A pneumothorax occurs when air enters the space between the lung and the chest wall. The resulting build-up of air prevents the lung from expanding and makes it difficult to breathe in the process. If the injury is open, the air can either enter the chest area from outside or from inside due to injury to or illness of the lungs. If air continues to enter the chest area and cannot escape, the resulting tension can cause the lungs to collapse and put pressure on the heart. In this case, this is known as a tension pneumothorax. A tension pneumothorax is a medical emergency and must be treated quickly.
The lung is surrounded by the membrane called the pleura, which consists of an inner and an exterior layer with a small space in between. A pneumothorax occurs when air enters this narrow space, either from the outside when there are external injuries or from the lungs in the event of lung disease or injuries to the lungs. If a valve mechanism forms in which air flows inwards but not outwards, the space in between is bloated (tension pneumothorax) and this can cause life-threatening pressure to be exercised on the lungs and the heart.
Rib fractures are a common cause of a tension pneumothorax. However, lung diseases such as lung cancer, asthma, lung emphysema or tuberculosis can also lead to a pneumothorax. However, a pneumothorax sometimes also occurs for no apparent reason. This is known as a spontaneous pneumothorax. Young, slim people who smoke seem to have a higher risk of suffering a spontaneous pneumothorax.
A pneumothorax can cause different symptoms, depending on its severity and how it arises. The symptoms can range from irritation of the throat, a mild feeling of pressure and pain through to severe breathlessness, widespread pain, lack of oxygen with cyanosis (blue discolouration of the skin) and a drop in blood pressure. If air gets under the skin as a result of injury, crackling or grating can be heard when pressure is placed on the skin.
If the patient has a suspected pneumothorax, a lung x-ray is carried out. In this way, a pneumothorax can be reliably diagnosed.
The treatment depends on the severity of the pneumothorax and what caused it. A spontaneous pneumothorax without visible reason can often be conservatively treated. However, the process and the regression of the pneumothorax must be closely monitored. In other cases, surgical release of the pneumothorax is required. A tube (thorax drainage) is inserted into the pleural cavity to this end so that the air can escape. If it is a tension pneumothorax, this needs to happen immediately.
If there is extensive injury to the lungs or the membrane, further surgical measures must be undertaken, depending on the situation.
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