In a pneumothorax, one or all of the lungs collapse. Reasons can be accidents or lung diseases, but pneumothorax can also occur spontaneously. The symptoms differ depending on the form and the duration of the healing is individual. What can affected people do with a pneumothorax?
- The X-ray shows a spontaneous pneumothorax of the left lung (right in the picture). The fine line shows that the two layers of the pleura are no longer firmly attached to each other.
- © iStock.com/Sopone Nawoot
If air penetrates the so-called pleural space between the lungs and chest wall, a pneumothorax develops. A pneumothorax can develop over days or be acute. In addition to spontaneous occurrence, injury or lung diseases can be the cause. The therapy and duration of healing depend on the severity of the pneumothorax.
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Symptoms: How does a pneumothorax manifest itself?
A pneumothorax manifests itself differently in a person without previous lung disease than in those who have already had lung tissue damage.
Symptoms of symptomatic pneumothorax
People who have symptomatic pneumothorax have had significant lung problems with shortness of breath in most cases. If a lung or parts of a lung collapse, this shortage of air increases and those who already have a serious chronic lung disease can quickly become life-threatening with an additional pneumothorax.
Symptoms of spontaneous pneumothorax
With spontaneous pneumothorax, on the other hand, there is classically a sudden, one-sided pain in the chest area, which is described as stinging and is breath-dependent. This pain intensifies with deep breathing, which leads to as shallow, accelerated breathing as possible.
Patients also try to avoid a breath-dependent cough due to shallow breathing. Depending on the type of pneumothorax, shortness of breath occurs quickly or gradually. In some cases, it can take days for the shortage of air to be felt.
Symptoms of tension pneumothorax
Tension pneumothorax is a much more acute clinical picture; it is a life-threatening acute case. The symptoms that appear are very severe and progress very quickly.
There is a rapidly increasing shortage of air and high heart rate. If left untreated, the full picture of cardiogenic shock, with cardiovascular failure, cyanosis (blue staining of the lips, skin and mucous membranes due to severe lack of oxygen), drop in blood pressure and congested neck veins can occur. Breathing is asymmetrical, the diseased side only performs very small breathing movements.
Tension pneumothorax can lead to the appearance of a skin emphysema (accumulation of air in the subcutaneous fatty tissue) because the air is pressed into the subcutaneous fatty tissue due to the high pressure. This can be seen from the swelling under the skin, which causes crackling noises when pressure is applied.
Therapy: how is a pneumothorax treated?
The therapy depends on how pronounced the pneumothorax is, what circumstances triggered the disease and how the patient's state of health is. The goal in all cases is to remove the air from the pleural space and prevent relapse.
All treatment options at a glance:
Wait for spontaneous healing under observation and oxygen: Very lengthy method, which is only considered in exceptional cases and with a very small pneumothorax.
Pleural drainage (suction of air through a lying drainage): A small tube is inserted into the pleural space and connected to a pump that creates a vacuum. This allows the air to be removed from the pleural space and the lungs to expand again. This procedure takes a few days and is suitable for almost all forms of pneumothorax as a first therapy.
Pleurodesis (gluing of lung skin and pleura): Gluing the pleural space is the method that effectively prevents renewed pneumothorax. Even if air gets into the pleural space again, the lungs cannot collapse because they are glued to the chest wall.
surgical intervention: A minimally invasive operation or thoracotomy (opening of the chest) is recommended if the lungs have not developed after several days despite drainage or if new air constantly flows into the pleural space.
Course: How long does it take to heal with pneumothorax?
A spontaneous pneumothorax recognized in good time has good chances of recovery and there are no long-term consequences. With severe previous diseases of the lungs, the prognosis is worse and life-threatening situations can arise. Mortality from an additional pneumothorax increases significantly, especially in people with advanced pulmonary emphysema or longstanding cystic fibrosis.
If a person has already had a pneumothorax, the event repeats itself with a probability of 25 to 50 percent, after the second pneumothorax even in 60 percent of the cases. The highest risk of relapse is in the first three months after the illness.
Depending on the severity of the disease, the time to complete healing ranges from a few days to several weeks. Once the pneumothorax has healed and there are no other lung diseases, those affected are fully resilient again. Sport, with the exception of deep-sea diving, is possible without hesitation.
What happens to a pneumothorax?
The lungs are an elastic organ that tends to contract like a balloon. To prevent this from happening, there is a negative pressure in the so-called pleural space (gap-shaped space between the lungs and chest wall) that tightens the lungs and allows them to follow the breathing movements of the chest. The lungs are surrounded by the so-called pleura (breast skin).
The breast skin consists of two layers. The outer layer is called the pleura and it lines the inside of the chest. The inner layer of the breast skin is called the lung skin and covers the surface of the lung. Both skins are smooth and moist so that they can slide on each other almost smoothly.
The thin pleural space in between is filled with some liquid, but contains no air. The two skins of the pleura adhere to each other during all breathing movements due to the slight negative pressure, like two moist glass plates placed on top of each other, and the lungs cannot detach from the chest wall.
With a pneumothorax, air penetrates into the pleural space. The air that has entered changes the normal pressure conditions, which normally prevent the lungs from collapsing. The negative pressure in the pleural space decreases, the two pleural membranes no longer adhere to each other and the lungs follow their tendency to contract. It shrinks or completely collapses. The gas exchange can then no longer take place in the collapsed (collapsed) lung. Usually only one lung is affected because the right and left chest cavity are separated.
Closed or open pneumothorax
There are several ways in which air can get into the pleural space. A closed pneumothorax is when a connection is established between the air-filled airways and the pleural space. If the air penetrates the pleural space from the outside through the chest wall due to an injury, this is an open pneumothorax.
morbidity
The likelihood of suffering from pneumothorax is relatively high at around seven cases per 100,000 inhabitants per year. Men are affected about seven times more often than women, the majority of those affected are smokers. In most cases, no reason for the development of pneumothorax can be found, this is particularly the case in tall, slim male patients between the ages of 15 and 35 years. In contrast, in the majority of the elderly there is a lung disease that causes pneumothorax.
Causes and forms of pneumothorax
There are different causes for pneumothorax. If it arises unexpectedly and in full health, one speaks of a spontaneous pneumothorax. If the pneumothorax is based on a previous disease of the lungs, it is a symptomatic pneumothorax. There is also the traumatic pneumothorax, which is the result of a chest injury, and the valve pneumothorax as a special form.
spontaneous pneumothorax
The cause is a spontaneously occurring defect in the lung tissue in the immediate vicinity of the lung skin. In these areas, enlarged alveoli are sometimes detectable, which is an inherited or acquired condition. Those affected had no complaints from these slight changes before the pneumothorax. In other cases, the lung tissue is completely normal. There are no clear risk factors; most of those affected are male, tall, slim and 15 to 35 years old.
Symptomatic pneumothorax
Damage to the lung tissue can be found here, which is responsible for the development of pneumothorax. These lung diseases are accompanied by emphysema (bloating of the alveoli), suppuration and bleeding in the lung tissue or other lung tissue damage. The pneumothorax is then a complication of the underlying disease.
The following diseases are possible:
Traumatic pneumothorax:
Injury (trauma) to the chest allows air to enter the pleural space from the outside through the injured open chest wall, or air or blood to accumulate in the pleural space from the inside due to injury to the lungs, trachea or bronchial tubes. The causes of the trauma are broken ribs and stab wounds, but also the consequences of tissue removal (biopsies) from the lungs, pulmonary mirroring (bronchoscopy), attempts at resuscitation (resuscitation), positive pressure ventilation or the placement of central venous catheters (CVC).
Probe form valve pneumothorax
The tension or valve pneumothorax is a special case. If a valve mechanism forms at the air entry point, new air flows into the pleural space with every breath without being able to escape again. There is an overpressure in the pleural space and the heart is pushed in the direction of the healthy half of the lungs.
In addition to the lung on the opposite side, the large blood vessels are also narrowed and acute circulatory failure occurs. Tension pneumothorax is an acute condition and can be fatal.
How do you diagnose a pneumothorax?
The first steps in diagnostics are a detailed consultation with the doctor and a physical examination by the doctor. The medical history gives indications of possible previous diseases of the lungs and typical symptoms of pneumothorax. By tapping and listening to the lungs with the stethoscope, the diagnosis can be confirmed for a larger pneumothorax, since no breathing noise can be heard over the affected lung section.
To confirm the diagnosis and find out the extent of the pneumothorax, one can X-ray the lungs. The collapsed lung is clearly visible on the X-ray.
In the case of existing lung diseases, it may be necessary to supplement the x-ray with a computed tomography (CT) in order to be able to assess the condition of the remaining lungs more precisely.
Can you prevent pneumothorax?
You cannot prevent pneumothorax from developing, but you can reduce the risk of the disease.
Cigarette smoking is considered an essential risk factor for spontaneous pneumothorax. The more cigarettes smoked a day, the higher the likelihood of developing the disease. Already consuming one to twelve cigarettes a day increases the risk of pneumothorax in men seven times. If you smoke more than 22 cigarettes a day, the risk is increased a hundredfold.
In addition, long-term cigarette consumption damages the lung tissue. The risk of symptomatic pneumothorax as a result of lung disease increases with time of consumption.
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