Pneumothorax occurs when air or some gas accumulated in the pleural space, which is a closed area between the lungs and the chest wall. For proper lung function, it is necessary that no air is present in the pleural space. This is the reason for the negative pressure in the pleural spaces which ensures that the lungs are inflated and fill the chest cavity. Due to this mechanism, the lungs increase in size during inspiration and decrease in size during expiration.
Causes of pneumothorax
Pneumothorax occurs when air enters the pleural space and interferes with the normally present negative pressure and causes the lung to move away from the chest wall. This affects the ability of the lung to inflate during inspiration and therefore greatly limits the exchange of respiratory gases between the blood and air in the lungs. The causes of pneumothorax are many. Injury to the chest wall is a common cause, where air from outside the chest wall enters the pleural space through the injury. In contrast, an injury to the lung, for example when pierced by a broken rib, can permit air to enter the pleural space via the lungs. Pneumothorax can occur as a complication to some surgical procedures and very often during a failed attempt to insert a catheter into the chest veins. It can also occur during procedures to remove infected fluids (which can press on the lungs) from the pleural space.
Types of pneumothorax
Pneumothorax is a condition that must be quickly diagnosed and treated. There are two basic types of pneumothorax – closed and open.
Uzavřený pneumotorax je způsoben poraněním plicní tkáně, ze které se vzduch dostává do pohrudniční dutiny. Při tomto druhu pneumotoraxu tedy není porušena hrudní stěna a není zde vytvořena komunikace s vnějším prostředím.
A closed pneumothorax is caused by damage to the lung tissue. In this case, the air enters the pleural space from within the body, from the lungs. Therefore, the chest wall is not damaged and there is no communication to the outside through the chest wall.
An open pneumothorax is caused by damage to the chest wall which allows air to enter the pleural space. A very dangerous form of the open pneumothorax is the tension pneumothorax, which sucks air into the pleural space during inspiration but traps the air during expiration. This causes the accumulation of air to increase in the pleural space and pushes on the lungs, other chest organs and the heart. The biggest risk is the possibility of limiting the heart function and interfering with its ability to pump blood to important organs. There are also serious breathing problems due to the collapse of one lung and the other lung can slowly lose its function as well.
The symptoms of pneumothorax
The symptoms of pneumothorax can be various and depend on the size and speed of its manifestation and also on other illnesses. Most often though, pacients complain of severe chest pain, cough and breathing problems. If there is damage to the chest wall, then frothy fluid can appear from the wound. In the case of tension pneumothorax, the pacient is pale and cyanotic (bluish skin colour) with a quick pulse and low blood pressure. Since these symptoms can appear in many different illnesses of the respiratory tract and the heart, it is up to the physician to properly diagnose pneumothorax and quickly start treatment.
Diagnosis of pneumothorax
The diagnosis of pneumothorax begins with the clinical symptoms such as quick pulse and low blood pressure. Breathing sounds on the damaged side can be lessened or even missing. Diagnosis is confirmed with a chest X-ray, where it is possible to see the enlarged pleural space, smaller lung and the heart that has been pushed towards the healthy side of the chest cavity.
The treatment of pneumothorax consists of inserting a needle into the pleural space and subsequent removal of the accumulated air. This allows for the re-emergence of the negative pressure and the lung once again fills the chest cavity and exhibits normal breathing movements. In terms of first aid, the first step is to call for professional help. It is also important to place the affected individual into a sitting position and cover the wound in order to prevent infection but allow for drainage of any blood. This is done by leaving the bottom part of the bandage loose. In the case of suffocation, place the individual into a stabilized position on the damaged side. Never remove foreign bodies from the wound!