Pneumothorax: definition, sequel, can you die?

What is a pneumothorax?

Pneumothorax refers to a escape of air from the lung that goes between the lung and the chest wall into the pleura (organ that covers the lung and the inside of the chest cavity). It translates to a detachment of the pleura and compression of the lung causing pain and difficulty in breathing. It can occur spontaneouslyespecially in young men, but also after a trauma or being secondary to a lung disease.

What are the types of pneumothorax?

There are different types of pneumothorax:

► the traumatic pneumothorax when the air comes from the outside via an external break such as a stab wound or a bullet, or an invasive gesture such as a puncture (we speak in this case of iatrogenic pneumothorax).

► the spontaneous pneumothorax, it occurs suddenly when the air comes from the airways of the lung through a breach. Spontaneous pneumothorax is usually mild. It is a pathology of the young subject, more readily affecting the slender, tall, thin and smoker subject.

► the catamenial pneumothorax is a recurrent form of pneumothorax, affecting some women during menstrual cycles. It usually kicks in within 48 hours before or after the onset of menstruation.

► the suffocating compressive pneumothorax occurs when an abnormal accumulation of air between the two layers of the pleura leads to suffocation by pressure on the lungs and on the heart. The pressure exerted is such that other nearby organs can be displaced, possibly causing a stoppage of venous circulation and a stoppage of cardiac function.

What symptoms when you have a pneumothorax?

Pneumothorax is characterized by a sharp and sudden chest painlateralized, hindering breathing, especially inspiration as well as frequent anguish related to this painful discomfort and a dry cough. Of the signs of gravity may also be present as cyanosis, blue discoloration of the skin or mucous membranes, tachycardia and accelerated breathing, difficulty speaking. “You must then consult the nearest emergency reception service, or even call 15”recommends Louis Stoffaes, intern in pulmonology and treasurer of the Association of young pulmonologists AJPO2.

“The real problem with pneumothorax is its high recurrence rate”

Complications: can you die from a pneumothorax?

Yes but it is very rareFortunately. “The most serious complication is the death from heart pump failure, explains the pulmonologist. It is fortunately very rare, and concerns traumatic pneumothorax Or on very damaged lung.” Another complication, benign but very impressive, is thesubcutaneous emphysema. “This is consistent with air having seeped under the skin, giving the patient a bibendum appearance.” On the other hand, a pneumothorax cannot cause lung cancer. “But unfortunately continued smoking can progress to lung cancer, pneumothorax can then become a telltale symptom” explains the pulmonologist.

“The real problem with pneumothorax is its high recurrence rate” warns Louis Stoffaes. To limit recurrences:

• It is imperative to quit smoking.
• Scuba diving is strictly contraindicated after a pneumothorax.
• Air travel is contraindicated for 3 weeks after a pneumothorax. “If you are a flight crew, it is best to approach an expert center to consider surgical pleurodesis.”
• In pregnant women, recurrences are more frequent, and like catamenial pneumothorax, it requires close gynecological follow-up.

In case of pneumothorax, the doctor first performs a physical examination of the patient where he auscultates the lungs “and can find a auscultatory silence“. A lung x-ray will confirm the diagnosis suspected by the clinic by highlighting a line objectifying a lung detachment.

What are the treatments for pneumothorax?

There are as many treatments as there are cases of pneumothorax, but the main purpose is to empty the air contained in the pleural cavity.

► When the disease is of low intensity, it is enough for the patient to rest so that the air infiltrated in the pulmonary pleura is evacuated. A drug treatment with analgesics will also be prescribed.

► In the most serious cases, an emergency procedure is performed : we are talking aboutexsufflation or a needle is introduced into the air cavity. Another technique is the pleural drainage using a gas suction system, which is placed through the ribs using a scalpel. “Among the medical techniques, let us mention the pleural talc with the insertion of talc between the two pleura, or even the mechanical abrasion of the pleura, aiming to make a pleural symphysis -pleurodesis- to prevent a recurrence”specifies Louis Stoffaes.

What are the causes of pneumothorax? The stress ?

Pneumothorax can be primitive, i.e. occurring on a healthy lung, and spontaneous, i.e. for no apparent reason. He can be secondary to progressive lung disease such as pulmonary fibrosis, emphysema, asthma, cystic fibrosis, an infectious pulmonary disease and more rarely cancer… The causes of a suffocating compressive pneumothorax are often unknown but it is often due to a severe trauma (e.g. gunshot wound, road accident). Catamenial pneumothorax is usually a symptom of thoracic endometriosis. The latter corresponds to the abnormal presence of endometrium (the lining of the uterus) inside the thorax. THE stress cannot cause pneumothorax nor can excessive exertion.

Thanks to Louis Stoffaes, pulmonology intern and treasurer of the Association of young pulmonologists – AJPO2.