Pneumothorax: symptoms, causes and treatment

A pathological condition in which air or other gas mixtures accumulate in the pleural cavity (the slit-shaped space between the parietal and visceral sheets of the pleura surrounding each lung) is called pneumothorax. Symptoms, causes and treatment of this condition will be discussed in the article.

General information

For the pleural cavity in the normal state is characterized by a negative pressure, this provides an adequate mechanism of breathing. If the pleura is damaged (for example, as a result of a rupture of the lung or bronchus), air enters the pleural cavity, the pressure leveling with the atmospheric or exceeds it. Air penetrated into the pleural cavity, leads to squeezing the lung, provokes its collapse and shutdown from the act of breathing. With a large volume of air, the intact lung is also subjected to compression, in addition, displacement of the mediastinal organs (large vessels, heart) is observed. All this largely violates the mechanism of blood circulation and respiration.

Pneumothorax: symptoms of pathology

This disease manifests itself as follows:

• A sudden pain in the chest - acute, worse during inspiration. Painful sensations can spread to the shoulder of the affected side.

• Suddenly developing shortness of breath - difficulty breathing, rapid breathing.

• Dry cough.

• Increased heart rate.

• Appearance on the skin of cold sweat.

• The common weakness.

• Feeling of fear.

• Cyanosis of the skin (if violations of the circulation and breathing are pronounced).

Forms of the disease

• Open pneumothorax. Symptoms in this condition are as follows: penetrated into the cavity of the pleura air through the damaged large bronchus or wound of the chest communicates with the environment, during inspiration air gets into the cavity of the pleura and exits back during exhalation. Pressure in the cavity of the pleura is compared with the atmospheric, which causes the lung to fall and turn it off from the breathing process.

• Pneumothorax closed develops when air enters the pleural cavity due to a defect in the pleura. Between the cavity of the pleura and the environment there is no message, and the incoming air in the volume does not increase. Pneumothorax closed has the easiest current from a clinical point of view. Air in small quantities can dissolve independently. If there was a closed pneumothorax, the symptoms in this case are: pain from the damaged side of the chest, pallor of the skin, lack of air.

• Stressed (valve) pneumothorax. This type of pathology is the heaviest. The symptom of valve pneumothorax is the formation, with a large wound and damage to the bronchus, of the average size of the valve structure that passes air into the pleural cavity during inspiration and prevents its exit into the external environment. The volume of air in the cavity of the pleura increases at the same time. This provokes the displacement and compression of the mediastinal organs with serious circulatory and breathing disorders.

Pneumothorax: causes of the disease

Depending on the causes of the onset, several types of ailment are distinguished.

Spontaneous pneumothorax

Symptoms of the pathology are due to rupture of the lung or bronchus, which is not associated with mechanical damage to the chest or lung. Spontaneous pneumothorax can be:

1. Primary (idiopathic) , arising for no apparent reason. More susceptible to this condition are young men of high growth of 20-40 years. The most common pathology is due to:

• Genetically determined deficiency of the enzyme alpha-1-antitrypsin, which provokes pathological changes in the lungs;

• Congenital weakness of the pleura, which can easily burst with laughter, severe coughing, intense physical exertion, deep breathing;

• Pressure drop due to deep immersion in water, diving, flight on an airplane.

2. Secondary (symptomatic), when against the background of already existing lung pathology spontaneous pneumothorax develops. Symptoms of the disease occur because of:

• Respiratory diseases, for example, it can be chronic obstructive pulmonary disease (chronic inflammatory disease of the respiratory system, which develops under the influence of a variety of environmental factors, the main one is smoking, which triggers the development of chronic respiratory failure), cystic fibrosis (a hereditary disease for which Characterized by a violation of the activity of the glands of external secretion), severe exacerbation of bronchial asthma;

• Infectious diseases of the lungs, for example, tuberculosis (infectious disease caused by mycobacteria), lung abscess (a restricted area of inflammation of the lung tissue, which is characterized by melting of the lung tissue and the formation of a cavity filled with purulent contents), pneumonia (pneumonia) against HIV infection;

• Lung diseases characterized by affection of connective tissue: fibrosing alveolitis, lymphangioleiomyomatosis, sarcoidosis, histiocytosis X;

• System pathologies of connective tissue with lung lesions: systemic scleroderma, rheumatoid arthritis, dermatomyositis;

• A tumor (lung cancer).

Traumatic pneumothorax

The causes of this phenomenon are chest damage:

• Blunt trauma;

• Penetrating wound.

Iatrogenic pneumothorax

This pathology is the result of certain medical manipulations:

• Pleural or pulmonary biopsy;

• Puncture;

• Installation of a subclavian catheter;

• Artificial ventilation.

Diagnostics

In order to diagnose "pneumothorax", the symptoms of pathology should be carefully studied by a specialist in the process of medical examination. Diagnostics includes the following activities:

• Patient examination: auscultation (listening) of the lungs, examination of the chest.

• Radiography of the chest, with which you can detect air in the pleural region. The procedure is the main method for diagnosing pneumothorax.

• Analysis of the gas composition of blood.

• Computer tomography, which allows to identify the causes of secondary spontaneous pneumothorax. This diagnostic method is used if the radiography is not sufficiently informative.

• Electrocardiography, with which it is possible to detect cardiac dysfunction with valve (strained) pneumothorax.

• Consultation of pulmonologist and thoracic surgeon.

Urgent care

You should know how to provide first aid in such a pathological condition as pneumothorax. Symptoms of it should become a signal to emergency medical actions. The patient must first of all provide free access to oxygen, calm him and immediately call a doctor.

Open pneumothorax involves the imposition of an occlusive dressing, which hermetically closes the damaged area of the chest wall. The dressing, which will not allow air to pass, can be made of polyethylene or cellophane and a thick cotton-gauze layer.

Valve pneumothorax requires an immediate pleural puncture, which will help spread the lung, eliminate free gas and prevent the displacement of the mediastinal organs.

Control measures against pathology

If pneumothorax is diagnosed, treatment involves the following:

• Pleural puncture, in which the air is sucked from the pleural cavity.

• Surgical suturing of ruptures of bronchial tubes, lungs, chest wall wounds.

• Drainage of the pleural cavity with the establishment of a drainage tube through which the removal of air from the pleural cavity will take place.

• If the pain is severe in a pathology such as pneumothorax, treatment may include the use of pain medication.

• Oxygen therapy (prolonged oxygen supply through special tube systems).

• Pleurodez - the procedure of fusion of pleura sheets with the help of surgical intervention or the introduction into the pleural cavity of special medications (if pneumothoraxes are repeated often).

Complications and consequences

Pneumothorax is a serious condition that can cause:

• Intrapleural bleeding.

• Pleurisy is an inflammation of the pleura that is characterized by the formation of adhesions that provoke pulmonary dilatation disorders.

• Subcutaneous emphysema is a phenomenon in which air enters the subcutaneous fatty tissue. Determine the state of the sites of swelling, swelling of the subcutaneous tissue: when pressed, a characteristic sound appears, similar to the crunch of dry snow.

• The air gets into the mediastinal fiber. In this case, squeezing of large vessels and heart is observed.

• In particularly severe cases (with a large lesion volume, a significant penetrating chest injury), a lethal outcome is not excluded.

Prevention

To prevent pneumothorax, you should follow certain rules:

• Timely cure of lung diseases.

• Refuse to smoke.

• Avoid injury to the chest.

• If pneumothorax happens quite often, it is recommended to perform the procedure of pleurodesis (adhesion of the pleura sheets).

Conclusion

In this article, we discussed such a disease as pneumothorax. Symptoms, causes and principles of treatment of pathology were examined by us. With any pneumothorax, immediate hospitalization of the patient for surgical treatment is necessary. With adequate modern therapy, the prognosis of spontaneous pneumothorax is generally favorable. The success of the treatment of traumatic pneumothorax is affected by the nature of concomitant thoracic injuries. Take care of yourself and be well!