PNEUMOTHORAX
Pneumothorax is a accumulation of air in pleural space, pneumothorax is differentiate by spontaneous, iatrogenic and traumatic.
Primary spontaneous pneumothorax occur without lung disease where as secondary spontaneous pneumothorax is occurs due to pulmonary diseases.
Iatrogenic pneumothorax may follows process such as pleural biopsy, subclavian or internal jugular vein catheter, thoracentesis, percutaneous lung biopsy, bronchoscopy with trans bronchial biopsy and positive pressure mechanical ventilation.
In tension pneumothorax ,the air pressure in the pleural space exceeds throughout the respiratory cycle.
Primary pneumothorax is thought that it is occur from rupture of sub pleural apical blebs in response to high negative intra pleural pressures.
Secondary pneumothorax occur due to complication of asthma, cystic fibrosis, tuberculosis, COPD, pneumocystis pneumonia, menstruation(catamenial pneumothorax) and wide variety of interstitial lung diseases like Langerhans cells Histiocytosis, tuberous sclerosis, Sarcoidosis, Lymphangioleiomyomatosis.
SYMPTOMS
In pneumothorax chest pain minimal to severe on the affected side and Dyspnea occurs in nearly all patients. Symptoms starts during rest and usually resolve within 24 hours even if pneumothorax persists. If pneumothorax is small (less than 15% of hemithorax), physical finding other than mild tachycardia are normal.
If pneumothorax is large with diminished breath sound, decreased movement of chest ,decreased tactile fremitus are often noted. Tension pneumothorax should be suspected in the presence of marked tachycardia , hypotension and mediastinal or tracheal shift.
TREATMENTS
Treatment of pneumothorax is depends on severity of disease and nature or type of underlying disease. Many small pneumothorax resolved spontaneously as air is absorbed from the pleural space, supplemental oxygen therapy may increase the rate of reabsorption. For spontaneous primary pneumothorax that are large and progressive, simple aspiration of drainage of pleural air with small bore catheter can be performed.
Patients with secondary pneumothorax, large pneumothorax, tension pneumothorax, or severe symptoms or those have a pneumothorax on mechanical ventilation should undergo chest tube placement (tube thoracostomy). The chest tube placed under water seal drainage and suction is applied untill the lung expands.
In some cases surgery performed in which resection of blebs responsible for the pneumothorax and pleurodesis by mechanical abrasion and insufflation of talc.
Patients who smoke should be advised to discontinue smoking because the risk of reccurence is 50% if smoking is continued.
Exposure to high altitude area, scuba diving, flying in unpressurized aircraft should be avoided.
For Informational purpose only. Consult your Physician for advice.
