A spontaneous pneumothorax, or the sudden collapse of a single lung, may occur without any trauma or injury. The pneumothorax results from the rupture of a blister on the lung, which allows air to leak out. When this condition occurs in an individual without prior history of lung disease, it is known as primary spontaneous pneumothorax. This is most commonly seen in tall, thin individuals between the ages of 17-40 who have a predisposition to spontaneous pneumothorax. The anatomy of their lungs, in addition to the large volume of air they hold makes it more likely that a small blister–a bleb–will burst on the upper part of the lung. The lung collapse is unpredictable, as it may occur during physical activity or simply at rest.
When the pneumothorax is due to an underlying lung condition such as emphysema, it is known as a secondary spontaneous pneumothorax. In this, the emphysematous blebs are larger and known as bulla.
There are different types of pneumothorax, each defined by its cause:
Primary spontaneous pneumothorax occurs when you don’t have an underlying lung disease. It is often caused by the rupture (bursting) of an air-filled sac in the lung, called a bleb or bullae. This occurs in young healthy patients. The recurrence risk for non-operated patients is almost 20%.
Secondary spontaneous pneumothorax is a complication of another lung disease, such as chronic obstructive lung disease (COPD, or emphysema), asthma or tuberculosis (TB). This condition is more challenging as the patients have underlying medical conditions that leaves them with less ”reserve” to tolerate even a partial lung collapse. The risk of recurrence is usually 50%, and surgical intervention is more often needed.
Tension pneumothorax occurs when excessive pressure builds up around the lung, forcing it to collapse. Because this pressure can also affect your heart’s ability to pump blood, it is considered the most serious type.
Catamenial pneumothorax is a condition of collapsed lung occurring in conjunction with the menstrual cycle.
It’s important to realize that you may have one or several of the symptoms listed below without having this condition. The same symptoms are often caused by other less serious health problems. Symptoms of pneumothorax can occur while you’re awake or asleep. They can include:
- Sudden, sharp pain in the chest that gets worse during coughing or taking deep breaths
- Acute shortness of breath
- Mild fever
- Tightness in the chest
- Rapid heartbeat
- Bluish color of the skin due to lack of oxygen
- Flaring of the nostrils
- Feelings of anxiety
- Low blood pressure
- A distended abdomen
- Being a tall, thin man between 20 and 40 years old
- A family history of pneumothorax
- Having other lung diseases such as COPD, emphysema, asthma, cystic fibrosis, tuberculosis or pertussis
- Menstrual periods
A physical examination of the chest to see if the affected side of your chest has diminished or shows a lack of breath sounds.
Other diagnostic tests can include:
- Chest X-ray to see if there is air outside the lung
- CT scan, ultrasound
- EKG to read electrical activity in the heart
- Pulse oximetry: A noninvasive way to measure your blood oxygen levels
MINIMALLY INVASIVE TECHNIQUES
Video Assisted Thoracoscopic Surgery (VATS)
For uncomplicated primary spontaneous pneumothorax in patients with a clean medical history, surgery may not be necessary unless the pneumothorax recurs.
In secondary spontaneous pneumothorax, surgery is done with a VATS approach. The bleb or bullae is removed, and the lung is made to adhere to the chest wall in order to prevent future pneumothoraces, using mechanical pleurodesis. Talc pleurodesis is used only for a failed primary procedure. This surgical technique almost always prevents recurrence of pneumothorax. Non-surgical management of secondary spontaneous pneumothorax can have a up to 50% recurrence rate.