Pneumothorax Types: A Quick Review

About this course

Pneumothorax is also called a collapsed lung. When air enters the pleural cavity (the space between the lung and chest wall), the buildup of air puts pressure on the lung. The pressure decreases the lung’s ability to expand and recoil with inspiration and expiration, resulting in lung collapse. The development of pneumothorax can be life-threatening and may require rapid interventions. This course will discuss traumatic and atraumatic pneumothorax, their signs and symptoms, treatment methods, and chest tube management.

Learning objectives

• Describe the tension pneumothorax
• Describe atraumatic pneumothorax, and the various types of pneumothorax within the classification.
• Recognize common signs and symptoms of pneumothorax.
• Understand treatment options for pneumothorax.
• Understand chest tube management for a patient diagnosed with pneumothorax.

Course outline

24 sections · finish in any order across devices

1. 1

   Introduction

   A pneumothorax is a collection of air inside the pleural cavity.1 It can also be defined as the air inside and outside the lung that is caused by excess pressure on the lung, often from trauma, causing communication through the chest wall, or from lung diseases, such as whooping cough, cystic fibros

   4 min

2. 2

   Defining Pneumothorax

   Pneumothorax is also called a collapsed lung.4 When air enters the pleural cavity (the space between the lung and chest wall), the buildup of air puts pressure on the lung. The pressure decreases the lung’s ability to expand and recoil with inspiration and expiration, resulting in lung collapse.4 Th

   4 min

3. 3

   Traumatic Pneumothorax

   Traumatic pneumothorax is caused by air in the pleural space , resulting in partial or completed lung collapse from penetrating or blunt force trauma.,5 Penetrating trauma includes stab wounds, bullet wounds, and impalement, and blunt trauma includes a rib fracture, increased intrathoracic strain, a

   4 min

4. 4

   Signs and Symptoms

   The following are some of the common signs and symptoms associated with traumatic pneumothorax:5

   4 min

5. 5

   Tension Pneumothorax

   In tension pneumothorax, a one-way valve is created in the pleural space, which allows air to enter the lung, but does not let it flow out. 1,5,12 As a result, the trapped air accumulates, compresses the lung, and increases intrathoracic pressure that decreases venous return to the heart and causes

   4 min

6. 6

   Iatrogenic Pneumothorax

   Iatrogenic pneumothorax is a subset of traumatic pneumothorax and is caused by invasive medical procedures like transthoracic needle aspiration, thoracentesis, central venous catheter placement, positive pressure ventilation, mechanical ventilation, and cardiopulmonary resuscitation.3,11 The risk of

   4 min

7. 7

   Primary Spontaneous Pneumothorax (PSP)

   In the United States, the prevalence and incidence of primary spontaneous pneumothorax are 7 per 100,000 males and 1 per 100,000 females per year.1,6 It is caused without any known elicit event and in patients with no underlying pulmonary disease.1,3 Primary spontaneous pneumothorax typically occurs

   4 min

8. 8

   Secondary Spontaneous Pneumothorax (SSP)

   Secondary spontaneous pneumothorax can occur in patients after an underlying pulmonary disease is diagnosed.1,3 It is more severe than primary spontaneous pneumothorax because it occurs in patients whose underlying pulmonary disease affects their pulmonary reserve.3 This form of spontaneous pneumoth

   4 min

9. 9

   Catamenial Pneumothorax

   Catamenial pneumothorax is a rare form of secondary spontaneous pneumothorax that affects women and occurs within 48 to 72 hours of the onset of menstruation in premenopausal women. Although rare, it can also happen in postmenopausal women taking estrogen.3,9 Women can experience recurrent episodes

   4 min

10. 10

    Needle Decompression

    Needle thoracostomy is used for emergent decompression of the chest.13 According to the American College of Chest Physicians, an angio-catheter should be placed in the second intercostal space at the midclavicular line.13 However, a patient with a high body mass index (BMI) may also have increased c

    4 min

11. 11

    Chest Tubes

    Chest tubes are used to drain air or fluid or to deliver pleurodesis agents and empyema treatment.13 They are made up of silicone or polyvinyl chloride and are extremely flexible.13 They are sized based on their diameter and are available in multiple french (Fr) sizes, such as pigtail (< 14Fr), larg

    4 min

12. 12

    Iatrogenic Pneumothorax

    Initial management involves checking if the patient is stable or unstable and providing supplemental oxygen to maintain adequate oxygenation.11 Patients with a small pneumothorax may require no treatment or intervention, and the trapped air can be observed with serial chest x-rays until the lung re-

    4 min

13. 13

    Aspiration With a Catheter

    Patients who are symptomatic and hemodynamically stable, or have a large-sized pneumothorax, around 2–3 centimeters of air in chest X-ray or more than 15% of the hemithorax, should undergo catheter aspiration.6 Aspiration can be done by inserting a chest tube until the lungs are re-expanded or inser

    4 min

14. 14

    Chest Tube

    A chest tube is also used to treat PSP by using a catheter attached to a one-way Heimlich valve and leaving it in place for one or more days.6 If the Heimlich valve fails, a water-seal device can also be used.6 70% of the air leaks are resolved within 7 days and 100% within 15 days.6 If air leaks pe

    4 min

15. 15

    Video-Assisted Thoracoscopic Surgery (VATS)

    Video-assisted thoracoscopic surgery (VTAS) is a minimally invasive medical procedure to remove parts of the diseased lung and lymph nodes. During a VATS, a small tube with a camera called a thoracoscope is inserted through a small incision between the ribs, allowing the surgeon to see the entire ch

    4 min

16. 16

    Thoracotomy

    Thoracotomy used to be the primary surgical treatment option for PSP and involved an incision in the pleural space of the chest wall.6 It is indicated for recurrent PSP with persistent air leaks or collapsed lung after pleural drainage placement, and is superior to other surgical interventions becau

    4 min

17. 17

    Secondary Spontaneous Pneumothorax

    Secondary spontaneous pneumothorax is more severe than primary spontaneous pneumothorax and is associated with persistent air leaks and increased inpatient mortality and recurrence risk.7 Thus, there are multiple treatment options available, divided into initial management, management with persisten

    4 min

18. 18

    Catamenial Pneumothorax

    There are no specific guidelines available for catamenial pneumothorax treatment.9 Surgery or hormonal therapies are used in combination or separately, depending on the cause of the pneumothorax, the patient’s overall health, age, and preference.9

    4 min

19. 19

    Tension Pneumothorax

    Treatment of tension pneumothorax depends on the circumstances at the time of symptom onset and the hemodynamic stability of the patient.14 For instance, initial management involves:14

    4 min

20. 20

    What Does Chest Tube Care Involve Once it is Placed?

    Multiple complications are associated with chest tubes, such as improper placement, infection, and pain during insertion, and can lead to life-threatening iatrogenic injuries if not managed properly.15 Thus, a trained healthcare provider is required to care for patients with chest tubes and an integ

    4 min

21. 21

    How is the Chest Tube monitored?

    The daily chest tube monitoring guidelines vary from institution to institution but generally includes:15,16

    4 min

22. 22

    Signs That the Chest Tube is not Functioning

    Multiple complications are associated with chest tube placement, positioning, and removal. These complications can lead to nonfunction of the chest tube from disturbed negative pressure within the chest drainage unit.17 Many factors lead to chest tube dysfunction by impairing the negative pressure i

    4 min

23. 23

    Interventions to Take When a Chest Tube is not Functioning

    If a pneumothorax is not treated with a chest tube alone, surgical options are considered.19 Surgical options include a thoracotomy and VATS.19 A thoracotomy is considered for penetrating trauma cases, with or without vital signs, and on the patient’s selection criteria.19

    4 min

24. 24

    Conclusion

    Pneumothorax often begins as a benign condition but can quickly evolve into a severe medical condition if treatment and management are not followed.1 It also has a high recurrence rate; for instance, the recurrence rate in the first five years for primary spontaneous pneumothorax is 30%, and 43% for

    4 min

This course satisfies

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References and resources

• McKnight CL, Burns B. Pneumothorax. PubMed. Published 2022. Accessed February 13, 2023. https://www.ncbi.nlm.nih.gov/books/NBK441885/#:~:text=Pneumothoraces%20can%20be%20even%20further
• Pneumothorax. www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumothorax
• Pneumothorax - Pulmonary Disorders. MSD Manual Professional Edition. Accessed February 13, 2023. https://www.msdmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax#v4755987
• Imran JB, Eastman AL. Pneumothorax. JAMA. 2017;318(10):974. doi:https://doi.org/10.1001/jama.2017.10476
• Pneumothorax (Traumatic) - Injuries; Poisoning. MSD Manual Professional Edition. Accessed February 13, 2023. https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-traumatic#:~:text=Traumatic%20pneumothorax%20is%20air%20in
• Vallejo FAG, Romero R, Mejia M, Quijano E. Primary Spontaneous Pneumothorax, a Clinical Challenge. IntechOpen; 2019. https://www.intechopen.com/chapters/65152
• Nava GW, Walker SP. Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. Journal of Clinical Medicine. 2022;11(5):1173. doi:https://doi.org/10.3390/jcm11051173
• Costumbrado J, Ghassemzadeh S. Pneumothorax, Spontaneous. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK459302/
• Catamenial Pneumothorax - National Organization for Rare Disorders. rarediseases.org. Accessed February 13, 2023. https://rarediseases.org/rare-diseases/catamenial-pneumothorax/?filter=Standard+Therapies
• Amer K. Pneumothorax. IntechOpen; 2019.
• Ojeda Rodriguez JA, Hipskind JE. Iatrogenic Pneumothorax. PubMed. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK526057/#:~:text=Iatrogenic%20pneumothorax%20is%20a%20patient%20safety%20indicator%20(PSI)%20condition.
• Pneumothorax (Tension) - Injuries; Poisoning. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-tension
• Tran J, Haussner W, Shah K. Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management. The Journal of Emergency Medicine. 2021;61(5):517-528. doi:https://doi.org/10.1016/j.jemermed.2021.07.006
• PMC E. Europe PMC. europepmc.org. https://europepmc.org/article/nbk/nbk559090
• Merkle A, Cindass R. Care Of A Chest Tube. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK556088/
• Bauman M, Handley C. Chest Tube Care: The More You Know, the Easier It Gets. https://www.myamericannurse.com/pdf/chest-tube-care-management-troubleshooting.pdf
• Hashmi U, Nadeem M, Aleem A, et al. Dysfunctional Closed Chest Drainage - Common Causative Factors and Recommendations for Prevention. Cureus. 10(3). doi:https://doi.org/10.7759/cureus.2295
• Kesieme EB, Dongo A, Ezemba N, Irekpita E, Jebbin N, Kesieme C. Tube Thoracostomy: Complications and Its Management. Pulmonary Medicine. Published 2012. https://www.hindawi.com/journals/pm/2012/256878/
• Bertoglio P, Guerrera F, Viti A, et al. Chest drain and thoracotomy for chest trauma. Journal of Thoracic Disease. 2019;11(Suppl 2):S186-S191. doi:https://doi.org/10.21037/jtd.2019.01.53
• Chang B, Tucker WD, Burns B. Thoracotomy. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK557600/
• Video-Assisted Thorascopic Surgery. www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/video-assisted-thorascopic-surgery

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