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Pneumothorax is a medical emergency that occurs when air leaks into the space between the lung and chest wall, causing the lung to collapse.
In severe cases, tension pneumothorax can occur whereby the leaked air increases pressure in the chest and compresses the affected lung, shifting the mediastinum (the heart and major blood vessels) to the opposite side, and impair blood flow to the heart. Because of this, tension pneumothorax can rapidly lead to respiratory failure and cardiovascular collapse if not treated immediately. It requires emergency intervention, such as needle decompression or chest tube insertion, to relieve the pressure and allow the lung to re-expand.
Pneumothorax can also occur along with other conditions, and in some cases, is associated with trauma or complication of a medical procedure.
Other Variations of Pneumothorax:
Haemopneumothorax - abnormal collection of blood within the space of the lungs, requires chest drain
Traumatic pneumothorax - caused by blunt or penetrating chest trauma (e.g. stab wound to chest)
Iatrogenic pneumothorax - air enters the spacec of the lungs during a medical procedure
Catamenial pneumothorax - collapsed lung that occurs within 72 hours before or after the start of menstruation, often associated with endometriosis, causing symptoms such as chest or shoulder pain and shortness of breath
Tension pneumothorax - excessive air collected within the space of the lungs causes severe pressure on the heart, major blood vessels and the opposite lung, compromising blood circulation
What causes it?
Most pneumothorax happen without any clear cause (Primary Spontaneous Pneumothorax). Pneumothorax can also result from blunt or penetrating trauma to the chest, certain medical interventions, or damage caused by existing lung conditions. Chronic smokers with weak lungs are at higher risk of getting a pneumothorax.
What are the symptoms?
Sudden chest pain
Shortness of breath
Rapid heart rate
Fatigue
Cyanosis (bluish tint to the skin due to lack of oxygen)
How is it diagnosed?
Pneumothorax is typically diagnosed through clinical evaluation and diagnostic imaging tests such as a chest X-ray.
Chest X-ray: A basic imaging test that captures the size and shape of the heart, lungs, blood vessels, airways and bones of the chest. Chest X-rays can also reveal fluid in or around your heart or lungs or air surrounding a lung.
CT scan (Computed Tomography): A CT scan first uses X-rays to produce detailed images of the body and after which, a computer is used to create cross-sectional images (known as slices) of the bones, tissues, and blood vessels. Images from a CT scan can show more details than that of a regular X-ray.
Ultrasound: This is a common and non-invasive test that uses high-frequency sound waves to create images of the inside of the body.
What are the treatments?
Whilst some pneumothorax cases can resolve on its own, it would still require close monitoring and regular follow-ups with a doctor. More serious pneumothorax cases may require a chest tube inserted to drain the air or in recurrent or severe cases, surgery.
Depending on your condition, our surgeons will advise on the best approach for treatment.
Needle Aspiration: A minimally invasive procedure to remove air from the pleural space using a needle, with local anaesthesia administered.
Chest Tube Insertion (Tube Thoracostomy): The insertion of a tube into the pleural space to continuously remove air, with local anaesthesia administered. A hospital stay post-treatment will also be required for monitoring purposes.
Surgery: Surgery may be performed for severe or recurrent cases to stop the airleak and prevent recurrence of a pneumothorax. Surgery is performed under general anaesthesia and involves an invasive procedure to find and eliminate the source of airleak as well as prevent recurrence using pleurodesis. Speak to your surgeons to find out more about the options available for your condition. One of the options avaliable is Uniportal Video Assisted Thoracic Surgery (UVATS), which is a minimally invasive surgery that involves accessing the lungs through a single 3cm incision. Through this single opening, the surgeon inserts a small camera and long, thin instruments to perform the surgery without needing to open the entire chest.
UVATS is a new surgical technique developed by Prof John Tam, in his pursuit to reduce post-operative pain and surgical risks for lung surgery patients.
