pneumothorax

Pneumothorax: description

A pneumothorax is a condition in which air has entered the so-called pleural space. The air is simply said next to the lung, so that it can not stretch properly. The reasons can be different. About nine out of every 100,000 people develop pneumothorax every year.

Negative pressure is lost

The lungs are enveloped externally by a smooth organ shell, the lung pelt. The pleura dresses as a thin skin on the chest wall from the inside and is close to the lung fur. In between there is a narrow fluid-filled space, the one Pleuraspalt is called. There is a certain negative pressure in the pleural space, through which so-called adhesion forces cause the chest and lung fur to stick together. Through this mechanism, the lungs follow the movements of the ribcage with each breath.

If air now penetrates into the pleural space, the physical adhesion forces are removed. The lung can not expand in the affected area when inhaling, but collapses (lung collapse). In some cases, however, only so little air penetrates into the pleural space that the affected person hardly notices symptoms of pneumothorax.

Various forms of pneumothorax

Doctors distinguish one inner of a external pneumothorax, In the outer form, the air enters from the outside between the chest wall and the lungs – for example in an accident where something sticks in the chest. More common, however, is the internal pneumothorax, where the air enters the pleural space through the airways. There can be several reasons for this.

A serious complication is the so-called Spannungspneumothorax, It occurs in about three percent of pneumothorax cases. In a tension pneumothorax, more air is pumped into the pleural space with each breath, but it can not escape. As a result, the air in the chest takes more and more space and also compresses the unaffected lung and in addition the large veins that lead to the heart. This is a life threatening condition that needs immediate attention!

Pneumothorax: symptoms

A pneumothorax manifests itself depending on the cause and severity in different symptoms. If there is very little air in the pleural space, this is called a Mantelpneumothorax, The lungs are still largely expanded, and it may be that the person has hardly any complaints. One Pneumothorax with pulmonary collapse However, it is a frightening condition, usually accompanied by clear symptoms:

• Shortness of breath, possibly accelerated (panting) breathing
• cough
• stinging, breath-dependent pain in the affected side of the chest
• possibly formation of a bubble under the skin (skin emphysema)

At a Spannungspneumothorax the shortness of breath continues to increase. If the lungs can no longer absorb enough oxygen to supply the body, the skin and mucous membranes start to turn blue (cyanosis). The heartbeat is flat and strongly accelerated. A tension pneumothorax must be treated as soon as possible.

Pneumothorax: causes and risk factors

Doctors differentiate depending on the cause of various forms of pneumothorax. One spontaneous pneumothorax mostly occurs without apparent trigger; One speaks in this case also of an idiopathic or primary pneumothorax.

Most sufferers are tall, lean people between 15 and 35 years. Spontaneous pneumothorax is most common in young men. The cause is usually unnoticed Emphysemblasen, which lie close to the lung pelt and suddenly burst. These emphysema gases form from the small alveoli (aveoli), through which the oxygen from the lungs enters the blood as the walls dissolve between the bubbles. One important risk factor for this is cigarette smoke – around 90 percent of people with spontaneous pneumothorax are smokers.

A symptomatic or secondary pneumothorax develops from another disease of the lung. In most cases, the first disease is a COPD (chronic obstructive pulmonary disease), more rarely other diseases such as pneumonia (pneumonia).

Of a traumatic pneumothorax In general, it is said that the lung skin or pleura is injured by an external action and air enters the pleural space. This can happen, for example, through a stab injury or a broken rib.

One iatrogenic pneumothorax means that the injury was caused by a medical examination or treatment. This can happen, for example, if the doctor places a central venous catheter, but also through mechanical ventilation or a puncture.

Pneumothorax: examinations and diagnosis

First, the doctor creates the Medical history (anamnesis), It is especially important for him to know if there were previous incidents and other lung diseases. Also, certain medical procedures or injuries to the chest, together with the typical symptoms, quickly guide the suspicion of pneumothorax.

Next, the doctor examines the affected person’s chest. Above all, he listens to the heart and lungs with a stethoscope – this is the case with a pneumothorax breath sounds In the affected lung usually significantly weakened. He also knocks off the chest and hears if the Knocking sound is changed.

If pneumothorax is suspected, it will become as soon as possible X-ray examination of the ribcage carried out. In most cases, some characteristic features on the X-ray image can be identified. In addition to the accumulation of air, sometimes the collapsed lung can be recognized on the x-ray.

If the X-ray examination does not provide a clear finding, further examinations may be necessary, for example an ultrasound examination, a computed tomography or a puncture of the suspicious area.

Pneumothorax: treatment

The treatment of a pneumothorax depends first on its exact expression. If there is little air in the pleural space (mantle pneumothorax) and there are no severe symptoms, the pneumothorax can often go back completely without treatment. In that case, the person concerned initially remains under medical observation in order to observe the further course of the disease.

If the lungs have collapsed, the treatment of choice is usually one pleural drainage, The doctor introduces a drainage tube specifically from the outside through the thorax into the pleural space. In pneumothorax, this is usually done by the second rib space from above (Monaldi drainage). Through the tube, the doctor can now carefully suck the air from the pleural space and restore the negative pressure.

In case of a risk of recurrent pneumothorax, doctors sometimes perform a special operation, the so-called pleurodesis, This procedure is performed using a thoracoscopy, a reflection of the thoracic cavity. During pleurodesis, the pleura and pleura are “glued together” so that the lungs can not collapse again.

In emergencies – especially with a tension pneumothorax after an accident – for example, the emergency doctor can puncture with a cannula for the first relief of the lungs of the pleural space, so that the air pumped into it can at least escape. Later follows a pleural drainage.

Pneumothorax: disease course and prognosis

The course of a pneumothorax depends on its cause as well as the form and extent of the causative injury. Prognosis in the most common form, spontaneous pneumothorax, is usually good. Not too extensive amounts of air in the pleural space (mantle pneumothorax), the body can often absorb gradually, so that the pneumothorax regresses by itself.

If the lung collapses, treatment with pleural drainage or surgery is usually necessary; those affected usually recover well. However, one-third of patients have spontaneous pneumothorax another incident (Relapse). The best prevention is surgery (pleurodesis). In addition, those affected should not do diving because of the pressure changes and best stop smoking – both reduces the risk of recurrence.

In a traumatic pneumothorax The prognosis depends on the injury of the lung and / or pleura. Damage caused by a puncture (iatrogenic pneumothorax) is usually very small and heals by itself, while in a major injury after an accident mortal danger can exist.

A tension pneumothorax must always be treated immediately, otherwise a severe course is likely.