Pneumothorax – Diagnosis, Treatment, and Surgical Procedures
Whether you’re dealing with a solitary pneumothorax or an extensive thoracic cavity, it’s important to know what to expect and how to treat it. This article will cover the diagnosis, treatment options, and surgical procedures that you can use to manage the condition.
Treatment options
Depending on the severity of the pneumothorax, treatment options include observation, needle aspiration, and chest tube insertion. The goal of treatment is to stop the recurrence of the disease.
The most common type of pneumothorax is called primary spontaneous pneumothorax. This condition is most common in people between the ages of 20 and 30. Symptoms of this condition include shortness of breath and dyspnea. Some patients may also experience hypoxia and tachypnea.
In some cases, a chest x-ray will be used to determine the exact location of the air. If the x-ray shows the lungs are not growing, the condition is classified as a simple, non-threatening pneumothorax. A three-sided occlusive dressing is usually applied to the open “sucking” chest wound.
Alternatively, a more invasive surgical approach can be used to treat pneumothorax. This method can be performed through video-assisted thoracic surgery (VATS) or through open thoracotomy. Typically, the procedure is completed in conjunction with a pulmonologist or anesthesiologist.
Another option for pneumothorax treatment is chemical pleurodesis. This technique involves the removal of the parietal pleura with dry gauze or a “scratchpad.” Medications such as doxycycline or tetracycline can be used in this procedure. The goal of chemical pleurodesis is to reduce the chances of recurrence by at least 5%.
Some patients with tension pneumothorax require a needle thoracostomy. This procedure can be done in an emergency setting to prevent further life-threatening complications. A thoracostomy tube is usually placed in the fifth intercostal space.
A thorax CT scan can be performed to confirm the diagnosis of a pneumothorax. This scan uses x-rays and computer technology to produce images of the chest. A patient with a tension pneumothorax may have tachypnea, tachycardia, or hypoxia.
Diagnosis
Despite the fact that pneumothorax is a common finding in critical illness, its diagnosis is still a challenge. It can be missed by bedside radiography, and delays in diagnosis can lead to further deterioration of respiratory compromise.
The initial diagnosis is made from a history, physical examination, and radiological investigation. Although x-rays are not always sensitive enough to rule out the presence of a pneumothorax, they can confirm its presence.
A chest x-ray shows an air pocket or air leak between the two layers of pleura. This is typically accompanied by dyspnea, pleuritic chest pain, and a dry hacking cough. The symptoms of a pneumothorax gradually subside as the body adapts to the collapse of the lung. The treatment for pneumothorax is to aspirate or drain the air.
The etiology of pneumothorax can be traumatic or iatrogenic. The symptoms are primarily dyspnea, but pain may also be felt in the neck, shoulder, or abdomen. The patient may need oxygen through a face mask.
In addition to the presence of a pleural gap, the lung pulse can be indicative of the presence of a pneumothorax. Lung pulsation is also useful in diagnosing the condition in patients who are unconscious.
The diagnosis of a pneumothorax is also confirmed by chest computed tomography or chest ultrasound. The sonographic signs are similar to the radiologic signs, with high specificity. The sensitivity and specificity of these methods were evaluated in a study of 200 consecutive undifferentiated intensive care unit patients.
In the emergency department, a pneumothorax was detected in over 20% of major blunt trauma patients. It was found that the rate of recurrence was highest during the first 30 days.
Primary vs secondary spontaneous pneumothorax
Depending on the physician and the patient, the treatment may vary from immediate needle decompression to a discharge with early follow-up. In most cases, pulmonary physicians perform minimally invasive procedures.
A thoracic surgeon will perform a thoracoscopy, which is a surgical procedure used to examine the chest cavity and remove or repair any obstruction. In this procedure, two ports are used. A chest tube is also inserted into the chest to allow the air to be evacuated.
The most common types of pneumothorax include traumatic, tension, and closed. The most common form of traumatic pneumothorax is caused by blunt trauma, and the patient is usually in a state of acute respiratory distress. In the thoracic cavity, there are numerous major blood vessels and lungs. The thoracic wall is lined with a pleural membrane, which is a thin-walled sac that houses serous fluid and lubricating microorganisms.
The most obvious symptom of a pneumothorax is shortness of breath. Other symptoms are dyspnea, wheezing, and chest pain. The most common treatments for pneumothorax involve a thoracoscopy, a chest tube, and immediate needle decompression.
The best way to treat a pneumothorax is to identify and treat the cause. A pneumothorax is a complication of pulmonary diseases, such as asthma, bronchiectasis, and emphysema. It is rare but can occur in patients with other lung diseases, such as sarcoidosis.
The most important symptom of a pneumothorax, however, is not the presence of a thoracic tube. It is the sudden onset of breathlessness that should prompt investigations to determine the etiology of the condition. A pneumothorax can be life-threatening, so it is important to diagnose and treat it in a timely manner.
Tube thoracostomy
Using a tube thoracostomy for pneumothorax is a safe surgical procedure, provided that the physician performing the procedure is experienced and competent. However, complications can occur. Among the possible complications are infection, direct lung damage, and acute ipsilateral ulnar neuropathy. Depending on the nature of the complication, a chest tube may be discontinued or removed.
Tube thoracostomy is a common procedure performed in the emergency room. In general, the procedure involves the placement of a tube through the chest wall between the ribs to drain a pleural effusion. The site is then covered with petroleum jelly to prevent air from entering the thoracic cavity.
In most cases, the tube is sutured in place. If the tube fails, a stent or coil embolization will be required to fix the air leak. The tube is then removed after 24 to 48 hours. A chest radiograph is taken to confirm the correct positioning of the tube.
The most common complication of tube thoracostomy is infection. The rate of infection is higher in patients with pleural effusions. Moreover, in some studies, empyema rates were reported to be up to 25%.
The second most common complication is iatrogenic lung perforation. This complication can be dangerous and requires surgical intervention. When the insertion of a chest tube causes perforation of the lungs, it can lead to a life-threatening situation.
In contrast, the most common complication of a closed-tube thoracostomy is not an infection. This is because the tube is not open during the procedure. Nevertheless, iatrogenic lung perforation has been reported during closed-tube thoracostomy. This is due to the occurrence of a tear in the pleural lining during bronchoscopy.
Arrhythmias are also possible complications. They can occur as a result of mechanical stimulation of the heart, pericardium, or vagus nerve. This complication can result in unresponsive bradycardia, which is fatal.
Chemical pleurodesis
Surgical treatment for pneumothorax has traditionally been the first choice, but in some cases, this approach is not always the best one. In these instances, chemical pleurodesis may be an option. A review article aims to discuss the literature on this topic.
Pneumothorax is a condition characterized by a collapsed lung, usually caused by interstitial pneumonia. It is not clear how to effectively treat this condition, as surgical intervention is expensive and patients often refuse it due to the risk of postoperative air leak.
Several different procedures have been proposed for achieving effective pleural symphysis. For example, mechanical abrasion was used in 1941 by Edward Delos Churchill. However, this technique has not been well studied in humans. A more recent approach has been tunneled pleural catheters.
Other methods of pleurodesis include doxycycline and minocycline. In an animal model, both agents have been shown to be effective. The efficacy of these agents has also been tested in network meta-analyses.
In the present study, we investigated the effectiveness of chemical pleurodesis in the treatment of primary spontaneous pneumothorax. Data were collected for 493 adult patients who underwent chest tube drainage at the Fukujuji Hospital from January 2016 to December 2020. The patients were divided into three groups: the surgical group, the pleurodesis group, and the non-pleurodesis group. The surgical group included 106 patients who underwent surgical intervention, while the pleurodesis group included 89 patients who underwent chemical pleurodesis.
The study was approved by the Fukujuji Hospital Institutional Review Board. The following data were collected: the number of patients, the nature of the pneumothorax, the duration of the illness, the geographical area, the type of studies, and the quality and follow-up time of the studies.
Health Sources:
Health A to Z. (n.d.). HSE.ie. https://www2.hse.ie/az/
U.S. National Library of Medicine. (n.d.). https://www.ncbi.nlm.nih.gov/
Directory Health Topics. (n.d.). https://www.healthline.com/directory/topics
Health A-Z. (2022, April 26). Verywell Health. https://www.verywellhealth.com/health-a-z-4014770
Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
Health Conditions A-Z Sitemap. (n.d.). EverydayHealth.com. https://www.everydayhealth.com/conditions/
