Pneumothorax

Introduction:

A pneumothorax means literally "air in the chest". The only problem is that the air this time is not in the lungs, but in the pleural space, which is located between the surface of the lung and the chest cavity. There is normally no air there, but just a bit of slippery fluid.

This way the pleural layer on the lung surface and the pleural layer inside the chest wall would be attached to each other by strong adhesive forces, but it still allows the lungs to move freely with every breath we take. With a penetrating injury such as a stab wound through the full thickness of the chest wall the integrity of the pleural mechanism is disturbed.

The recoil of the lung tissue from the elastic tissue in the lung collapses part or all of the lung and air gets sucked in creating the pneumothorax . This illustration shows schematically what happened without the gory details you would see as a physician in the Emergency Room of a hospital where this patient should be.

In emphysematous patients there often is an emphysematous bleb (an air filled thin blister that can easily break), usually located in the upper lung regions. Tall men, often younger than 40 years of age, can get a so-called "spontaneous" pneumothorax with no apparent cause. A more sinister cause can be a tumor in the bonchial tube (lung cancer) where the tumor creates a connection between the air from the bronchial tree and the pleural space resulting in a pneumothorax as well. Occasionally a procedure such as a central intraveonous line can cause a pneumothorax as well, which is why physicians usually do a chest X-ray when the procedure is completed to check this out.

Signs and symptoms:

The patient is suddenly short of breath and likely also complains of chest pain due to the irritation of the very sensitive pleural surfaces by air that is normally not found there. A minor pneumothorax may be missed and may be only detected on chest X-rays that perhaps were done because of an associated cough from a cold, where the doctor wanted to rule out pneumonia. With a larger pneumothorax there could be a dry, hacking cough and heart palpitations may be felt. In a large pneumothorax where most of the lung is collapsed, the circulatory symptoms may be in the foreground with a sudden collapse and serious breathing problems. There is a particularly serious pneumotharax, where a valve mechanism develops. With every breath the patient takes, more air gets pumped into the pneumothorax leading to a tension pneumothorax. This link describes the symptoms of this.

Diagnostic tests: The patient with a pneumothorax usually has less chest wall movements on the affected side. There may or may not be a lack of oxygen when arterial blood gases are taken. A chest X-ray shows a lack of lung markings on the affected side (see arrow), but the physician has to spefically look for this in more subtle cases. Auscultation (stethoscope) often reveals to the physician a lack of breath sounds on the affected side.

Treatment:

The treatment for a pneumothorax is usually a chest tube for a view days in the hospital setting until the hole in the lung seals itself as shown on this link. The chest tube is hooked up to a vacuum, which fascilitates reexpansion of the lung. Within a short period of time (1 to 3 days) the cardiovascular status tends to stabilize and the patient can often be discharged home within less than a week from the date of the hospital admission. In the case of lung cancer the patient has to be worked up and treated by a cancer specialist. In the case of an emphysematous bleb at the top of the lung, resection of this through thoracoscopy (essentially a "chop-stick" surgical set-up) can be used instead of an open procedure in order to resect the diseased top lung portion. In the case of a minor to mid-size lung surgery procedure (the top two situations of this image) this can be done with a stapling device.

Pain relief:

There is an FDA approved non-drug method available, IceWave patches from Lifewave, which will control pain. This is mentioned in the book "Breakthrough" by Suzanne Somers (Ref. 10) where newer insights of antiaging medicine are also reviewed. Although the patches are placed over acupuncture points, there are no needles involved. Nanotechnology, a newer technology, was used in the manufacturing of these patches and infrared (heat) waves from body heat are utilized to stimulate an acupuncture point, which modifies pain perception and reduces pain to half or less. Medically this would be considered an excellent pain reliever. For more info on the patches see the IceWave patches from Lifewave link above (click "products"). In the US a 5 pack of the IceWave spray is available that can be directly sprayed onto the skin in the area where the pain is located.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

2. National Asthma Education and Prevention Program. Expert Panel Report II. National Heart, Lung and Blood Institute, 1997.

6. Merck Manual 1999. Section 6: Pulmonary disorders

10. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: Dec. 22, 2008