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PostPosted: Sun Mar 15, 2009 1:45 pm    Post subject: thought this may be usefull
 
Pneumothorax

What is it?
The inside of the chest is divided into three basic parts: the right hemi thorax (right side), the left
hemi thorax (left side), and the mediastinum (the center section.). The right and left sides do not
communicate with each other. Therefore, what happens on one side of the chest does not
necessarily occur on the other side.
Each lung completely fills its side of the chest. Under normal conditions, there should be no
space between the lung and the chest wall. There is a potential space between the lung and the
chest wall called the pleural space. If air is introduced into the pleural space, then the lung
separates from the chest wall. This collection of air inside the chest, surrounding the lung, is
called a pneumothorax. Some refer to this loss of lung volume as “a collapsed lung.” In fact, the
lung is not like a balloon that pops when it is injured. The lung has substance inside it, and will
usually remain partially inflated. However, if sufficient air continues to enter the pleural space, the
lung can be nearly completely compressed by air under pressure, and a “tension pneumothorax”
results.
What causes it?
There are many causes of pneumothorax. Any condition that can result in air entering the pleural
space is a culprit. There are generally three sources of air: the lung, the atmosphere, and the
abdomen.
The Lung
The lung is the most frequent source of air causing pneumothorax. There are a large number of
conditions of the lung that can lead to this problem. They include:
· Congenital blebs
· Giant blebs
· Emphysema
· Trauma
· Lung cancer
· Granulomatous disease
· Iatrogenic (secondary to medical treatments)
Blebs are similar to large, air-filled blisters that exist on the surface of the lung. The most common
form of blebs is congenital blebs; that is, the patient is born with them. These congenital blebs are
typically located at the apex, or top of the lung, in tall thin individuals. Like any thin walled blister,
the bleb can eventually rupture, leaking air into the chest. This air collects outside the lung,
causing the lung to be pushed away from the chest wall, or “collapse”. The patient typically has a
sharp pain in the chest, and becomes short of breath. The same events occur whether the
disease process is due to congenital blebs, giant blebs, or emphysema.
The patient who presents with a pneumothorax for no apparent reason is said to have a
spontaneous pneumothorax. Typically, at the time of the first pneumothorax, a chest tube is
placed and the air leak allowed to heal. If the patient heals the leak, but the pneumothorax recurs,
then the patient should usually undergo surgical therapy In trauma, the lung leaks air into the chest due to an injury. The lung is injured by very high
pressures from a blunt force, or is pierced by a sharp object or bullet. The mechanism of
pneumothorax is the same as for blebs.
Occasionally, lung cancers and infections in the lung will create an air leak, and a pneumothorax
occurs.
Finally, procedures such as lung biopsy or drainage of fluid with a needle will create a leak from
the lung.
The Atmosphere
Air enters the chest from the atmosphere due to a defect or hole in the chest wall. The most
common causes are trauma and drainage procedures. Trauma may result in a small or large
defect in the chest wall through which air may enter the chest. In drainage or biopsy procedures,
a needle is passed through the chest wall to drain fluid or to perform a biopsy. When this is done,
there is always a chance that air will be introduced into the chest, and a pneumothorax result.
The Abdomen
Air enters the chest from the abdomen occasionally during laparoscopic surgery. Carbon dioxide
is insufflated into the abdomen under pressure during laparoscopy. Occasionally, a patient will
have a small defect in the diaphragm that allows the carbon dioxide to enter the chest, thereby
causing a pneumothorax.
What is the treatment of pneumothorax?
The treatment depends upon the cause of the pneumothorax. In almost all cases, a chest tube is
placed under local anesthesia to drain the air out of the chest and re-expand the lung. A chest
tube is a small plastic catheter about the diameter of the small finger. While the patient is awake
and lying flat, local anesthetic (“novacaine”) is injected into a spot usually beneath the breast. A
tiny incision is made in the skin, and the tube is introduced into the chest between the ribs. It is
secured into place with sutures. The tube is connected to a device that aspirates the air from the
chest, and re-expands the lung.
The tube will remain in place until one of two things happens. The first: the tube is removed when
the air leak spontaneously heals. The second: the air leak fails to heal within a reasonable period
of time (4-7 days), so the patient undergoes a surgical procedure to close the leak.
Fortunately, most patients heal their air leak within a short period of time. However, if the leak
does not heal and surgery is required, thoracoscopy is usually sufficient to repair the problem.
The procedure is called thoracoscopy, bleb resection, and talc pleurodesis.
At thoracoscopy, a small endoscope (camera) is introduced into the chest, and the bleb is
identified. A special surgical device is used to remove the bleb and seal the lung. Then, a
pleurodesis is performed. A pleurodesis is a procedure that “glues” the lung up to the chest wall,
so that the lung is adherent to the chest wall, and cannot separate from the chest wall in the
future. There are several techniques of pleurodesis, including pleurectomy, instillation of sterile
talc, and instillation of bleomycin. The objective of each of these techniques is to create adhesion
between the lung and chest wall to prevent a recurrent pneumothorax.
When something other than a bleb is the cause of the pneumothorax, thoracoscopy may be
inadequate to repair the problem, and a thoracotomy may be required. At the time of
thoracotomy, the cause is identified and treated appropriately.
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Hazz Reply with quote
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Joined: 12 May 2008
Posts: 210
Location: Florida

PostPosted: Sun Mar 15, 2009 10:31 pm    Post subject:
 
Shocked
Thank You for this information garethreynolds! Very Happy

This will help a lot of people that did not get the infor from there health care people. Wink
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garethreynolds Reply with quote
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Joined: 09 Mar 2009
Posts: 10
Location: stowmarket,uk

PostPosted: Thu Mar 19, 2009 9:15 pm    Post subject: more info
 
Pneumothorax

Cross-section diagram showing lungs with pneumothorax (092.gif)

A pneumothorax is air that is trapped next to a lung. Most cases occur 'out of the blue' in healthy young men. Some develop as a complication from a chest injury or a lung disease. The common symptom is a sudden sharp chest pain followed by pains when you breathe in. You may become breathless. In most cases, the pneumothorax clears without needing treatment. The trapped air of a large pneumothorax may need to be removed if it causes breathing difficulty. An operation is needed in some cases.
What is a pneumothorax?

Cross-section diagram showing lungs with pneumothorax (092.gif)
A pneumothorax is air that is trapped between a lung and the chest wall. The air gets there either from the lungs or from outside the body.
What are the causes?
Primary spontaneous pneumothorax

This means that the pneumothorax develops for no apparent reason in an otherwise healthy person. This is the common type of pneumothorax. It is thought to be due to a tiny tear of an outer part of the lung - usually near the top of the lung. It is often not clear why this occurs. However, the tear often occurs at the site of a tiny 'bleb' or 'bullae' on the edge of a lung. These are like small 'balloons' of tissue that may develop on the edge of a lung. The wall of the 'bleb' is not as strong as normal lung tissue and may tear. Air then escapes from the lung but gets trapped between the lung and the chest wall.

Most occur in healthy young adults who do not have any lung disease. It is more common in tall thin people.

About 2 in 10,000 young adults in the UK develop a spontaneous pneumothorax each year. Men are affected about four times more often than women. It is rare in people over the age of 40. It is also much more common in smokers compared to non-smokers. Cigarette smoke seems to make the wall of any bleb even weaker and more likely to tear.

About 3 in 10 people who have a primary spontaneous pneumothorax have one or more recurrences sometime in the future. If a recurrence does occur it is usually on the same side and usually occurs within three years of the first one.
Secondary spontaneous pneumothorax

This means that the pneumothorax develops as a complication (a 'secondary' event) of an existing lung disease. This is more likely to occur if the lung disease weakens the edge of the lung in some way. This may then make the edge of the lung more liable to tear and allow air to escape from the lung. So, for example, a pneumothorax may develop as a complication of COPD (chronic obstructive airways disease) - especially where lung bullae have developed in this disease. Other lung diseases that may be complicated by a pneumothorax include: pneumonia, tuberculosis, sarcoidosis, cystic fibrosis, lung cancer, and idiopathic pulmonary fibrosis.
Other causes of pneumothorax

An injury to the chest can cause a pneumothorax. For example, a car crash or a stab wound to the chest. Surgical operations to the chest may cause a pneumothorax. A pneumothorax is also an uncommon complication of endometriosis.
What are the symptoms of a pneumothorax?

* The typical symptom is a sharp, stabbing pain on one side of the chest which suddenly develops.
* The pain is usually made worse by breathing in (inspiration).
* You may become breathless. As a rule, the larger the pneumothorax, the more breathless you become.
* You may have other symptoms if an injury or a lung disease is the cause. For example, cough or fever.

A chest x-ray can confirm a pneumothorax. Other tests may be done if a lung disease is the suspected cause.
What happens to the trapped air and small tear on the lung?

In most cases of spontaneous pneumothorax the pressure of the air that leaks out of the lung and the air inside the lung equalises. The amount of air that leaks (the size of the pneumothorax) varies. Often it is quite small and the lung collapses a little. Sometimes it can be large and the whole lung collapses. If you are otherwise fit and well, this is not too serious as the other lung can cope until the pneumothorax goes. If you have a lung disease, a pneumothorax may make any existing breathing difficulty much worse.

The small tear that caused the leak usually heals within a few days, especially in cases of primary spontaneous pneumothorax. Air then stops leaking in and out of the lung. The trapped air of the pneumothorax is gradually absorbed into the bloodstream. The lung then gradually expands back to its original size. Symptoms may last as short as 1-3 days in cases of primary spontaneous pneumothorax. However, symptoms and problems may persist longer, especially in cases where there is an underlying lung disease.
Tension pneumothorax

This is a rare complication. This causes shortness of breath that quickly becomes more and more severe. This occurs when the 'tear' on the lung acts like a one way valve. In effect, each breath in (inspiration) 'pumps' more air out of the lung, but the valve action stops air coming back into the lung to equal the air pressure. The volume and pressure of the pneumothorax increases. This puts pressure on the lungs and heart. Emergency treatment is needed to release the trapped air.
What is the treatment for pneumothorax?
No treatment may be needed

You may not need any treatment if you have a small pneumothorax. A small pneumothorax is likely to clear over a few days. A doctor may advise an X-ray in 7-10 days to check that it has gone. You may need painkillers for a few days if the pain is bad.
Aspirating (removing) the trapped air is sometimes needed

This may be needed if there is a larger pneumothorax or if you have other lung or breathing problems. As a rule, a pneumothorax that makes you breathless is best removed. It is essential to remove the air quickly in a 'tension' pneumothorax. The common method of removing the air is to insert a very thin tube through the chest wall with the aid of a needle. (Some local anaesthetic is injected into the skin first to make the procedure painless.) A large syringe with a three way tap is attached to the thin tube that is inserted through the chest wall. The syringe sucks out some air, the three way tap is turned, and the air in the syringe is then expelled into the atmosphere. This is repeated until most of the air of the pneumothorax is removed.

Sometimes a larger tube is inserted through the chest wall to remove a large pneumothorax. This is more commonly needed for cases of secondary spontaneous pneumothorax when there is underlying lung disease. Commonly, the tube is left is left place for a few days to allow the lung tissue that has 'torn' to heal.

Note: it can be dangerous to fly if you have a pneumothorax. Do not fly until you have the 'all clear' from your doctor following a pneumothorax. Also, do not go to remote places where access to medical care is limited until you have the 'all clear' from a doctor.
Treating recurrences

Some people have repeated episodes of spontaneous pneumothorax. If this occurs, a procedure may be advised with the aim of preventing further recurrences. For example, an operation is an option if the part of the lung that tears and leaks air out is identified. It may be a small 'bleb' on the lung surface that can be removed. Another procedure that may be advised is for an irritant powder (usually a kind of talc powder) that can be put on the lung surface. This causes an inflammation which then helps the lung surface to 'stick' to the chest wall better.

A lung specialist will be able to give the pros and cons of the different procedures. The procedure advised may depend on your general health, and whether you have an underlying lung disease.

If you are a smoker and have had a primary spontaneous pneumothorax, you can reduce your risk of a recurrence by stopping smoking.
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PostPosted: Wed Apr 15, 2015 3:54 am    Post subject:
 
This means that the pneumothorax develops as a complication (a 'secondary' event) of an existing lung disease. This is more likely to occur if the lung disease weakens the edge of the lung in some way. This may then make the edge of the lung more liable to tear and allow air to escape from the lung. So, for example, a pneumothorax may develop as a complication of COPD (chronic obstructive airways disease) - especially where lung bullae have developed in this disease. Other lung diseases that may be complicated by a pneumothorax include: pneumonia, tuberculosis, sarcoidosis, cystic fibrosis, lung cancer, and idiopathic pulmonary fibrosis.
Other causes of pneumothorax
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