Accumulation of air in the plural cavity named as pneumothorax. Finally it will leads to to lung collapse
In normal lungs it has double layered pleura one is outer part connected with intercostal cold parietal pleura other one is connected was with lung this is in a pot inner layer between these two layers it has fluid it will prevent from faction.
Between these two plural layers there is intra pleural pressure this pressure helps to keep lungs expanded lung collapse in word chest wall bulge outward.
Courses of air into pleural cavity according to this we can classified pneumothorax into two oneness spontaneous pneumothorax other Venice from attic pneumothorax in spontaneous pneumothorax it has 2 types primary and secondary spontaneous pneumothorax means without chroma any warning without precipitating causes pneumothorax can occur.
Primary spontaneous pneumothorax is causes by idiopathic. Which Means the course is unknown normally in young male tall usually smokers aged below 30 years old.
In in the the case of secondary spontaneous pneumothorax host by underlying factor already persistent disease in lungs.
The air can enter in the pleural cavity bye two paths. Oneness subpleural bleb intra plural blab mostly in in young tall smoker male patients. Another way by pulmonary bullae.
Emphysema– is is elastic tissue destruction in the distal airway. It will leads to destruction and cavitedry lesson.
Rather than emphysema lung abscess, TB, pneumonia pneumocystis pneumonia cystic fibrosis pulmonary infraction carcinoma of lungs also can cause secondary spontaneous pneumothorax.
Traumatic pneumothorax is air enters via trauma to lungs or chest wall.
Another way the pneumothorax classified into to three
Closed pneumothorax is once air leak into the the pleural cavity the lession will be closed.so further air leackege will be stoped. In here risk is Less.
Open pneumothorax is is there is entry point in in inspiration and expiration. Both closed pneumothorax and open pneumothorax are standard pneumothorax which means with the time the volume of of air bubble will not increase. In here rim of air is less than 3cm.
Other one is tension pneumothorax this is most dangerous type of pneumothorax in this condition savere hypoxemia will occur therefor mediastinal shift will occur. it will compress the the heart and major blood vessels so that venous return and cardiac output will be increased. Main sign of tension pneumothorax is tracheal deviation this is a a really dangerous complication of pneumothorax finally it will end up in cardiac arrest.
In tension pneumothorax chest hole wall will bulge out so chest wall movement will decrease.
Symptoms of pneumothorax
Shortness of breath
Distress and anxious
Tachypnea (increased respiratory rate)
Rapid and weak pulse
Neck vein encouraged
pale cyanotic appearance
Investigations and management
In palpation we can heard the hyperresonant sound. As well as absence of breath sound. For this decompress will be done in the second intercostal space using a wide bore needle. The needle should not be removed. Thoraco chest tube can be used.
For the secondary tension pneumothorax aspirate before taking the chest x-ray. Aspirate with large bore (nearly 8cm) needle. Decompression can be done. But it is temporary management. So chest tube will be fixed.
Pneumothorax is hemodynamically unstable because blood pressure will be decreased tachycardia will occur and also respiratory rate will increase. In x-ray no peripheral vasculature margin can be seen.
CT scan is also benifitial in the investigation process. Indication for the CT scan are.
- Underlying lung disease in chest X- Ray
- Uncertain diagnosis
- Not routinely indicate
Sometimes bleb or bullae are confused with pneumothorax in this time CT scan can be done. And also bedside ultrasound is most common. In ultrasound scan lung sliding can be noted.
ABG test also will be done. Hypoxia will be there. But bicarbonate will be in in normal level. Later stages respiratory alkalosis can occur. CO2 will be decreased. So decreased ventilation may occur.