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Pneumothorax

A Collapsed Lung

A pneumothorax, or collapsed lung, occurs when a person’s chest cavity becomes filled with air or gas that is supposed to be inside of the lung. Thoracic surgeons at CVTSA routinely treat patients from Virginia, Washington DC and Maryland with pneumothoraces.  To understand a pneumothorax, it is important to understand how the lungs work.

Lungs are the essential organs of respiration, allowing the body to take in oxygen and eliminate carbon dioxide. Oxygen is delivered to the chest through the trachea (windpipe) and bronchial tubes in the lungs, which are composed of three lobes on the right and two lobes on the left. The lobes are composed of smaller units, segments, which are in turn further composed of millions of elastic, air sacs (alveoli). It is at the level of the alveoli that the gas exchange of carbon dioxide for oxygen takes place. Blood vessels (pulmonary arteries and veins) cast off carbon dioxide and absorb oxygen. The carbon dioxide is then expelled via the airways as oxygen is propelled by the heart to the distant parts of the body. At any stage of this process, diseases that affect the lungs may occur.

 pneumothorax with chest tube

When a pneumothorax occurs, it can result from an injury to the chest, excess pressure in the lungs or because of another disease affecting the lungs such as COPD, asthma, lung cancer or cystic fibrosis.

A pneumothorax can also be caused by a bleb which is an air filled sack in the lungs. One way to explain a bleb is to think of the elastic air sacs (alveoli) as having turned into a blister full of air that has very thin walls. This blister takes up space and compresses normal lung tissue. Since these blisters have very thin walls, they are more prone to rupture. The air then leaks out into the space outside the lung but inside the chest cavity, thereby causing the lung to collapse, i.e. a punctured lung.

Symptoms

• Sudden sharp chest pain, made worse by a deep breath or a cough

• Shortness of breath

• Chest tightness

• Easy fatigue

• Rapid heart rate

• Sudden shoulder or back pain

If you experience any of these symptoms, you should seek medical attention.

Determining a Pneumothorax

To determine if you have a pneumothorax, your doctor will perform a number of exams. The first will be listen to your lungs with a stethoscope and determine if there are either decreased or no breath sounds on the affected side. Your physician will also order a chest x-ray to determine if there is air outside of your lungs.

Treating a Pneumothorax

Sometimes a small pneumothorax may go away on its own because the ruptured bleb heals itself.

When a large pneumothorax occurs, the air around the lung must be removed so that the lung can re-inflate. There are a number of ways to deal with a pneumothorax, including surgery. If surgery is warranted, a thoracic surgeon can perform Video Assisted Thoracic Surgery (VATS) in which two small incisions about 2-4 cm in length each are made in the spaces between your ribs. By placing a camera in one incision and specially designed instrumentation in another, the surgeon can seal the puncture to the lung which caused the pneumothorax.

Prognosis

Up to 50% of patients who have a pneumothorax will have another, but there are few if any long-term complications after successful treatment.

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