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Spontaneous Pneumothorax

Spontaneous pneumothorax is a sudden collection of air or gas in the chest that causes the lung to collapse in the absence of a traumatic injury to the chest or lung.  Usually, a distinction is made between a spontaneous (primary) pneumothorax, and secondary (complicated) pneumothorax.

 

SPONTANEOUS (PRIMARY) PNEUMOTHORAX

Spontaneous pneumothorax occurs in individuals with no known lung disease.  It affects close to 9,000 persons in the United States each year- most often among tall, thin men between 20 and 40 years old.  The cause of this type of pneumothorax is the rupture of a bleb or cyst in the lung.

Symptoms include:

  • Chest pain on affected side
  • Dyspnea (shortness of breath)
  • Cough
  • Abnormal breathing movement
  • Rapid respiratory rate

Spontaneous pneumothorax is diagnosed by chest radiographs.

The way the condition is treated is dependant on its size and course.  The objective of treatment is to remove the air from the pleural space, allowing the lung to reexpand.  A small pneumothorax will resolve on its own in 1 to 2 weeks.  Larger pneumothoraxes require either needle aspiration or a chest tube.  Hospitalization is required for chest tube management as the reexpansion of the lung may take several days with the chest tube left in place.  Surgery may be performed for a repeated episode to prevent recurrence.

 

SECONDARY PNEUMOTHORAX

Secondary 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.  This condition is generally severe and often life threatening.

Symptoms and diagnostic procedures of secondary pneumothorax are identical to that of primary spontaneous pneumothorax.

The therapeutic options for this condition are also the same as those for primary spontaneous pneumothorax, but the circumstances are much more urgent.  A small pneumothorax can be life threatening and virtually all patients are treated with chest tubes.  Sudden death may occur before chest tubes can be place and respiratory failure can occur within hours after the tubes are inserted.  The mortality rate associated with secondary pneumothorax is high (15%).

The recurrence rate for both primary and secondary spontaneous pneumothorax is about 40% and occurs in intervals of 1.5 to 2 years.  Patients suffering from this condition should be advised to discontinue smoking and avoid high altitudes, scuba diving, or flying in unpressurized aircrafts to prevent the recurrence of pneumothorax.

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