What is pneumothorax (Collapsed Lung)?
Pneumothorax occurs when the accumulated air in the lungs leaks between the pleural cavity. The space between the lungs and chest wall is called the pleural cavity. The accumulated air outside the gap between the lungs and chest wall exerts pressure on the lungs. This can collapse the lungs and is also called as collapsed lungs in medical terms.
It can lead to a complete collapse or partial collapse. Pneumothorax can be caused due to an injury, medical procedure or damage due to lung diseases. Sometimes, a pneumothorax can occur without any reason.
Pneumothorax can occur if a person has the chronic obstructive pulmonary disease. However, the occurrence can be common in both categories of people— with or without an underlying lung disease.
Sometimes, the long-term impact of pneumothorax can vary depending on the trapped air between the lungs and chest. If the trapped air is in a small amount, there can be very few or no further complications. If the trapped air is in large amounts, it can have an effect on the heart and can be life-threatening.
Types of pneumothorax
The pneumothorax is classified into five major types and is briefed below.
Simple pneumothorax
Simple pneumothorax is a non-extending type. The cause of the simple pneumothorax is unknown. Tall adolescent males are at a higher risk of simple pneumothorax. However, females are equally vulnerable to this condition.
Other risk factors include smoking, connective tissue disorders like rheumatoid arthritis, and activities like scuba diving can also cause pneumothorax.
Primary spontaneous
Primary spontaneous pneumothorax can occur in people who do not have any underlying lung diseases. The cause of such lung collapse is unknown.
People who smoke tobacco, people in the age group of 15–34 and with a family history of pneumothorax, are at higher risk of getting affected by such disease. However, with proper and timely treatment, primary spontaneous pneumothorax can be prevented from being fatal
Secondary spontaneous or disease-related
Secondary spontaneous can occur if a person is affected with lung diseases or disorders. The secondary spontaneous pneumothorax causes more significant symptoms than the primary spontaneous pneumothorax.
It can be fatal if left untreated, and some of the diseases that can lead to pneumothorax are listed below.
- Asthma,
- Sarcoidosis,
- Pulmonary fibrosis,
- Lung cancer,
- Sarcomas,
- Tuberculosis and
- Pneumonia.
Connective tissue disorders like systemic sclerosis, rheumatoid arthritis and polymyositis can also cause secondary spontaneous pneumothorax.
Children with certain conditions like congenital malformations, measles and echinococcosis are at a higher risk of getting affected with secondary spontaneous pneumothorax.
Traumatic or injury-related
Traumatic pneumothorax occurs as a result of major injury. Injuries related to lung and chest wall can cause such diseases.
When there is a rib injury or fracture, the sharp edges of the rib can damage the chest wall, lungs and surrounding tissues. This can lead to traumatic pneumothorax.
Other major injuries like car accidents, sports injuries and stab wounds can also lead to pneumothorax.
Pneumothorax can occur when a wound is caused due to an injury left untreated or ignored. This is common in people who experienced traumatic accidents.
Injury-related pneumothorax is common for scuba divers. The pressure on land is different when compared to a deep underwater environment. While diving in such a high-pressure environment, they experience pressure from the water and air. This pressure can damage the lungs and cause pneumothorax.
Certain clinical procedures like a catheter insertion to the chest through veins or trying to take a sample from the lungs can also cause pneumothorax. There will be medical follow-ups to look for any early symptoms of pneumothorax.
Tension pneumothorax
Tension pneumothorax can be caused due to any of the above types. Tension pneumothorax is caused when a person inhales, and the air escapes into the cavity between pleural space, which forms a one-way valve. This will inhibit the outflow of air.
The escaped air cannot be released while exhaling, and this can lead to increased air pressure in the pleural space. This can compromise the cardiopulmonary function and leads to tension pneumothorax.
The tension pneumothorax can be life-threatening, and it requires immediate medical attention to avoid being fatal.
Pneumothorax Symptoms
Some of the common symptoms of pneumothorax are discussed below. The symptoms can differ from one person to another and also on the severity of the disease.
Bluish skin
Bluish skin can be caused when there is a lack of oxygen.
Chest pain or ache and tightness
Chest pain or ache and tightness are common symptoms of pneumothorax. The trapped air can exert pressure on the lungs from the outside and cause pain or tightness.
Shortness of breath and coughing
Shortness of breath and coughing can commonly occur in pneumothorax.
Fatigue
Fatigue can be caused due to insufficient oxygen. Sometimes, you might feel tired and drained out of energy due to an insufficient supply of oxygen.
Fast breathing
Fast breathing is a common symptom of pneumothorax. When you run out of breath, it can cause fast breathing.
Fast heartbeat
Fast heartbeat can be common in elderly patients with underlying health conditions like COPD and lung diseases.
Diagnosis
The diagnosis of pneumothorax is explained below.
Physical exam
Physical examination is important, and the doctor will inquire about certain medical history and underlying medical conditions.
Physical examination is conducted to test for any injury in the trachea, injury in the neck veins and other respiratory problems.
If the affected person is stable enough, the healthcare professional can inquire about the symptoms experienced. Sometimes, patients might have decreased movement on the affected side.
With the help of physical examination, other findings like unequal breath sounds,decreased movement on the affected side and abnormalities in the vital signs. With the physical examination findings, further diagnosis will be conducted.
X-rays
Chest x-rays are useful to diagnose collapsed lungs. X-rays will quantify the size of the pneumothorax and other underlying pathology. The chest x-ray will also spot any abnormalities or disease in the airways.
The chest x-ray gives a clear image of the lung and if there is any presence of water in the lungs or air surrounding the lungs.
CT scan
X-rays are useful in detecting the presence of pneumothorax. But in some patients, further clear confirmation may be required, and for that CT scan will be useful.
Computed tomography will have a rotating x-ray machine and a computer. The CT scan provides a detailed image of the blood vessels, soft tissue and bones surrounding the lungs. It gives a better perspective about the disease than x-rays.
CT scan gives a detailed information if any rib has punctured the lungs. This can lead to pneumothorax. It also gives certain information about internal bleeding and other damaged inner organs.
Electrocardiogram (EKG)
An electrocardiogram records the electrical signal of the heart. EKG is a common test to detect changes in the heartbeat and other heart-related problems.
The electrocardiogram is useful in accessing pneumothorax. It detects the changes in amplitude and waves insertions and alterations when a person breathes. It also detects the changes in right-axis deviations.
Arterial blood gas or pulse oximetry
The arterial blood gas and pulse oximetry will measure the amount of oxygen the lungs can pump. This will give detailed information about lung functions.
The arterial blood gas test is an invasive method and requires a blood sample from the patient.
The pulse oximetry is not an invasive method, and a small sensor will be attached to the patient’s finger. This will provide the measurement of the oxygen that is present in the blood.
The arterial blood gas measures the presence of oxygen and carbon dioxide in the blood. The blood sample is collected from the artery. This test gives a detailed information about the oxygen, carbon dioxide and acidity levels in the blood.
This method of diagnosis will only give the result from the collected blood and can be less accurate. It cannot be used as a confirmation test.
Treatment
The treatment for a pneumothorax depends on the diagnosis and symptoms of the patient.
Observation
The first treatment option will be observed. The patient will be kept under observation for a certain time. The symptoms will also be observed, and then treatment will be provided.
Supplemental oxygen
Supplemental oxygen is given to patients when they have shortness of breath. Supplemental oxygen will help them to breathe properly without any difficulty.
Needle aspiration
Needle aspiration is a technique to treat pneumothorax. A needle will be inserted along with a flexible tube called a catheter. The catheter will be passed between the ribs that are air-filled and pressed against the lungs.
The needle will be removed, and with the help of the catheter, the excess air will be removed. The inserted catheter will be left for a few hours so that the lungs are expanded again and also to make sure the pneumothorax does not occur again.
Chest tube drainage
The chest tube drainage will have a flexible, hollow tube that will be inserted into the chest. It helps to drain the fluid or air from the lungs. The tube will be inserted between the chest cavity and the inner lining of the chest. This technique is used to expand the lungs fully.
Chemical pleurodesis
Chemical pleurodesis is a technique used to relieve pleural effusion. This technique is mostly used when there is fluid build-up between the membranes surrounding the lungs.
The chemical will be placed between the two membranes that line the lungs, which causes the membrane to scar and adhere together.
This scarring will help to annihilate the pleural space between the membranes. The procedure will be carried out in the operating room with general anaesthesia.
This technique is efficient if carried out in general. However, if there are many effusions, the technique will not be efficient.
Surgery
When the other options like chest tube and chemical pleurodesis do not work, surgery option is suggested. The surgery is called thoracoscopy.
The surgery option is considered when a person experiences two or more experiences of pneumothorax. Also, the surgery is suggested when there is full collapse and tension pneumothorax of the lungs.
There are other methods and techniques available to treat pneumothorax, but when there is a repeated occurrence, surgery is suggested.
After the surgery, a person may feel certain discomfort. However, these complications and discomforts may settle down as hours pass. If the complications still persist, consult your doctor immediately.
Prevention
There are certain ways to prevent from getting affected with pneumothorax. Certain lifestyle changes are required to prevent pneumothorax.
Stop smoking
Smoking increases the risk of getting affected with pneumothorax. So avoid the habit of smoking.
Avoid or limit activities with drastic changes in air pressure
Activities like scuba diving and jumping from a higher altitude can cause a major difference in pressure and increases the risk of pneumothorax.
See your provider regularly to monitor any lung conditions
Sometimes, an underlying lung condition or a disease can lead to pneumothorax. It is advisable to get checked about the lung conditions atleast once in six months.
If you have a lung problem, keep up with your medical visits
If you are affected by any kind of lung disease or condition, frequent medical visits to monitor the disease are important. This will keep a check on your health and also monitors any development in the new disease.
Conclusion
The reason for pneumothorax is unknown, and lung collapse can be prevented by abstaining from certain activities like smoking can prevent pneumothorax from occurring.
The common symptoms of pneumothorax are chest pain and shortness of breath. So if a person experiences such symptoms, it is important to get immediate medical attention. If left untreated, pneumothorax can be fatal.
In some cases, pneumothorax can heal by itself, but in major cases, it requires medical treatment to handle the symptoms and complications.
Sometimes a pneumothorax cannot be prevented due to a family history. In such conditions, a person makes certain lifestyle changes to prevent the occurrence of pneumothorax.
