Barrel Truama Chest Walls Just Continue to Expand and Then Stay Expanded

Pneumothorax

Pneumothorax

Pneumothorax is the medical term for a collapsed lung. Pneumothorax occurs when air enters the space around the lungs (pleural space). Air can enter the pleural cavity when there is an open injury to the chest wall or a tear or rupture of the lung tissue, interfering with the pressure that keeps the lungs swollen. Causes of ruptured or injured chest walls or lungs can include lung disease, sports injuries or accidents, assisted breathing with a ventilator, or even changes in air pressure that a person experiences while scuba diving or mountain climbing. Sometimes the cause of a pneumothorax is unknown.

The change in pressure caused by a hole in the chest or lung wall can cause the lung to collapse and put pressure on the heart. If there is only a small amount of air trapped in the pleural cavity, as in the case of spontaneous pneumothorax, it often resolves on its own if there are no further complications. More serious cases involving larger volumes of air can be fatal if left untreated.

Types and causes of Pneumothorax

The two basic types of pneumothorax are traumatic pneumothorax and nontraumatic pneumothorax. Tension type pneumothorax is common in trauma cases and requires emergency medical care.

Traumatic pneumothorax occurs after some type of trauma or injury occurs to the chest wall or lungs. This can be a minor or significant injury. Trauma can damage the structure of the chest and cause air to leak into the pleural cavity. Examples of injuries that can cause traumatic pneumothorax include:

• trauma to the chest from a motor vehicle accident

• broken ribs

• a hard blow to the chest

• stab or gunshot wounds to the chest

• medical procedures that can damage the lungs, such as insertion of a central line, use of a ventilator, lung biopsy, or CPR.

Nontraumatic pneumothorax does not occur after injury and occurs spontaneously, which is why it is also referred to as spontaneous pneumothorax. There are two main types of spontaneous pneumothorax: primary and secondary. Primary spontaneous pneumothorax (PSP) occurs in people without lung disease, often affecting tall, thin young men.

Secondary spontaneous pneumothorax (SSP) tends to occur in older people with known lung problems. Some of the conditions that increase SSP risk include:

• chronic obstructive pulmonary disease (COPD), such as emphysema or chronic bronchitis

• acute or chronic infections, such as tuberculosis or pneumonia

• lung cancer

• Cystic fibrosis, a genetic lung disease that causes mucus build up in the lungs

• asthma, a chronic obstructive airway disease that causes inflammation

Sign and Symptomp

Sign and Symptomp

Symptoms of a traumatic pneumothorax often appear during chest trauma or injury, or shortly thereafter. The onset of symptoms of spontaneous pneumothorax usually occurs at rest. A sudden onset of chest pain is often the first symptom. Other symptoms may include:

• chest pain

• shortness of breath, or dyspnea

• cold sweats

• turning blue, or cyanotic

• fast heart rate

Diagnosis is based on the presence of air in the space around the lungs. Examination using a stethoscope can detect changes in lung sound, but detecting small pneumothorax can be difficult. Some radiological tests may be difficult to interpret because of the position of the air between the chest wall and the lungs. Imaging tests commonly used to diagnose pneumothorax include:

• Erect posteroanterior chest radiograph

• CT-scan

• Thoracic ultrasound

Treatment

Treatment options may include observation combined with chest tube insertion, or more invasive surgical procedures to treat and prevent further lung collapse.

Watchful observation is usually recommended for those who have a small PSP and who are not short of breath. In this case, the doctor will monitor the patient's condition regularly because air absorbs from the pleural cavity. An X-ray will often be done to check if the lungs have fully expanded again.

Routine physical activity has not been shown to worsen or delay healing of a pneumothorax. However, it is often recommended that intense physical activity or high-intensity exercise be postponed until the lungs have completely healed and the pneumothorax is gone.

Pneumothorax can cause decreased oxygen levels in some people. This condition is called hypoxemia. Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. This can be done at the bedside without the need for general anesthesia. Needle aspiration may be less comfortable than chest tube placement, but it is also more likely to need to be repeated.

To insert a chest tube, the doctor will insert a hollow tube between the ribs. This lets in air flow and the lungs expand again. The chest tube may remain in place for several days if there is a large pneumothorax.

Surgical treatment for pneumothorax is necessary in certain situations. Some patients may need surgery if they experience recurrent spontaneous pneumothorax. Large amounts of air trapped in the chest cavity or other lung conditions may also require surgical repair.

There are several types of surgery for pneumothorax. One option is a thoracotomy. During this operation, the surgeon will make an incision in the pleural cavity to help them see the problem.

Another option is thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS). The surgeon inserts a small camera through the chest wall to help them see inside the chest. Thoracoscopy can help surgeons decide on treatment for pneumothorax. Possibilities include sewing the blister closed, closing the air leak, or removing the part of the lung that has collapsed, which is called a lobectomy.

The long-term prognosis depends on the size of the pneumothorax, as well as the cause and treatment required. In general, small pneumothoraxes that do not causes significant symptoms can be treated with minimal observation or treatment. If the pneumothorax is large, as a result of trauma, affects both lungs, or because of an underlying lung disease, treatment and recovery may be more complicated. Recurrent pneumothorax can be more difficult to treat.

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Source: https://spesialis1.btkv.fk.unair.ac.id/pneumothorax/