Pneumothorax

-Hitesh Rohit(3rd year

B.P.T.)
 INTRODUCTION:-
• A collapsed lung.
• This condition occurs when air leaks into the space between the
lungs and chest wall(pleura).
• Approximately 40% of pneumothoraces are traumatic (due to
chest wall trauma or iatrogenic procedures).
• Spontaneous pneumothorax occurs without a precipitating
event in individuals with preexisting lung disease.
• The air pushes on the outside of your lung and makes it
collapse.

• Pneumothorax can be a complete lung collapse or a collapse

of only a portion of the lung.
CAUSES:-
• Chest injury-
• Any blunt or penetrating injury to the chest,
• Injuries during physical assaults or car crashes,
• Injuries during medical procedures,i.e. insertion of a needle into
the chest.

• Ruptured air blisters- Small air blisters (blebs) can develop on the
top of the lungs. These blebs sometimes burst-allowing air to leak
into the space that surrounds the lungs.
• Lung disease - COPD, pneumonia and cystic fibrosis

• Mechanical ventilation - A severe type of pneumothorax can

occur in people who need mechanical assistance to breathe.
• The ventilator can create an imbalance of air pressure within
the chest. The lung may collapse completely.
TYPES OF PNEUMOTHORAX:-
• There are three types of pneumothorax-
• 1)open pneumothorax
• 2)close pneumothorax
• 3)tension pneumothorax
• 1)Open pneumothorax

• Open pneumothorax occurs when air gets into the

pleural space from an injury to the chest.
• An open pneumothorax means the air in the pleural space
communicates freely with the outside environment.
• When air can move freely through the chest wall, into and out
of the pleural space, the patient is unable to maintain a
negative pleural space pressure.(plu. Pressure= atm. Pressure)
• Because an effective negative pleural space pressure cannot
be maintained in both the affected and unaffected hemithorax,
the patient’s ability to move air into the lungs is severely
diminished.
• Lung volumes are decreased, lung compliance is decreased,
ventilation–perfusion mismatching is increased, and gas
exchange is impaired.
• 2)Close pneumothorax:-

• Closed pneumothorax is when air or gas gets in the pleural

space without any outside wound.
• This sometimes happens when the lung is already injured
somehow, like from diseases such as cancer or cystic fibrosis.
• Pleural pressure is negative.
3) Tension pneumothorax:-

• Air trapped into pleura due to leak in pleuralspace.

• A tension pneumothorax means air can enter the pleural space
but cannot escape into the external environment .
•This is an acute life-threatening situation .
•As air continues to enter and become trapped in the pleural
space, the intrapleural pressure rapidly increases .
•This causes the lung on the involved side to collapse.
•The mediastinal structures are pushed away from the affected
side.
• The increased thoracic pressure causes a decrease in venous
return, cardiac output falls, and systemic hypotension and
shock are the result.
• Lung volumes are significantly reduced, lung compliance is
decreased, and the alveolar-capillary surface area available
for gas exchange is cut by more than 50%
CLINICAL
PRESENTATION:-
• A steady ache in the chest
• Shortness of breath/dyspnea 
• Breaking out in a cold sweat
• Tightness in the chest
• Cyanosis
• Severe tachycardia
• Hypotension
 DIAGNOSIS:-
• Possible deviation of mediastinum toward contralateral side
• Decreased or absent breath sounds with decreased or absent
vocal fremitus on the affected side
• Abnormal chest x-ray showing dense-appearing underlying lung
tissue; thin, fine line at periphery;
and uniform translucency with complete absence of lung markings
in area of pneumothorax;
possible overexpansion of the affected rib cage with
flattening of the hemidiaphragm if pneumothorax is large.
TREATMENT:-
• The definitive treatment of an open pneumothorax is the
application of an airtight, sterile dressing over the sucking
chest wound and the placement of a chest tube into the pleural
space of the affected hemithorax.
• The chest tube is connected to suction so that the air and any
fluid or blood within the pleural space can be evacuated.
• These measures will reexpand the collapsed lung.
• Mechanical ventilation and supplemental oxygen may be
required until the patient can maintain tissue oxygenation
independently.
• A tension pneumothorax is treated as an emergency by
inserting a needle into the pleural space to allow air to escape.
• This is immediately followed by placement of a chest tube
connected to suction so that air can be continuously evacuated
from the pleural space along with any blood or fluid.
• Pleurodesis in patients with repetitive pneumothorax
(a procedure which obliterates the pleural space to prevent
future pneumothoraces)