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Pleural Effusion

Pneumothorax is defined as a collection of gas in the pleural space that results in complete or partial collapse of the lung. Normally the pressure in the normal pleural sac is sub atmospheric. With leakage of air into the pleural space the pressure approaches atmospheric, which leads to the collapse of the lung. If pressure in a pneumothorax rises above atmospheric as may occur in a one way (ball valve) leak into the pleural space, a tension pneumothorax is present. This is an emergency.

A pneumothorax is defined as free air (pneumo) trapped within the chest cavity (thorax) - but not within the lungs themselves. Pneumothoraces are divided into tension and non-tension pneumathoraces. A pneumothorax may occur for no identifiable reason; doctors call this a spontaneous pneumothorax. Pneumothorax is considered one of the most common forms of thoracic disease and is classified as spontaneous (not caused by trauma), traumatic, or iatrogenic. Pneumothorax may occur after resuscitation of the baby with oxygen with a pressure bag and mask, as a complication of meconium aspiration syndrome , or most often simply spontaneously when the baby takes its first big breaths. It affects close to 9,000 persons in the United States each year- most often among tall, thin men between 20 and 40 years old.  Spontaneous pneumothorax usually occurs when a small weakened area of lung (bulla) ruptures (primary spontaneous pneumothorax). A pneumothorax may become life-threatening if the pressure in your chest prevents the lungs from getting enough oxygen into the blood.

Pneumothorax is one type of lung disorders called air leak syndrome. A baby can have more than one form of air leak. Signs of pneumothorax include respiratory distress in general - grunting, flaring of the nostrils (nares) , and rapid breathing (tachypnea). The intrapleural space is normally just a 'potential space' that exists between two layers of 'pleura' - thin tissue layers, one of which covers lungs, and one of which lines the chest cavity. If a pneumothorax is severe or the baby is otherwise compromised (for example with respiratory distress syndrome), surgical placement of a plastic suction tube may be done to suck out the air as it leaks out into the pleural space around the lung. A non-tension pneumothorax by contrast is a less severe pathology because the air in the pneumothorax is able to escape. A tension pneumothorax results from any lung parenchymal or bronchial injury that acts as a one-way valve and allows free air to move into an intact pleural space but prevents the free exit of that air. Because of the underlying lung disease, the symptoms and outcome are generally worse in secondary spontaneous pneumothorax; the recurrence rate is similar to that of primary spontaneous pneumothorax.

Causes of Pneumothorax

The comman causes of Pneumothorax include the following :

  • A pneumothorax is usually caused by an injury to the chest, such as a broken rib or puncture wound.
  • Air leaks occur when the alveoli (tiny air sacs) become overdistended and burst.
  • Drugs and toxins.
  • Chemotherapy for malignancy.
  • People who smoke cigarettes are much more likely to suffer a spontaneous pneumothorax than those who don't.
  • Tension pneumothorax is caused when excessive pressure builds up around the lung, forcing it to collapse.
  • Paraquat poisoning.
  • Spontaneous pneumothorax can result from damage to the lungs caused by conditions such as chronic obstructive pulmonary disease (COPD) , asthma , cystic fibrosis , and pneumonia.
  • Tension pneumothorax may be the result of blunt trauma with or without associated rib fractures.
  • Spontaneous pneumothorax can also occur in people who don't have lung disease.

Symptoms of Pneumothorax

Some sign and symptoms related to Pneumothorax are as follows:

  • Sudden sharp chest pain , made worse by a deep breath or a cough.
  • Bluish color of the skin caused by lack of oxygen.
  • Chest tightness.
  • Primary pneumothorax is usually associated with pain and shortness of breath.
  • Rapid respiratory rate.
  • Secondary pneumothorax in patients with associated lung disease causes severe shortness of breath; pain is also common.
  • Easy fatigue.
  • Rapid heart rate.
  • Splinting - bending over or holding the chest to protect against pain.

Treatment of Pneumothorax

Here is list of the methods for treating Pneumothorax:

  • A chest tube ( chest tube insertion ) placed between the ribs into space surrounding the lungs helps clear the air and allows the lung to re-expand.
  • Supplemental oxygen may be needed to help air around the lung be reabsorbed more quickly.
  • A tension pneumothorax is a contraindication to the use of military antishock trousers.
  • A procedure called pleurodesis can help prevent air and fluid buildup around the lungs and prevent collapses.
  • High frequency ventilation is sometimes used for babies with PIE.
  • Surgery may be needed to prevent recurrent episodes.