Pneumothorax

Brief presentation of spontaneous pneumothorax and treatment (click)

Παρουσίαση κλινικού περιστατικού με αυτόματο πνευμοθώρακα

 

Definition

Auto pneumothorax (spirit = air + chest) is the non-traumatic collection of air within the pleural cavity.

 

Types
  • Primary spontaneous pneumothorax (PSP), which is not associated with clinically evident lung disease.
  • Secondary spontaneous pneumothorax (SSP), which is associated with clinically evident lung disease.

 

Epidemiology

Primary spontaneous pneumothorax usually occurs in tall and thin people, aged 15-34 years. It rarely occurs in people older than 40 years. Secondary spontaneous pneumothorax occurs mainly in patients with underlying lung disease, usually in people older than 55 years. The reported incidence is 6.3-24/100000 per year for men and 1.2-9.8/100000 per year for women.

The most likely risk factors for spontaneous pneumothorax are:

 

Causal factors

The main causes of air collection within the pleural cavity are as follows:

 

Pathogenesis

The interpretation of the pathogenesis of spontaneous pneumothorax is based on the following hypotheses:

  • the degradation of pulmonary elastic fibres promotes the formation of subpulmonary emphysematous cysts
  • the presence of emphysematous cysts promotes inflammation leading to the obstruction of small airways
  • an increase in intra-alveolar pressure to levels higher than the intrapulmonary pressure results in air escaping from the alveoli into the pleural cavity

Very small (blebs) or larger (bullae) emphysematous cysts have been found in 94% of patients with recurrent or complicated spontaneous pneumothorax. Primary pneumothorax may be familial.

 

Symptoms

Symptoms usually present suddenly and may be mild or absent. The most common symptoms are:

  • Shortness of breath
  • Chest pain
    • sudden
    • Acid
    • unilateral
    • localized on the sides
    • greater intensity at the start
    • usually sets after 24h

It has also been observed that 87% of patients were not doing any activity at the onset of symptoms, 9% of patients were doing some sudden movement, while only 2% were doing some vigorous activity. In catamenial pneumothorax, the symptoms occur during menstruation, and there are usually concomitant symptoms of endometriosis. Symptoms of cardiorespiratory dysfunction are usually due to tension pneumothorax.

 

Clinical examination
  • reduced development of the mediastinum
  • transcendence in impact
  • reduction or absence of respiratory depression

 

Diagnostic approach
  • Imaging control
    • Chest X-ray
    • Chest CT
    • Transthoracic ultrasound

 Chest X-ray

 Chest X-ray

 Computed tomography of the chest

 Computed tomography of the chest

Transthoracic chest ultrasound

Address

 

General recommendations

  • In case of tension pneumothorax, immediate drainage is recommended
  • Monitoring is suggested for:
    • patients with small spontaneous pneumothorax (distance between free lung boundary and chest wall < 2cm) and non-significant dyspnoea
    • selected, asymptomatic patients with large spontaneous pneumothorax (distance between free lung boundary and chest wall > 2cm) 
  • High flow oxygen administration to all patients
  • Hospital admission of all patients with secondary spontaneous pneumothorax
  • Interventional treatment is recommended in all patients with primary or secondary spontaneous pneumothorax and dyspnoea related to the extent of the pneumothorax
    • pneumothorax drainage by the insertion of a needle, catheter or chest tube
      • needle drainage can be as effective as tube insertion and thus reduce hospital days
    • pleurodesis with pleurodesis agent through the chest tube or thoracoscopically (VATS)
      • chemical pleurodesis is suitable for patients who are unable or do not want surgical treatment
  • For patients with recurrent spontaneous pneumothorax it is recommended:
    • pleurodesis with pleurodesis agent through the chest tube or thoracoscopically (VATS)
      • thoracoscopic talc infusion reduces the recurrence rate compared to talc injection through the chest tube
      • pleurodesis with minocycline infusion reduces the recurrence rate and subsequent thoracoscopic procedures
    • surgical treatment
      • for difficult or recurrent pneumothoraces, open access and pleurectomy has the lowest recurrence rate (1%)
      • the thoracoscopic approach compared to the open approach has similar results
  • The treatment of catamenial pneumothorax involves a combination of surgery and hormone therapy

 

Surgical treatment

 

Pneumothorax drainage with needle insertion into the affected hemithorax

 

Pneumothorax drainage with placement of a chest drainage tube in the affected hemithorax

 

Thoracoscopic and open treatment

 

Pleurisy

 

Complications of pneumothorax

 

Forecast

Secondary spontaneous pneumothorax is associated with higher morbidity and mortality than primary spontaneous pneumothorax

 

Guidelines

 

You can arrange an appointment with the doctor

In the morning the Thoracic Surgeon, Dr Athanasios Kleontas MD is at the Interbalkan Medical Center of Thessaloniki, while in the evening he is at his private office (73, Ermou St).

+30 2310 - 400000

Office 11, 2nd floor. Dec 1742

ATHANASIOS D. KLEONTAS

SOCIAL NETWORKS

PATIENT VISITATION HOURS

Doctor is available (by mobile) 24 hours a day, 7 days a week.

You meet him only by appointment at his private office:

Monday to Friday : 18.00 - 21.00

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