Spontaneous pneumothorax

Definition
Spontaneous pneumothorax is a collection of air or gas in the chest that causes the lung to collapse (see also pneumothorax) in the absence of a traumatic injury to the chest or lung.

Causes, incidence, and risk factors

A primary spontaneous pneumothorax occurs in a person with no known lung disease. It affects between 8,000 and 9,000 persons in the USA each year, usually tall, thin men between 20 and 40 years old.

Usually, the rupture of a small bleb or bulla (an air- or fluid-filled sac in the lung) causes primary spontaneous pneumothorax. Secondary spontaneous pneumothorax occurs in the setting of known lung disease, most often Chronic obstructive pulmonary disease (COPD).

Other lung diseases commonly associated with spontaneous pneumothorax include: Tuberculosis, Pneumonia, Asthma, cystic fibrosis, lung cancer, and certain forms of interstitial lung disease.

Symptoms

     
  • Sudden chest pain or chest tightness       o Dull or sharp or stabbing       o Worsened by breathing deeply or by coughing  
  • Shortness of breath  
  • Rapid respiratory rate  
  • Abnormal breathing movement       o Splinting (bending over or holding the chest to protect against pain)       o Restricting chest wall motion when breathing (protection against pain)  
  • Cough

Note: The symptoms often begin suddenly, and may occur during rest or sleep.

Signs and tests
Listening to the chest with a stethoscope (auscultation) during a physical examination reveals decreased breath sounds.

Tests performed include:

Treatment
The objective of treatment is to remove the air from the pleural space, allowing the lung to re-expand. Small pneumothoraces may resolve on their own.

Aspiration (withdrawal) of air through a catheter to a vacuum bottle may re-expand the lung.

The placement of a chest tube between the ribs into the pleural space allows the evacuation of air when simple aspiration is not successful, or the pneumothorax is large. Re-expansion of the lung may take several days with the chest tube left in place. Hospitalization is required for chest tube management.

Surgery may be indicated for recurrent episodes.

Patients should discontinue Smoking and avoid high altitudes, scuba diving, or flying in unpressurized aircraft to prevent the recurrence of pneumothorax.

Expectations (prognosis)
Between 30-50% of patients with spontaneous pneumothorax experience recurrence, but there are no long-term complications following successful therapy.

Complications
Spontaneous pneumothorax can recur.

Calling your health care provider
Call your health care provider if severe Shortness of breath develops.

Call your health care provider if you have had a spontaneous pneumothorax and you are experiencing the same or similar symptoms.

Prevention
Stopping Smoking will decrease the risk of developing severe lung disease that may lead to pneumothorax. Controlling lung diseases such as Asthma may lower the risk of pneumothorax.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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