Pneumothorax
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Basics
Description
- Presence of free air in the intrapleural space
- Spontaneous pneumothorax is due to atraumatic rupture of alveolus, bronchiole, or bleb
- Primary spontaneous pneumothorax (2/3 of incidences):
- No underlying pulmonary pathology present
- Rupture of small subpleural cyst or bleb
- Primarily young, healthy patients (20–40 yr old) with tall, thin body habitus
- Risk factors: Smoking, family history, Marfan syndrome, homocystinuria, thoracic endometriosis
- Evidence of possible increased incidence with changes in weather pattern/atmospheric pressure
- Secondary spontaneous pneumothorax from underlying pulmonary pathology (see Etiology)
- Tension pneumothorax:
- Air continues to enter pleural space through bronchoalveolar disruption and becomes trapped via “ball-valve” mechanism
- Intrapleural pressure increases
- Venous return to right heart decreases, resulting in decrease in cardiac output
- Mediastinum shifts toward uninvolved side, mechanically interfering with right atrial filling
- Ventilation compromise and ventilation/perfusion mismatch result in hypoxemia
Etiology
- Idiopathic
- Airway disease:
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Cystic fibrosis
- Infections:
- Necrotizing bacterial pneumonia
- TB
- Fungal pneumonia
- Pneumocystis carinii
- Neoplasm
- Interstitial lung disease:
- Sarcoidosis
- Idiopathic pulmonary fibrosis
- Lymphangiomyomatosis
- Tuberous sclerosis
- Pneumoconioses
- Connective tissue diseases
- Pulmonary infarction
- Endometriosis
- Blunt chest trauma
- Penetrating trauma to neck or trunk
- Iatrogenic:
- Central line placement
- Other vascular access procedures
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Presence of free air in the intrapleural space
- Spontaneous pneumothorax is due to atraumatic rupture of alveolus, bronchiole, or bleb
- Primary spontaneous pneumothorax (2/3 of incidences):
- No underlying pulmonary pathology present
- Rupture of small subpleural cyst or bleb
- Primarily young, healthy patients (20–40 yr old) with tall, thin body habitus
- Risk factors: Smoking, family history, Marfan syndrome, homocystinuria, thoracic endometriosis
- Evidence of possible increased incidence with changes in weather pattern/atmospheric pressure
- Secondary spontaneous pneumothorax from underlying pulmonary pathology (see Etiology)
- Tension pneumothorax:
- Air continues to enter pleural space through bronchoalveolar disruption and becomes trapped via “ball-valve” mechanism
- Intrapleural pressure increases
- Venous return to right heart decreases, resulting in decrease in cardiac output
- Mediastinum shifts toward uninvolved side, mechanically interfering with right atrial filling
- Ventilation compromise and ventilation/perfusion mismatch result in hypoxemia
Etiology
- Idiopathic
- Airway disease:
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Cystic fibrosis
- Infections:
- Necrotizing bacterial pneumonia
- TB
- Fungal pneumonia
- Pneumocystis carinii
- Neoplasm
- Interstitial lung disease:
- Sarcoidosis
- Idiopathic pulmonary fibrosis
- Lymphangiomyomatosis
- Tuberous sclerosis
- Pneumoconioses
- Connective tissue diseases
- Pulmonary infarction
- Endometriosis
- Blunt chest trauma
- Penetrating trauma to neck or trunk
- Iatrogenic:
- Central line placement
- Other vascular access procedures
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