Pneumothorax-Pleural Diseases

Lung with pneumothorax

What is Pneumothorax?

Pneumothorax is a common medical condition in Singapore with symptoms ranging from mild to life-threatening1. It is also known as a collapsed or deflated lung and it occurs when air leaks into the space between your lungs and chest wall. This creates a large amount of pressure on your lungs causing it to either fully (complete) or partially (portion) collapse. 

There are 5 types of pneumothoraxes, these are2:

  • Primary spontaneous pneumothorax: occurs in people who do not have any other lung conditions. May be due to abnormal air sacs or alveoli that break apart and release air.
  • Secondary spontaneous pneumothorax: caused by various lung conditions such as chronic obstructive pulmonary disorder (COPD), emphysema, or cystic fibrosis.
  • Iatrogenic pneumothorax: complications from some medical procedures such as a lung biopsy.
  • Catamenial pneumothorax: affects women who have endometriosis. The endometrial tissue forms cysts that can bleed into the pleural space and cause the lungs to collapse.
  • Injury-related pneumothorax: injuries such as a fractured rib may cause the lungs to collapse.
Picture of a normal lung vs collapsed lung

What are the common causes?

A pneumothorax can occur for a variety of reasons which fall under two categories, a traumatic pneumothorax and a non-traumatic pneumothorax3. 

Traumatic Pneumothorax 

  • Caused by injury or some form of trauma.
  • Types of trauma or injury include: broken ribs, injury from vehicular accidents, large force to the chest during contact sports, stab wounds, complications of medical procedures such as lung biopsy, increased pressure to the chest when at high altitudes, flying, or diving.
  • Examples are: iatrogenic pneumothorax, injury-related pneumothorax.

Non-traumatic Pneumothorax

  • Also known as spontaneous pneumothorax.
  • Examples are: catamenial pneumothorax, primary spontaneous pneumothorax which have no known cause, and secondary spontaneous pneumothorax which can be caused by various lung conditions such as COPD, tuberculosis, lung cancer, cystic fibrosis, emphysema, asthma, etc.
  • Can also be caused by inhaling drugs.

What are the common symptoms of Pneumothorax in Singapore?

Symptoms of a pneumothorax are very similar to other respiratory conditions, these symptoms are:

  • Chest pains
  • Cough
  • Increased heart rate
  • Breathlessness
  • Fatigue
  • Blue tint to skin
  • Rapid breathing

In some instances, a pneumothorax may be life-threatening, if you experience the symptoms stated above, seek medical attention.

Is Pneumothorax painful?

Yes, pneumothorax can cause chest pains.

Who is at risk of Pneumothorax in Singapore?

Anyone can get a pneumothorax, however, individuals with the following risk factors are more susceptible:

  • Recent medical procedures: lung biopsies and some other medical procedures may result in a pneumothorax4.
  • Contact sports: such as rugby, football, or boxing4.
  • Diving: scuba diving or deep-sea diving4.
  • Smoking: smoking increases your risk of many lung conditions including pneumothorax3.
  • Genetics: some types of pneumothorax can be passed down from family members4,5.
  • History of pneumothorax: individuals who had a pneumothorax in the past are at a high risk of having another1
  • Physical traits: research has shown that tall and thin individuals are more susceptible to pneumothorax3.
  • Gender: males are more likely than females to get pneumothorax3.

How is Pneumothorax diagnosed in Singapore?

The symptoms of a pneumothorax are very similar to other respiratory conditions, so the following diagnostic tests will have to be conducted6:

  • Chest x-ray: imaging of your lungs will be taken, and your respiratory specialist will be able to identify if you have a pneumothorax.
  • Computed tomography scans (CT-scans): gold-standard for diagnosing pneumothorax, very accurate.
  • Thoracic ultrasound: a probe will be used to examine your chest and check for signs of a pneumothorax.

What are the treatment options for Pneumothorax in Singapore?

Once a pneumothorax is diagnosed, treatment will commence based on the underlying cause. Mild cases of pneumothorax may heal on its own, however, for larger, more significant ones, the following treatment options are available2:

  • Oxygen therapy: supplemental oxygen may be provided if you are showing symptoms but your pneumothorax is mild. 
  • Needle aspiration: air is removed from the pleural space using a syringe, allowing the lungs to reinflate after some time.
  • Chest tube insertion: a chest tube attached to a valve is inserted into your pleural cavity and continuously sucks air out, allowing your lungs to reinflate.
  • Pleurodesis: a procedure that sticks the lungs to the chest wall, which removes the space between the two and reduces or completely negates the possibility of future pneumothorax.
  • Surgery: thoracotomy, thoracoscopy, or lobectomy

Frequently asked questions

What is tension pneumothorax?

A tension pneumothorax is a life-threatening condition that occurs when there is continuous leakage of air into the pleural space, this compresses the lungs, heart, blood vessels, and other structures in the chest7.

Can a pneumothorax heal on its own?

Yes, if it is small enough.

References

  1. Andrew DeMaio, R. S. (2021). Management of Pneumothorax. Clinic in Chest Medicine, 729-738.
  2. Cleveland Clinic Medical Professional. (2021, May 11). Collapsed Lung (Pneumothorax). Retrieved from Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/15304-collapsed-lung-pneumothorax 
  3. Noppen M, D. K. (2008). Pneumothorax. Respiration, 121-127.
  4. Krause, L. (2021, October 19). Pneumothorax (Collapsed Lung). Retrieved from healthline: https://www.healthline.com/health/collapsed-lung 
  5. Mayo Clinic Staff. (2021, May 21). Pneumothorax. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367 
  6. Jacqueline Tran, W. H. (2021). Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management. Journal of Emergency Medicine, 517-528.
  7. Castillo, A. H. (2022). Tension Pneumothorax. Retrieved from Osmosis from Elsevier : https://www.osmosis.org/answers/tension-pneumothorax 
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