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German: Pneumothorax

1 Definition

Pneumothorax is a condition in which air accumulates in the pleural space. This, ultimately, can result in the collapse of the lung.

2 Pathogenesis

Due to the accumulation of air between the two layers of the pleura (pleura visceralis directly on the surface of the lung, and pleura parietalis covering the inside of the thoracic wall), the normally negative pleural pressure is disrupted, leading to the reduction of adherence between the two layers. Thus, the lung is not following the thoracic movement anymore, leading to a loss of capacity and a partial or complete collapse of the affected lung side.

There can be external (e.g. trauma) and internal (e.g. emphysema) causes for the development of a pneumothorax. Pneumothorax can occur in combination with pleural effusion, e.g. as haematopneumothorax.

3 Possible Causes

There are many reasons for a pneumothorax, which can be summarized in four categories. Among the most common causes are:

  1. Traumatic causes: blunt or sharp traumatic injuries to the chest wall can lead to pneumothorax ranging from stabbing to fractured ribs and barotrauma.
  2. iatrogen causes: interventions such as central venous catheterization can lead to accidental injury of the pleura
  3. pulmonary diseases: Some pulmonary diseases can, as a complication, lead to a leak of air outside the alveoli. Reasons for this can be chronic diseases such as Asthma bronchiale, COPD (especially if emphysema and bulla occur) or interstitial tissue diseases (fibrosis, sarcoidosis), tumors, infectious diseases such as pneumonia (e.g. Pneumocystis pneumonia) and tuberculosis. Also systemic connective tissue diseases such as rheumatic diseases and genetic syndroms like Marfan's syndrome can present with pneumothorax.
  4. idiopathic: often in young, asthenic men

4 Symptoms

Among typical symptoms of Pneumothorax are:

  • breathing dependent pain on the affected side
  • Dyspnea, shortness of breath
  • coughing

5 Diagnostics

  • Anamnestic information regarding e.g. accidents
  • Inspection to see possible injuries, asymmetric breathing movement
  • Auscultation is an important technique in discovering a pneumothorax. There are no breathing sounds on the affected side, in certain positions a bubble sound can be heard.
  • Percussion is hypersonoric on the affected side
  • sonography, x-ray, CT

6 Therapy

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