- The lungs are covered by a saclike
membrane known as the pleura, which separates the lungs from
the bony (ribs) chest wall. The pleurae have two layers: one
covers the lungs (visceral), the other is attached to the
inside of the chest cavity (parietal). Between the two
layers there is a thin film of fluid that lubricates the
lungs, allowing them to move smoothly during respiration
(breathing). Under normal conditions, there should be no air
between the lungs and the chest cavity. The introduction of
air into this cavity will cause the lung to collapse, and
- The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax
- Depends on the size of p.
- Chest pain:
- Sharp or stabbing
- Chest tightness
- Made worse by breathing or coughing
- Shortness of breath
- Cyanosis or bluish color to the skin and lips due to
hypoxia (low oxygen level)
- Rapid rate of breathing
- Patient may be in Shock or unconscious, especially with
trauma or tension p.
- Primary p. -- in healthy individuals this
occurs without any underlying diseases
- Secondary -- complication of underlying
- Spontaneous p. -- often occurs after the
rupture of a bulla (aka bleb) or blister (not found in normal
lungs), which are small air-filled sacs in the lungs of
individuals with certain risk factors. Could be primary or
- Procedures or surgeries
- Skin may show the site of trauma
- Low Blood Pressure
- Fever may be present
- Air can leak under the skin (subcutaneous Emphysema) and has a spongy feel
- Pallor -- pale skin
- Rapid heart and respiration rate
- The chest movements are not symmetrical
- The trachea (major airway -- located in the center of
the neck) may be shifted in tension p.
- When the doctor listens to the heart or the lungs, the
normal sounds may be diminished or absent.
- Chest X-Ray will show the abnormal air pocket,
and Collapsed Lung or structures that have
been pushed to one side.
- CAT scan, using computer imaging, shows detailed views
of the chest and lungs.
- Blood tests may show low oxygen
levels (<80 mm Hg) and acidic blood (acidosis = pH
- Tall thin males in their 20-40s (Marfan's and
- Family history of p.
- History of p. -- 50% chance of recurrence after one
- COPD (Chronic Obstructive Pulmonary Disease) or Emphysema
- Cystic Fibrosis
- Whooping Cough
- Rapid climbing to high altitudes or while scuba diving
- Pneumonias such as with klebsiella or
- Traumatic -- injury to the chest such as in knife or
gunshot wounds, automobile accident, procedures like
pleural biopsy, endoscopy, Thoracentesis, chest tube placement
- Tension p. -- the air is trapped and builds up with
each breath. It can put pressure on and shift other
structures in the chest, such as the esophagus, trachea,
heart, and blood vessels.
- Tension p. risk factors -- lung
infections, trauma to the chest, mechanical ventilation (a
machine that breaths for the patient), and CPR.
- Outpatient treatment -- if there is no hypoxia
(reduction of oxygen supply to tissues) and the collapse is
less than 30%:
- Assurance that air will be absorbed into the body
- Oxygen therapy
- Monitor blood pressure, heart rate and
- In patient with severe symptoms and collapse
- Objective is to remove the air.
- General physician may consult with a surgeon or a
pulmonologist (lung doctor).
- A needle may be used to remove the air.
- Aspiration involves inserting a catheter (Teflon tube)
into the chest cavity (between the ribs) and attaching to
a simple bottle (vacuum inside with no air). This may be
enough to expand the Collapsed Lung.
- A plastic chest tube is inserted through an incision
in the chest (between the ribs) and then connected to
suction. This method may take few days to drain the
trapped air and expand the Collapsed Lung.
- Multiple episodes of Pneumothorax may require surgery or
injection of medicines (talc or Doxycycline) into the
Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk
to your doctor before high altitude climbing, flying, or
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