Types of pneumothorax
Primary spontaneous occurs in people without known lung disease: the cause is usually small air bubbles under the pleura that burst. Secondary develops against the background of chronic obstructive pulmonary disease, emphysema, tuberculosis, cystic fibrosis and is more severe because the respiratory reserve is already reduced. Traumatic occurs after a rib fracture, injury or medical manipulation. Tension pneumothorax is especially dangerous, when air enters the cavity with each breath and does not come back out: the pressure increases, the heart and large vessels are compressed.
- Primary spontaneous - in healthy young people
- Secondary - due to lung diseases
- Traumatic - after injuries and procedures
- Stressful - life-threatening option
- Possible bilateral pneumothorax
Symptoms
The typical onset is sudden, often at rest: a person feels a sharp stabbing pain in one side of the chest, which intensifies when inhaling, and a lack of air. The pain may radiate to the shoulder or neck. Dry cough, palpitations, pallor and cold sweat are added. With a small volume of air, complaints are moderate and sometimes go away after a few hours, which is why the person delays seeking treatment. In the tense version, shortness of breath rapidly increases, lips turn blue, blood pressure drops - this is an emergency situation.
- Sudden unilateral chest pain
- Increasing shortness of breath
- Dry cough
- Rapid heartbeat
- Paleness, cold sweat
- Blueness of the lips in severe cases
Diagnostics
The doctor detects weakening of breathing and a characteristic sound when tapping on the affected side. The main method of confirmation is a chest x-ray, where the edge of the collapsed lung and a strip of air are visible. Computed tomography more accurately assesses the volume of air, the condition of the lung tissue and the presence of bullae, so it is performed when the picture is unclear and before surgery. Blood oxygen saturation must be measured, and in severe cases, blood gases must be examined. In case of tension pneumothorax, assistance is provided immediately, without waiting for an image.
- Examination, auscultation and percussion of the chest
- Chest X-ray
- CT scan of the chest if unclear and before surgery
- Pulse oximetry
- Blood gases in severe condition
- ECG to rule out cardiac causes of pain
Treatment
Tactics depend on the volume of air, the severity of symptoms and the type of pneumothorax. With a small primary pneumothorax without severe shortness of breath, observation in a hospital with oxygen is possible: the air is gradually absorbed by itself. If the volume is significant, a puncture is performed or a drainage is installed through which the air escapes and the lung expands. Secondary pneumothorax almost always requires drainage. If the pneumothorax recurs, does not straighten out, or occurs on both sides, an operation is performed: the altered areas of the lung are removed and a procedure is performed that glues the lung to the chest wall to prevent relapse.
- Hospitalization and oxygen therapy
- Observation with low air volume
- Pleural puncture
- Drainage of the pleural cavity
- Video-assisted thoracoscopic surgery for relapses
- Pleurodesis to prevent recurrences
- Mandatory smoking cessation
After discharge and prevention of relapse
The likelihood of recurrent pneumothorax is significant, especially in smokers and in the first months after the episode. Therefore, quitting smoking is the most effective measure. Heavy physical activity and straining are limited for several weeks; the regimen is specified by the attending physician. Flights and scuba diving require special attention: you can fly only after full expansion of the lung and a doctor’s permission, and diving after spontaneous pneumothorax is usually contraindicated for life unless preventive surgery is performed. If sudden chest pain recurs, you should immediately call an ambulance.
- Complete smoking cessation
- Limiting exercise for a period specified by the doctor
- Flights only after photo verification
- Avoidance of scuba diving
- Follow-up examination by a pulmonologist
- Treatment of underlying lung disease
- Call 103 immediately if symptoms recur
