What is air ball
A pneumothorax is a condition in which air has entered what is known as the pleural space. Put simply, the air is next to the lungs, so that they can no longer expand properly. The reasons for this can be different. Every year around nine out of 100,000 people develop a pneumothorax.
Negative pressure is lost
The outside of the lungs is covered by a smooth organ shell, the lung membrane. The pleura, as a thin skin, lines the chest wall from the inside and lies close to the pleura. In between there is a narrow, liquid-filled space that you can use Pleural space is called. There is a certain negative pressure in the pleural space, through which so-called adhesive forces make the pleura and lung pleura adhere to each other. This mechanism allows the lungs to follow the movements of the chest with each breath.
If air penetrates the pleural space, the physical adhesive forces are canceled. The lungs cannot expand in the affected area when you breathe in, but instead collapse (lung collapse). In some cases, however, so little air penetrates the pleural space that the person concerned hardly notices symptoms of a pneumothorax.
Different forms of pneumothorax
Doctors distinguish one inner of a external pneumothorax. With the outer shape, the air enters from the outside between the chest wall and the lungs - for example in an accident in which something stabs the chest. More common, however, is the internal pneumothorax, in which air enters the pleural space through the airways. There can be several reasons for this.
A serious complication is the so-called Tension pneumothorax. It occurs in about three percent of pneumothorax cases. With a tension pneumothorax, more air is pumped into the pleural space with each breath, but it can no longer escape. As a result, the air in the chest takes up more and more space and also presses the unaffected lungs together as well as the large veins that lead to the heart. This is a life threatening condition that needs immediate treatment!
A pneumothorax manifests itself in different symptoms depending on the cause and severity. If there is very little air in the pleural space, this is also called one Mantle pneumothorax. The lungs are still largely expanded and the person concerned may have hardly any symptoms. A Pneumothorax with collapsed lung however, is a frightening condition that is usually accompanied by clear symptoms:
- Shortness of breath, possibly accelerated (panting) breathing
- Throat irritation
- sharp, breath-dependent pain in the affected side of the chest
- possible formation of an air bubble under the skin (skin emphysema)
At a Tension pneumothorax the shortness of breath increases further and further. If the lungs can no longer absorb enough oxygen to supply the body, the skin and mucous membranes turn blue (cyanosis). The heartbeat is flat and fast. Tension pneumothorax needs medical attention as soon as possible.
Pneumothorax: causes and risk factors
Doctors differentiate between different forms of pneumothorax depending on the cause. A Spontaneous pneumothorax usually occurs without a recognizable trigger; one speaks in this case of an idiopathic or primary pneumothorax.
Most people affected are tall, slim people between the ages of 15 and 35. Spontaneous pneumothorax is most common in young men. The cause are mostly unnoticed emphysema bubbles that lie close to the lung membrane and suddenly burst. These emphysema bubbles form from the small alveoli (aveoli) through which the oxygen from the lungs reaches the blood when the walls between the individual bubbles dissolve. An important risk factor for this is cigarette smoke - around 90 percent of people with spontaneous pneumothorax are smokers.
A symptomatic or secondary pneumothorax develops from another disease of the lungs. In most cases, the first illness is COPD (chronic obstructive pulmonary disease), less often it is other diseases such as pneumonia.
Of a traumatic pneumothorax One speaks generally when the pleura or pleura is injured by an external influence and air penetrates into the pleural space. This can happen, for example, from a stab wound or a broken rib.
A iatrogenic pneumothorax means that the injury was caused by a medical examination or treatment. This can happen, for example, when the doctor places a central venous catheter, but also with mechanical ventilation or a pleural puncture.
Pneumothorax: examinations and diagnosis
First, the doctor creates the Medical history (anamnesis). It is particularly important for him to know whether there have been previous incidents and other lung diseases. Certain medical interventions or injuries to the chest, along with the typical symptoms, also quickly lead to suspicion of a pneumothorax.
Next, the doctor examines the person's chest. Above all, he listens to the heart and lungs with a stethoscope - this is the case with a pneumothorax Breathing sound usually significantly weakened in the affected lung. He also taps the chest and listens to see if it does Knocking sound is changed.
If a pneumothorax is suspected, a X-ray examination of the chest carried out. In most cases, some distinctive features can be seen on the X-ray. In addition to the accumulation of air, the collapsed lung can sometimes also be seen on the X-ray.
If the x-ray examination does not produce a clear result, further examinations may be necessary, for example an ultrasound examination, computed tomography or a puncture of the suspicious area.
The treatment of a pneumothorax depends first of all on its exact form. If there is only a little air in the pleural space (mantle pneumothorax) and there are no severe symptoms, the pneumothorax can often regress completely without treatment. In this case, the person concerned initially remains under medical observation in order to observe the further course of the disease.
If the lungs have collapsed, the therapy of choice is usually one Pleural drainage. The doctor inserts a drainage tube from the outside through the chest and into the pleural space. In the case of pneumothorax, this usually happens through the second space between the ribs from above (Monaldi drainage). The doctor can now carefully suck the air out of the pleural space through the tube and thus restore the negative pressure.
If there is a risk of recurring pneumothorax, doctors sometimes also perform a special operation, the so-called Pleurodesis. This procedure is performed with the help of a thoracoscopy, a reflection of the chest cavity. In pleurodesis, the pleura and pleura are “glued” together so that the lungs cannot collapse again.
In emergencies - especially a tension pneumothorax after an accident - the emergency doctor can, for example, puncture the pleural space with a cannula to first relieve the lungs, so that the air pumped in can at least escape. A pleural drainage follows later.
Read more about the therapies
Read more about therapies that can help here:
Pneumothorax: disease course and prognosis
The course of a pneumothorax depends on its cause and the type and extent of the injury that caused it. The prognosis for the most common form, spontaneous pneumothorax, is usually good. The body can often gradually absorb not too extensive amounts of air in the pleural space (mantle pneumothorax), so that the pneumothorax regresses by itself.
If the lungs collapse, treatment with pleural drainage or surgery is usually necessary; people usually recover well from this. However, it occurs in a third of patients with a spontaneous pneumothorax another incident (Relapse). The best prevention here is an operation (pleurodesis). In addition, because of the changes in pressure, those affected should not practice diving and it is best to stop smoking - both of these reduce the risk of a relapse.
In a traumatic one Pneumothorax the prognosis depends on the injury to the lungs and / or pleura. Damage caused by a puncture (iatrogenic pneumothorax) is usually very small and heals on its own, while a major injury after an accident can be fatal.
A tension pneumothorax must always be treated immediately, otherwise a severe course is likely.
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