Pneumothorax is a condition when air collects in the pleural cavity, which is the space between the lungs and the chest wall. This air can enter due to an injury to the chest or a tear in the lung. As a result , the lungs become deflated (collapsed) and cannot inflate.
Based on the cause, pneumothorax is divided into two, namely traumatic pneumothorax and nontrauma pneumothorax. Traumatic pneumothorax can result from an injury to the chest. Meanwhile, nontrauma pneumothorax can occur with or without preceded by lung disease .
When viewed from the severity, pneumothorax can be classified into:
Simple pneumothorax
In simple pneumothorax , only part of the lung collapses, but it can cause decreased oxygen levels in the blood and shortness of breath. Simple pneumothorax is not an emergency, but it still needs to be monitored.
Tension pneumothorax
In tension pneumothorax , all parts of the lung collapse, causing decreased function of the heart and other organs. Tension pneumothorax can cause death if not treated immediately.
Open pneumothorax
In an open pneumothorax , there is an open hole in the chest so that outside air can go in and out of the pleural space. If the hole is getting bigger, the lungs will be even more deflated so that the sufferer can find it difficult to breathe.
Causes of Pneumothorax
Pneumothorax can occur suddenly without a known cause or as a result of a number of the following conditions:
- Lung diseases, such as chronic obstructive pulmonary disease (COPD) , asthma, whooping cough , lung cancer, and cystic fibrosis
- Injuries to the chest, for example from gunshot wounds, stab wounds, impacts, broken ribs, or medical procedures, such as biopsies and CPR
- Rupture of an air-filled sac ( bleb ) outside the lungs due to emphysema or COPD
- Impaired balance of air pressure in the chest due to the use of breathing apparatus ( ventilator )
Pneumothorax risk factors
Pneumothorax can basically be experienced by anyone. However, people with the following conditions are more at risk for developing a pneumothorax:
- Male gender
- 20ꟷ40 years old
- Have a smoking habit
- Has a tall and thin posture, like in people with Marfan syndrome
- Have a family history of pneumothorax
- Suffering from lung disease, especially COPD
- Have had a pneumothorax before
Pneumothorax symptoms
The increase in air pressure in the pleura will prevent the lungs from expanding when you inhale. As a result, symptoms may appear in the form of:
- Hard to breathe
- Stabbing chest or shoulder pain, which gets worse when you take a deep breath or cough
- A cold sweat
- Bluish skin color ( cyanosis )
- Heart beat
- Weak
- Cough
In pneumothorax caused by other than injury, the above symptoms can develop from time to time when the patient is resting, sleeping, or while awake. However, if the pneumothorax is caused by an injury, the above symptoms can be quickly felt by the sufferer.
When to see a doctor
Immediately check with your doctor if you experience the symptoms mentioned above, especially if the symptoms appear after experiencing a chest injury or you have risk factors as mentioned above.
Keep in mind, an examination must still be done if you have a chest injury even if you don't have any symptoms, or only have mild symptoms. If the chest pain feels unbearable or your breath feels increasingly short, go immediately to the emergency room at the nearest hospital.
Pneumothorax diagnosis
The doctor will ask the patient about the symptoms experienced and the patient's medical history. The doctor will also carry out a physical examination, namely by listening to the sound in the patient's chest using a stethoscope , as well as checking blood pressure.
After that, to confirm the diagnosis, the doctor will carry out an examination with:
- Arterial blood gas analysis , to measure the oxygen level in the patient's blood
- Scan with ultrasound, chest X-ray , or CT scan, to get an image of the patient's lung condition
Pneumothorax Treatment
Treatment for a pneumothorax aims to reduce the pressure in the lungs so that they can expand properly and to prevent the disease from recurring. The treatment method that the doctor will choose depends on the severity and condition of the patient.
The following are several treatment methods that can be used to treat pneumothorax:
1. Monitoring or observation
If only a small part of the patient's lung has collapsed and there is no severe respiratory distress, the doctor may only monitor the patient's condition.
Monitoring is carried out by running X-rays periodically until the patient's lungs can re-expand. The doctor will also give oxygen if the patient has difficulty breathing or the oxygen level in the body decreases.
During the monitoring period, the doctor will ask the patient not to do strenuous activities, travel by airplane or dive, until the lungs recover.
2. Needle aspiration or chest tube placement
If most of the lung has collapsed, the doctor must remove the collection of air in the pleural space. To do this, doctors can use the following methods:
Needle aspiration, namely by inserting a needle into the patient's chest
Chest tube installation is done by inserting a tube through an incision between the sternum so that air can escape through the tube.
Pleurodesis
To prevent a collapsed lung from recurring, the doctor will perform a pleurodesis procedure. This action begins by making an incision between the patient's sternum.
Next, the doctor will install a special tube to deliver certain chemicals, such as doxycycline . These chemicals will attach the lungs to the chest wall thereby preventing outside air from entering the chest cavity.
3. Operation
Surgery is performed if other treatment methods are ineffective or the pneumothorax recurs. Surgery is performed to repair the leaky part of the lung.
In severe cases, the doctor will perform a lobectomy, which is the removal of the collapsed part of the lung.
Pneumothorax complications
Severe pneumothorax is a dangerous condition. If left unchecked, sufferers can experience complications in the form of:
- Respiratory failure
- Empyema , which is the collection of pus in the pleural space
- Pulmonary edema, which is the accumulation of fluid in the lung sacs
- Hemopneumothorax, namely the collection of air and blood in the pleural space
- Pneumomediastinum, namely the collection of air in the middle of the chest
- Pneumopericardium, which is a collection of air between the layers of the heart
- Hypoxemia, which is a lack of oxygen in the blood due to respiratory failure
- Subcutis emphysema , which is accumulation of air in the skin tissue
- cardiac arrest
Pneumothorax prevention
Not yet known how to prevent pneumothorax. However, if you have a history of pneumothorax, prevent a recurrence of this condition by taking the following steps:
- Stop smoking habit .
- Limit physical activities that are hard on the lungs, such as diving.
- Undergo treatment and routine checks to the doctor, especially if you suffer from lung disease.