pneumothoraxin

Pneumothorax is the presence of air in the pleural space, the thin cavity between the lung and the chest wall, which can cause partial or complete collapse of the affected lung. It may be spontaneous or result from trauma or medical procedures. In some cases air accumulates under pressure, causing tension pneumothorax, a life-threatening emergency.

Pneumothorax is commonly categorized as spontaneous (primary or secondary), traumatic, or iatrogenic. Primary spontaneous pneumothorax occurs without an underlying lung disease and is more common in tall, thin individuals; secondary spontaneous pneumothorax occurs with preexisting lung conditions such as chronic obstructive pulmonary disease. Traumatic pneumothorax results from chest injury, while iatrogenic pneumothorax follows medical procedures such as central venous access, intubation, or lung biopsy. Tension pneumothorax represents a clinical escalation where air trapping increases intrapleural pressure, leading to mediastinal shift and hemodynamic instability.

Risk factors for pneumothorax include smoking, genetic predisposition, and underlying lung disease. Symptoms typically involve sudden chest pain and shortness of breath. On examination, there may be decreased or absent breath sounds on the affected side, hyperresonant percussion, and reduced chest wall expansion. In tension pneumothorax, patients may develop hypotension, tachycardia, distended neck veins, and tracheal deviation.

Diagnosis is usually confirmed with chest imaging. A chest radiograph is the standard initial test; ultrasound can rapidly detect pneumothorax at the bedside, and CT scanning provides detailed assessment when needed.

Management depends on the size and stability of the pneumothorax. Small, stable cases may be observed with supplemental oxygen and serial imaging. Large or symptomatic pneumothoraces require intervention with needle decompression in suspected tension scenarios, followed by chest tube thoracostomy. Recurrent or persistent air leaks may be treated with surgical options such as pleurodesis or bullectomy. Prognosis is generally favorable with timely treatment, though recurrence risk is higher after primary spontaneous pneumothorax.