Pneumothorax

Pneumothorax means air in the pleural space, making an air containing pleural cavity. Air may enter the pleural cavity through the chest wall, mediastinum, or disphragm, or from a puncture of the visceral pleura convering the lung. The term spontaneous pneumothorax refers to cases which are not due to trauma.

Causes:

1. Spontaneous

1) Primary -- Due to rupture of apical subpleural bleb (Benign spontaneous pneumothorax). Most common in young men.

2) Secondary -- Rupture of subpleural TB focus (active lesion or local emphysematous area from old scarring). Emphysematous bullae. Congenital cysts and bullae. Honeycomb lung.Oesophageal brupture.

Infections (other than TB) -- Bacterial pneumonia, lung abscess, pneumocystis carinii pneumonia, whooping cough ,bronchiectasis.

Diffuse fibrosing pulmonary disease: Sarcoidosis, Pneumoconiosis, Interstitial fibrosis.

Asthma -- Chronic bronchitis and emphysema.

Cystic fibrosis.

Neoplasms -- Bronchial or pleural.

Secondary to spontaneous mediastinal emphysema.

Pulmonary infarction.

2. Traumatic

Iatrogenic or accidental -- Chest aspiration, transbronchial biopsy, needle aspiration lung biopsy, intercostal never block, subclavian cannulation, positive pressure ventilation, transthoracic liver biopsy, surgical procedures at base of neck, chest compression injury (including external cardiac massage).

Non-iatrogenic -- Penetrating chest wounds, Crush injury.

Symptoms: Vary depending on -- (a) amount of air in the pleral sac, (b) rapidity of its accumulation, (c) condition of the lungs.

1. Insidious onset -- Vague discomfort in chest, later shortness of breath on exertion. In tuberculous spontaneous pneumothorax the onset is not always sudden as the condition commonly occurs in patients suffering from advanced pulmonary T. B. which has already cut down their normal activities. Patient may complain of more breathlessness or may have chest pain, or the pneumothorax may be latent and detected by routine chest examination.

2. Sudden onset -- Feeling of something snapping in the chest, severe pain, shock, increasing shortness of breath. Blood streaked sputum, cyanosis, restlessness and collapse.

3. If hydropneumothorax -- Splash of fluid in the chest when he jumps may be the first intimation to the patient.