pneumotorax

Pneumothorax, sometimes spelled pneumotorax in some texts, is the presence of air in the pleural space, causing partial or complete collapse of the lung due to loss of negative intrapleural pressure. It can occur spontaneously or as a result of trauma or medical procedures.

It is commonly classified as primary spontaneous pneumothorax (no underlying lung disease), secondary spontaneous pneumothorax (associated with lung disease such as COPD or interstitial lung disease), traumatic pneumothorax (from chest injury), and iatrogenic pneumothorax (from medical procedures). A potentially life-threatening form is tension pneumothorax, where trapped air increases pressure and shifts mediastinal structures.

Symptoms include sudden chest pain and shortness of breath. On examination there may be decreased breath sounds on the affected side, hyperresonance to percussion, tachycardia, and reduced chest expansion. Tension pneumothorax can cause hypotension, tachycardia, distended neck veins, and tracheal deviation.

Diagnosis is usually by chest radiograph, showing a visible pleural line with absent distal markings. In emergency settings ultrasound or CT can aid. Vital signs and clinical suspicion guide urgency of treatment.

Management depends on size, symptoms, and stability. Small, asymptomatic pneumothoraces may be observed with supplemental oxygen. Larger or symptomatic cases commonly require needle aspiration or chest tube thoracostomy. Tension pneumothorax requires immediate needle decompression, followed by chest tube placement. Recurrent cases or persistent air leaks may be treated with pleurodesis or thoracoscopic surgery. Preventive measures include smoking cessation and careful management of underlying lung disease.