Pneumothorax

Condition in which air accumulates in the pleural sac, causing it to expand and thus compress the underlying lung, which may then collapse. (The pleural sac is a cavity formed by the two pleural membranes that line the thoracic cavity and cover the lungs.) Traumatic pneumothorax is the accumulation of air caused by penetrating wounds (knife stabbing, gunshot) or other injuries to the chest wall, after which air is sucked through the opening and into the pleural sac. Spontaneous pneumothorax is the passage of air into the pleural sac from an abnormal connection created between the pleura and the bronchial system as a result of tuberculosis or some other lung disease. The symptoms of spontaneous pneumothorax are a sharp pain in one side of the chest and shortness of breath.

Causes Your two lungs are separated by your heart, airways and the major blood vessels in the center of your chest (mediastinum). All these structures are enclosed by your chest wall, a combination of ribs, cartilage and muscle. Each lung is covered by a thin, moist tissue called the pleura, which also lines the chest wall. The two layers of pleura are like pieces of smooth satin that allow your lungs to expand and contract easily. Your lungs and chest wall are both elastic, but as you inhale and exhale; your lungs recoil inward while your chest wall expands outward. The two opposing forces create a negative pressure in the pleural space between your rib cage and lung. When air enters that space, either from inside or outside your lungs, the pressure it exerts can cause all or part of the affected lung to collapse.

There are several types of pneumothorax, which are defined according to what causes them: Primary spontaneous pneumothorax. This usually occurs in otherwise healthy people with no history of chest trauma. It's most common in tall, thin men many of them smokers between 20 and 40 years of age. Primary spontaneous pneumothorax is thought to develop when a small air blister (bleb) on the lung ruptures. Blebs are caused by a weakness in the lung tissue and can rupture from changes in air pressure when you're scuba diving, flying, mountain climbing or, according to some reports, listening to extremely loud music.

Primary spontaneous pneumothorax can run in families, and researchers think that genetic factors also may play a role. A primary spontaneous pneumothorax is usually mild because pressure from the collapsed portion of the lung in turn collapses the bleb. Secondary spontaneous pneumothorax. This develops in people who already have a lung disorder, especially emphysema, which progressively damages your lungs. Other conditions that can lead to secondary pneumothorax include tuberculosis, pneumonia, cystic fibrosis and lung cancer. In these cases, the pneumothorax occurs because the diseased lung tissue is next to the pleura.

Although the signs and symptoms of primary and secondary spontaneous pneumothorax are identical, secondary pneumothorax can be more severe and even life-threatening because diseased tissue opens a wider hole and therefore lets more air into the pleural space than does a small, ruptured bleb. Traumatic pneumothorax. Any blunt or penetrating injury to your chest can cause lung collapse. Knife and gunshot wounds, a blow to the chest, even a deployed air bag can cause a pneumothorax. So can injuries that inadvertently occur during certain medical procedures such as the insertion of chest tubes, cardiopulmonary resuscitation (CPR) and lung or liver biopsies. Pneumothorax is especially common in people whose breathing is aided by a mechanical ventilator.

Tension pneumothorax. The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air becomes trapped in the pleural space or because the entering air is from a positive-pressure mechanical ventilator. The force of the air can cause the affected lung to collapse completely. It can also push the heart toward the uncollapsed lung, compressing both it and the heart. Tension pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated quickly.

Anatomy and Function of the Normal Lung The chest contains two lungs, one lung on the right side of the chest, the other on the left side of the chest. Each lung is made up of sections called lobes. The lung is soft and protected by the ribcage. The purposes of the lungs are to bring oxygen (abbreviated O2), into the body and to remove carbon dioxide (abbreviated CO2). Oxygen is a gas that provides us energy while carbon dioxide is a waste product or "exhaust" of the body. To deliver oxygen to the body, air is breathed in through the nose, mouth or both. The nose is the preferred route since it is a better filter than the mouth. The nose decreases the amount of irritants delivered to the lung, whilst also heating and adding moisture (humidity) into the air we breathe. When large amounts of air are needed, the nose is not the most efficient way of getting air into the lungs and therefore mouth breathing may be used. Mouth breathing is commonly needed when exercising. After entering the nose or mouth, air travels down the trachea or "windpipe". The trachea is the tube lying closest to the neck. Behind the trachea is the esophagus or "food tube". When we inhale air moves down the trachea and when we eat food moves down the esophagus. The path air and food take is controlled by the epiglottis, a gate that prevents food from entering the trachea. Occasionally, food or liquid may enter the trachea resulting in choking and coughing spasms. The trachea divides into one left and one right breathing tube, and these are termed bronchi. The left bronchus leads to the left lung and the right bronchus leads to the right lung. These breathing tubes continue to divide into smaller and smaller tubes called bronchioles. The bronchioles end in tiny air sacs called alveoli. Alveoli, which means "bunch of grapes" in Italian, look like clusters of grapes attached to tiny breathing tubes. There are over 300 million alveoli in normal lungs. Gas exchange in the lungs is between the alveolar air and the blood in the pulmonary capillaries. This exchange is a result of increased concentration of oxygen, and a decrease of C02. Homeostasis is maintained by the respiratory system in two ways: gas exchange and regulation of blood pH. Gas exchange is performed by the lungs by eliminating carbon dioxide, a waste product given off by cellular respiration. As carbon dioxide exits the body, oxygen needed for cellular respiration enters the body through the lungs. ATP, produced by cellular respiration, provides the energy for the body to perform many functions, including nerve conduction and muscle contraction. Lack of oxygen affects brain function, sense of judgment, and a host of other problems.

Pathophysiology
Penetrating chest that causes injury

Opening pleural cavity

Atmosphere is greater then pleural pressure

Air in the pleural cavity

Increase pressure in the chest

Pneumothorax

Decrease oxygen in the body

Chest pain Tachypnea and Tachycardia