Pneumothorax - Causes and Symptoms

Definition

The pneumothorax is an accumulation of air within the pleural space (ie between the two membranes that cover the lungs and the chest wall, respectively). This phenomenon causes a partial or complete collapse of the lung, which can no longer expand and guarantee a correct respiratory function.

The pneumothorax can be spontaneous (primitive or secondary to underlying pathologies) or post-traumatic. It is not always possible to identify an obvious cause.

The air can infiltrate into the pleural space following penetrating thoracic lesions and closed traumas (eg fracture of a rib or inhalation of a foreign body) or it can accumulate from the mediastinum following the rupture of a bronchus or the perforation of the esophagus. Furthermore, pneumothorax may be secondary to medical procedures, including transthoracic needle aspiration, thoracentesis, central venous catheter placement, mechanical ventilation and cardiopulmonary resuscitation.

The primitive spontaneous pneumothorax is due to the rupture of congenital bubbles (called blebs), generally located at the lung apices. It is found predominantly in healthy male subjects, aged between 16 and 40, lean and long-limbed, often smokers and without previous pathologies affecting the respiratory system.

More frequently, spontaneous pneumothorax is secondary to airway diseases, such as chronic obstructive pulmonary disease, asthma, cystic fibrosis, necrotizing pneumonia, tuberculosis and other diseases that affect the lung parenchyma. Less frequent causes include idiopathic pulmonary fibrosis, histiocytosis with Langerhans cells, sarcoidosis, primary lung cancer and metastatic sarcoma.

A typical disease of the female sex that may present with pneumothorax is lymphangioleiomyomatosis, which can lead to the development of emphysematous-like lesions in the lungs. Furthermore, among women, the so-called catamenial pneumothorax may occur, to be attributed to an intrathoracic endometriosis, where the endometrial tissue at pleural level undergoes cleavage phenomena in conjunction with the menstrual cycle.

In adults, pneumothorax can also be caused by connective tissue diseases, such as ankylosing spondylitis, Ehlers-Danlos and Marfan syndrome, polymyositis or dermatomyositis, systemic sclerosis and rheumatoid arthritis.

Pneumothorax causes acute chest pain, similar to a stab and difficulty breathing. In some cases, it is completely asymptomatic. Pain may simulate pericarditis, pneumonia, pleurisy, pulmonary embolism, cardiac ischemia or musculoskeletal (when referred to the shoulder) or abdominal damage.

Most cases of pneumothorax require an aspiration of air from the pleural space by catheter or thoracostomy drainage. If it occurs again, the surgical resolution of the problem may be considered