Pneumothorax means the accumulation of air in the chest cavity as a result of rupture of the lung. Accumulated air impairs the comfortable expansion of the lungs, making it difficult to breathe.
How Does Pneumothorax Occur?
When the lung is likened to a tree, the air taken during respiration is carried to the alveoli, which are the most extreme points in the airways, re-oxygenating the carbon dioxide-rich blood known as dirty blood, and oxygenating the blood circulation in the body. provides delivery. Respiration and oxygenation process in the lung takes place in a closed environment. If there is a leak site due to any reason in the lung tissue, the inhaled air accumulates between the lung tissue and the chest wall.
Pneumothorax means air accumulation in the chest cavity as a result of rupture in the lung. Accumulated air impairs the comfortable expansion of the lungs, making it difficult to breathe. Especially in smokers, air sacs called bullae form in the lungs, and when these burst, pneumothorax occurs. However, pneumothorax may occur not only due to the bursting of the bulla, that is, due to a lung disease (such as pneumonia, cancer, cyst) tearing the lung or perforation of the lung as a result of trauma.
The most common cause is traumas. In addition, it can also be seen as a result of spontaneous explosion of air sacs developed due to age and/or chronic diseases. traffic accident, severe blow, gunshot or penetrating gun injuries. In addition, lung collapse can be seen during or after lung biopsy, sometimes as a result of the broken rib sinking into the lung, during heart massage and during biopsy with bronchoscopy (endoscopy of the lung). pneumonia (pneumonia), tuberculosis (tuberculosis), sarcoidosis (a disease of unknown origin, which can affect organs such as the eyes, lymph nodes, skin, heart, brain, especially the lungs), cystic fibrosis (lungs, pancreas, liver, intestines, sinuses) and an inherited disease affecting the reproductive organs), bullae, bleb (air sacs), and lung cancer predisposing to the development of pneumothorax� It may be �.
What are the Symptoms of Pneumothorax?
Symptoms vary according to the severity of the disease. Shortness of breath is usually seen with sudden onset and severe chest pain. If the leak is large and the lung is deflated, the patient may develop sudden hypotension and shock. Other accompanying symptoms may include coughing, rapid pulse and bruising on the lips. > Thin, smoking men aged 20-40 years were defined as the risk group for pneumothorax. The presence of a previous underlying lung disease may be a predisposing cause. Some genetic diseases (eg, alpha-1 antitrypsin deficiency) are more prone to pneumothorax.
Other people who are in the risk group, although less frequently: Those who are exposed to pressure changes (such as divers, airplane travelers, pilots, mountain climbers) Patients who are connected to a ventilator (mechanical ventilation).
How is Pneumothorax Diagnosed?
Diagnosis is made by combining patient complaints, presence of underlying lung disease, and previous history of pneumothorax. In physical examination, respiratory sounds disappear or decrease and/or are heard deeply. Chest radiography (plain radiography, computed tomography) is necessary to determine the degree of lung leakage. Tension pneumothorax, which prevents blood from being pumped into the body, is seen. These patients require an urgent approach.
How is Pneumothorax Treated?
The basic principle of treatment is to evacuate the air accumulated in the chest cavity and to reduce the pressure on the lung. For this reason, air can be evacuated by placing a tube in the chest cavity. In most of the patients, this treatment is sufficient, because the ruptured area in the lung renews itself in a few days and closes. However, if the healing takes a long time or the air sacs in the lung are large and likely to burst again, the recommended minimally invasive methods are to repair the tear area and remove the air sacs. If there is no symptom or mild, if pneumothorax has developed for the first time and there is no obvious air gagging or bullae in the radiological evaluation, these patients can be followed up with observation and oxygen therapy. Underwater drainage is applied with a 2-2.5 cm incision at the breast level, called thoracostomy.
Usually, observation and underwater drainage are sufficient in the first attack. However, some patients may require surgical treatment. These patients are:
- Patients with prolonged air leakage,
- Recurrent pneumothorax cases,
- Patients with bilateral pneumothorax,
- Patients with one lung,
- Patients with an occupational predisposition to pneumothorax (such as pilot, diver) are treated surgically even if it is the first attack.
What Should Be Considered After the Surgical Approach?
- Smoking is definitely it should never be used again,
- It should not be stopped even in the smoking environment (substances that break down elastin and collagen fibers, including the lungs and other organs, in cigarettes, quickly penetrate the skin and mix into the blood),
- The given drugs should be used regularly,
- Regular walking should be done,
- Conditions such as constipation that require straining should be avoided,
- Plenty of fruits and vegetables should be consumed,
- Heavy loads should not be lifted. These patients should stay away from physical activities and sportive activities that require effort or straining for at least 6 months.
- Patients should have regular monthly check-ups.
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