The pleura covers the one hand, the inner wall of the rib cage and on the other hand, the outer face of the lungs. Between the two is a liquid. At the moment of inspiration, the volume of the rib cage increases and stretches the lung passively. If air enters the space between the visceral pleura and parietal pleura, it is question of pneumothorax. Consequently, the lung collapses because the pull of the visceral pleura is no longer maintained and elastic fibers tighten in the lung.
About one person in 10,000 suffers from pneumothorax. Men, especially lean subjects and large, are more frequently affected than women. An initial pneumothorax usually occurs between 10 and 30 years.
We distinguish a primary form and a form of secondary pneumothorax.
In the primary form, there is a healthy lung tissue, small bubbles can be noted in the lung surface in most cases. These bubbles burst and create a passage between the respiratory system and the pleural cavity. We know that smokers are more frequently with primary pneumothorax than non-smokers.
Pneumothorax can be triggered by physical exertion, coughing or sneezing or occur spontaneously.
It can also happen that the air enters the pleural cavity, particularly for injuries. A venting mechanism is switches on, allowing air to enter into the pleural cavity, without being able to come out. Thus, pressure is growing, compressing the lung and can block blood flow to the heart. In this case, it is called tension pneumothorax, the patient’s life is in danger and emergency care is imperative.
A pneumothorax can also be caused by aspiration or biopsy performed by a physician.
The goal of treatment is to evacuate the air in the pleural cavity but also to prevent further occurrence. If tension pneumothorax, the first step is to relieve the emergency patient by inserting a hollow needle.
If very little air is present in the pleural cavity, pneumothorax may resolve on their own and specific treatment is not necessary. Regular checks on an outpatient or hospital must however be made. When the observation is made at the hospital, the process can be accelerated by oxygen inhalation. Secondary pneumothorax should always be treated in hospital.
In this case, insertion of a drain under local anesthesia is necessary: to do this, a small tube is inserted from outside into the pleural cavity. This tube can produce a depressurization through which air is drawn. The drain can be removed when there is more air coming out the drain after a while and when X-rays showed that the pleura is adhered to the wall of the chest. This treatment is always done in the hospital.
If a pneumothorax occurs repeatedly (recurrent), a CT scan is usually performed to determine if a relapse prevention can be implemented. This is an open procedure or thoracoscopy (a process similar to gastroscopy or fluoroscopy knee) of welding the visceral pleura and parietal pleura. To do this, the surgeon inserts talc in the pleural cavity or it scratches the surface, which leads to inflammation of both pleurae, then their adhesion. Small bubbles may possibly occur on the surface of the lungs and can lead to pneumothorax are removed during the operation.
It should avoid physical exertion in the first three weeks after recovery.
For divers, the caution after pneumothorax: indeed, the risk of recurrence is very high and the occurrence of pneumothorax during a dive can be life threatening.