SPONTANEOUS PNEMOTHORAX CHIZINDU IHINWO 1009

INTRODUCTION Spontaneous pneumothorax is a collection of air or gas in the space between the lungs and the chest that "collapses" the lung and prevents it from inflating completely. Spontaneous means there is no traumatic injury to the chest or lung.

There are two types of spontaneous pneumothorax: 1)Primary spontaneous pneumothorax 2)Secondary spontaneous pneumothora Primary spontaneous pneumothorax occurs in people without lung disease. It occurs most often in tall, thin, young people.

Secondary spontaneous pneumothorax occurs in people who have underlying lung disease. The most common lung disease that causes spontaneous pneumothorax is chronic obstructive pulmonary disease (COPD). Other lung diseases associated with spontaneous pneumothorax include: Asthma Cystic fibrosis Interstitial lung disease Lung cancer Pneumonia Tuberculosis

Signs and Symptoms Symptoms often begin suddenly, and may occur during rest or sleep. They can include:Abnormal breathing movement Restricting chest wall motion when breathing to protect against pain Splinting -- bending over or holding the chest to protect against pain Cough Rapid respiratory rate Shortness of breath Sudden chest pain or chest tightness Breathing or coughing makes pain worse Chest pain may be dull, sharp, or stabbing

TREATMENT for Pneumothorax The objective of treatment is to remove the air from around the lungs, allowing the lung to re-expand N/B=Small lung collapses may get better without any treatment. Simple aspiration(thoracentesis) Intercostal tube drainage Pleurodesis Surgery

Complication Tention Pneumothorax Pneumomediastinum Pneumoperitoneum Interstitial Emphysema Subcutaneous Emphysema

Risk factors Patients affected by PSP tend to be tall.[1] Marfan's syndrome or a Marfan's habitus increases the risk. Smoking increases the risk of pneumothorax. Smoking is associated with a 12% risk of developing pneumothorax in healthy smoking men compared with 0.1% in non-smokers.[1]  Pneumothorax is not usually associated with physical exertion and the onset is just as likely to occur during sedentary activity.[1] 

Case Study John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospital’s emergency room. The emergency room physician listened to John’s breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor’s questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker. After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in John’s right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lung’s own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of the pneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying in nonpressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray.

Case Background Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal. The pneumothorax decreases the efficiency of the respiratory system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If the pneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the reexpansion of the lung

References Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax. Chest.  http://www.nytimes.com/health/guides/disease/spontaneous-pneumothorax/overview.html http://www.mrmjournal.com/content/6/1/6 http://www.patient.co.uk/doctor/pneumothorax-pro