small injury, doctors wait and keep the affected person under observation, as smaller wounds often close up again on their own. Oxygen is given to facilitate breathing. Repeated chest X-rays are used to check whether the condition is improving.
- Larger pneumothorax (Rule of thumb: larger than 3 cm): If there is no improvement or the air entry point into the pleural space is too large, a drain is inserted: Under local anesthesia, the physician inserts a narrow tube into the hole, through which the inflowing air is removed.
If the lung is already damaged by disease or has already suffered a pneumothorax, the risk of a repeated spontaneous pneumothorax is increased. Therefore, the lungs and pleura of the affected person are taped so that a new penetration of air is excluded.
What can the patient do??
After a chest drainage, you should take it easy on yourself physically. Do not exercise for 14 days, do not lift heavy objects and do not travel by air or go diving to avoid unnecessary pressure fluctuations in the lungs.
Smoking is not only a risk factor for developing pneumothorax, after an initial pneumothorax it also increases the risk of recurrence. For the sake of your health, you should refrain from smoking.