Pneumothorax

A pneumothorax is an accumulation of air in the pleural space.

Primary spontaneous pneumothoraces occur mostly in young people without known respiratory illnesses; smoking, male sex, and increased height are known associations. Patients with pre-existing pulmonary diseases may develop secondary spontaneous pneumothoraces.

A secondary spontaneous pneumothorax occurs in relation to a known lung disease.

A tension pneumothorax, when intrapleural pressure exceeds atmospheric pressure throughout expiration, is a medical emergency that requires immediate intervention to decompress (needle or open) the involved hemithorax.

Patients with pneumothoraces typically complain of dyspnea and chest pain. In tension pneumothorax, patients are distressed with rapid labored respirations, cyanosis, profuse diaphoresis, tachycardia, and eventually shock.

First-line treatment of pneumothoraces depends on the clinical scenario, but includes observation with supplemental oxygen therapy, percutaneous aspiration of the air in the pleural space, chest-tube thoracostomy, and in some cases video-assisted thoracoscopy or thoracostomy.

Patients who suffer spontaneous pneumothoraces are at risk for recurrence. Pleurodesis (either by mechanical abrasion or by chemical irritation of pleural surfaces) can be used to limit the likelihood of recurrence, and multidisciplinary teams should be involved in decision-making.

Pneumothorax occurs when air gains access to, and accumulates in, the pleural space.[1]Jantz MA, Pierson DJ. Pneumothorax and barotrauma. Clin Chest Med. 1994 Mar;15(1):75-91. http://www.ncbi.nlm.nih.gov/pubmed/8200194?tool=bestpractice.com