Pneumothorax

Pneumothorax

    * Introduction
    * Etiology
    * Clinical manifestations and diagnosis
    * Treatment and evolution
Pneumothorax is defined by the presence of air in the pleural space. The term "pneumothorax" means "air in the chest" (tire = air torax = thorax). This translation is not correct, because the air is accumulated exclusively in the pleural space between the two foils.

 
Pneumothorax can be spontaneous when occurring without there being a history of chest trauma, or traumatic when such an event occurred in the past. Compressive pneumothorax occurs when pressure inside the pleural space is positive throughout the respiratory cycle.

 
There are some bubbles in spontaneous pneumothorax (small cysts) subpleurale who break into the pleural cavity. This form occurs very frequently in smokers or those who have a previous lung disease and is often recurrent, it can occur in healthy individuals and by barotrauma (high altitude flight or dive into water from height).

 
Pneumothorax most often occurs suddenly, with chest pain unilaterally irradiated to shoulder the entire chest or abdomen, violent, increased cough and dyspnea accompanied by intense (difficulty breathing). Half of the thorax is affected relaxed, immobile and breathing present a series of characteristic signs. Diagnosis is confirmed by chest radiography.

 
Pneumothorax can occur more or less pronounced: the amount of air that penetrate between the pleura may be minimal, so that symptoms experienced by patients are negligible, but can also occur on the so-called "spontaneous pneumothorax" life threatening due to severe limitation respiratory and circulatory function. Pneumotoaxul spontaneously occurs when air enters the pleural space through a broken pulmonary alveolus, whose hole closes expiratory phase of breathing, so that at each breath-valve-like a more and more air enters the pleural space, which no longer to escape. Because interpleurala pressure increases greatly affected colabeaza lung and breathing becomes unusable in the process. Increasing pressure pushes the mediastinum and heart, leading to the collapse of the other lung.

 
Complications that can occur are: acute respiratory failure with or without circulatory failure, delay reexpansionarii, associating additional pleural effusion (aseptic, purulent or bloody) and recurrent pneumothorax.

 
Treatment aims to relieve pain and shortness of breath (by decompression of lung and treatment with analgesics, cough and oxygen) to prevent recurrences and lung reexpansioneze (by eliminating the cause and / or pleura symphysic - that it creates an adhesion of the pleura, which will prevent a further accumulation of air in the pleural cavity).

 
Anatomy

The lungs and chest cavity are lined internally by a thin layer, called the pleura, which has two parts: - Visceral pleura: a thin layer of tissue that covers the surface of both lungs; - Parietal pleura: a thin layer of tissue that lines the inside of the chest, upper diaphragm and pericardium; If the lungs to expand normally, they foil the parietal are glued together by a liquid film lubrication role. Because of this, the lungs are very close to the chest wall, but with all these moves without friction during breathing movements. Parietal foils are so thin, that are not normally visible at chest radiography.