What is Spontaneous Pneumothorax?
Spontaneous pneumothorax is a condition where gas unexpectedly collects in the space between the lungs and the chest wall. This happens without a clear cause, like an injury or a procedure done by a doctor. Spontaneous pneumothorax comes in two types: primary and secondary. Primary spontaneous pneumothorax (PSP) happens to people who don’t have any known lung disease, while secondary spontaneous pneumothorax (SSP) happens to those who do have a known lung disease.
People with this condition might experience a variety of symptoms, including a rapid heart rate (tachycardia) and difficulty breathing (dyspnea). One serious complication that can happen is a tension pneumothorax, which is a medical emergency where air gets into the chest, causing the lung to collapse.
Diagnosis of spontaneous pneumothorax starts with a doctor suspecting the condition based on symptoms, and this can be confirmed using imaging techniques like an X-ray. The treatment varies depending on several factors, such as the patient’s overall health, the size of the pneumothorax, whether it’s the first time or a recurrent condition, and whether it’s a primary or secondary spontaneous pneumothorax.
What Causes Spontaneous Pneumothorax?
Spontaneous pneumothorax is when air enters the space around the lungs, causing the lung to collapse. There are two types: primary and secondary.
Primary spontaneous pneumothorax is not linked to any specific lung disease. On the other hand, secondary spontaneous pneumothorax is linked to several possible lung conditions. These include:
– Chronic obstructive pulmonary disease, a long-term lung disease that affects breathing.
– Asthma, another condition that makes it hard to breathe.
– Cystic fibrosis, a genetic disorder that mainly impacts the lungs.
– Certain types of pneumonia, an infection that inflames the air sacs in the lungs.
– Pulmonary abscess, which is a pus-filled cavity in the lung.
– Tuberculosis, a serious infection that primarily affects the lungs.
– Lung cancer.
– Interstitial lung disease like idiopathic pulmonary fibrosis and sarcoidosis, both involving inflammation and scarring in the lungs, and lymphangioleiomyomatosis.
– Connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, and rheumatoid arthritis.
– Pulmonary infarct, which is a type of lung damage.
– Foreign body aspiration, when something is mistakenly breathed into the airways.
– Conditions related to a woman’s menstrual cycle due to thoracic endometriosis, a condition where tissue similar to the lining of the uterus develops outside of the uterus.
– Birt-Hogg-Dube syndrome, a rare genetic condition that can lead to skin abnormalities, lung cysts, and kidney cancer.
Risk Factors and Frequency for Spontaneous Pneumothorax
Spontaneous pneumothorax, or an unexpected collapsed lung, is more common in adults compared to children, and in males compared to females. In the US, the number of adult males getting spontaneous pneumothorax every year ranges from 7.4 to 18 per 100,000 people, while for adult females, it ranges from 1.2 to 6 per 100,000 people. The rate of secondary spontaneous pneumothorax, which means the condition happens because of an underlying lung disease, is similar for both males and females. Also, the disorder can occur in children, but it’s much less common. Other risks include a history of smoking, being tall and thin.
- Spontaneous pneumothorax is more common in adults and males.
- In the US, 7.4 to 18 per 100,000 adult males and 1.2 to 6 per 100,000 adult females experience this condition each year.
- The rates of secondary spontaneous pneumothorax are similar for males and females.
- The incidence in children is lower, with 4 per 100,000 boys and 1.1 per 100,000 girls experiencing it each year.
- Other risk factors include a history of smoking and being tall and thin.
Signs and Symptoms of Spontaneous Pneumothorax
Spontaneous pneumothorax is a condition where a lung collapses on its own, without an injury or exertion. People usually report sharp chest pains on the side of the affected lung or sudden breathing difficulty. Rapid heart rate is a common sign, but if the pneumothorax is small (affects less than 15% of the lung), there may be no obvious signs. If the pneumothorax is larger (affects more than 15% of the lung), signs can include reduced chest movement on the affected side, less or no breath sounds in the affected lung, swollen neck veins, changes in heart beat, an echo-like sound when the chest is tapped, and reduced vibration when the chest is touched. A serious but rare complication of spontaneous pneumothorax is a tension pneumothorax, which makes it hard to get oxygen into the body, lowers blood pressure, and causes the windpipe to shift.
- Sharp chest pain or sudden difficulty in breathing
- Rapid heart rate
- Reduced movement of the chest on the affected side
- Less or no breath sounds in the affected lung
- Swollen neck veins
- Changes in heartbeat
- Echo-like sound when the chest is tapped
- Reduced vibration felt when the chest is touched
Testing for Spontaneous Pneumothorax
The condition known as spontaneous pneumothorax, also known as a collapsed lung, is often identified by reviewing a patient’s medical history and conducting a physical examination. This can then be confirmed through imaging technologies. An X-ray of the chest is commonly used to diagnose a spontaneous pneumothorax. It would show that a lung lining, known as the visceral pleura, has moved away from the chest wall, and the area in between does not have normal lung images.
Even though X-rays taken while standing up are usually preferred, it’s worth noting that an X-ray taken while exhaling doesn’t necessarily enhance the clarity of the diagnosis. An ultrasound can also be used to help determine if a patient has a spontaneous pneumothorax. Some research suggests that ultrasound can be a more sensitive method for diagnosis compared to an X-ray. Yet, both these techniques have their limits, as they don’t estimate the size of the collapsed lung very accurately.
The use of computerized tomography, otherwise known as a CT scan, for diagnosing a spontaneous pneumothorax has been a topic of discussion within medical circles. CT scans have a high level of accuracy in pinpointing the condition, especially when the initial imaging tests are inconclusive or negative but there’s still a high suspicion of a spontaneous pneumothorax.
While measuring the levels of gases in the bloodstream isn’t necessary for diagnosing a spontaneous pneumothorax, it can provide useful information. These measurements can be used to check for any signs of acute respiratory alkalosis, which refers to an imbalance of carbon dioxide and oxygen levels in the body. Additionally, in instances where tension physiology – an extreme form of a lung collapse – is suspected, these measurements help in assessing changes in the differences of oxygen levels between the air sacs and arteries.
Treatment Options for Spontaneous Pneumothorax
The primary aim of spontaneous pneumothorax treatment is to release the air trapped in the space surrounding the lungs (pleural space) and to prevent future episodes. Certain treatment guidelines are mainly focused on managing the condition in adults, but may not specifically address cases in children. However, it is generally recommended to provide the patients with supplemental oxygen and to regularly monitor their heart and lung function. Oxygen can hasten the absorption of air from the pleural space, compared to not using oxygen.
If a patient experiencing spontaneous pneumothorax is not stable or displays severe symptoms suggestive of tension pneumothorax (a more severe type of pneumothorax), emergency treatments like needle decompression can be done to relieve the pressure in the pleural space, before placing a chest tube.
For stable patients with a small, initial episode of spontaneous pneumothorax, it is often suggested to manage the condition by supplying extra oxygen and monitoring the patient closely for at least six hours. If a repeated chest x-ray shows stable condition and the patient has access to follow-up care, they might be discharged with instructions to return after 24 hours for a re-check. Some patients with a large pneumothorax but without any symptoms may also be considered for an observation and conservative treatment approach, without any invasive interventions.
For those individuals who have a large or symptomatic pneumothorax, potentially techniques for managing the condition may include using a small catheter to aspirate the air, or placing a chest tube if the former method doesn’t work. More complex conditions may require using minimally invasive surgery (video-assisted thoracoscopy surgery or VATS) or a more invasive surgical procedure (thoracotomy) to perform bullectomy (removal of air-filled spaces in the lung), pleurectomy (removal of part of the pleura), and creating abrasion in the pleural space with a gauze (mechanical pleurodesis).
Patients with repeated episodes of spontaneous pneumothorax may require admission to the hospital for chest tube placement and preparation for VATS. For those who can’t undergo VATS, alternative options include chemical pleurodesis- a treatment that brings about inflammation in the lining of the lungs, thereby preventing the formation of more air pockets. This involves introducing irritants such as tetracyclines or talc, via a chest tube.
For adults with a type of pneumothorax that results from pre-existing lung disease (secondary spontaneous pneumothorax), supplemental oxygen and repeat chest x-rays are often recommended. In some cases, a chest tube or pleural catheter may be inserted to drain the air. Unlike primary spontaneous pneumothorax, observation alone is not suggested due to the increased risk of death associated with secondary spontaneous pneumothorax. Referral to a lung specialist is recommended once the patient is stable.
What else can Spontaneous Pneumothorax be?
The following conditions could cause similar symptoms:
- Heart attack (MI)
- Tearing or rupture in the main artery leading from the heart (Aortic dissection)
- Inflammation of the sac-like covering around the heart (Acute pericarditis)
- Blood clot in the lungs (Pulmonary embolism)
- Injury to the ribs or chest area (Rib & chest trauma)
