Common Thoracic Problem

Pneumothorax

Causes

  1. Primary (unknown cause in healthy person)

    This accounts for majority of spontaneous pneumothorax that occurs in adolescent and young adult
    some predisposing factor such as male sex, tall and thin body build, slender finger and long limbs compared to trunk length.

    Its recurrence tend to be high and come in close interval. Asymptomatic attack sometime occur and increase its risk of spontaneous hemopneumothorax when recurrence cause breaking of vessels containing weak adhesion band from chest wall to the lung

  2. Associated with congenital disorder affecting whole body

    These are rare diseases with examples: pulmonary leiomyomatosis - benign multiple soft tissue tumour in lung
    Histiocytosis X - lymphomproliferative disease with malignancy potential.

  3. Associated with menstruation and congenital problem of diaphragm or endometriosis

    Catamenial pneumothorax occur in female of reproductive age group - tends to be recurrent and painful.

  4. Associated with chronic lung disease or emphysematous lung disease

    Occur in smoker or patient with obstructive lung disease where multiple weakened lung and destroyed lung tissue cause easy rupture of pleural causing air leak to pleural space. Tends to be indolent and recurrent and difficult to treat.

Symptoms

  1. sharp chest pain followed by mild discomfort in breathing
  2. severe shortness of breath and fast heart rate - tension pneumothorax
  3. some cough , sneezing
  4. No symptom, detected on X ray

Treatment option

Acute phase
  1. Chest tube drainage - insertion through chest wall intercostal plastic tubing that connect to air - valve system where air can leak out but negative pressure maintained without air sucking in
  2. Chest aspiration
  3. Oxygen therapy

Prevention of attack or definitive treatment when spontaneous cessation of air leaking failed on conservative treatment

  1. Video assisted throacoscopic pleurodesis

    - Consist of 2 parts
    - Excision of weak point usually assocated with adjacent lung bleb
    - Stimulation of formation of firm and dense adhesion of lung to chest wall especially on apical part

  2. Chemical reaction

    Bedside or operative insufflation of talcum powder

  3. Open surgery

    Rarely used nowadays mainly for failed cases or patient with partial adhesion

Success of treatment depend on prudence selection of treatment modality and skill in achieving good pleurodesis under VAT approach