What is a lung deflation (pneumothorax)?
A hole in the lungs causes air to escape into the space between the lung and the chest wall. Air and gas accumulation is observed in this space between the chest wall. This causes the lungs to collapse completely or partially. This is why it is also called collapsed lung.
Lung deflation, which is usually associated with tuberculosis, can also be seen frequently in smokers. Another group at great risk are people with COPD. The reason for the formation of these risk groups is that people with these characteristics have weaker lung structures than the population. This means that defense mechanisms against spontaneous development of holes are lower.
Types of lung deflation (pneumothorax)
There are basically 2 types of lung deflation: spontaneous and traumatic. Although less common, tension and menstrual pneumothorax are also among the types of lung deflation.
In spontaneous lung collapse, the lungs collapse without any injury to the lung. Spontaneous pneumothorax is divided into primary and secondary spontaneous pneumothorax. In the first spontaneous pneumothorax, the cause of lung collapse is the rupture of abnormal air pockets in the lungs, releasing air. In primary spontaneous pneumothorax, there is no underlying health condition or disease that causes the lung to deflate.
In the secondary type of spontaneous pneumothorax, the factors that cause the lungs to collapse are lung diseases. These diseases cause blockage of the lungs. This blockage leads to the formation of bullae, swollen areas that can burst.
Another type of lung deflation is traumatic pneumothorax. Traumatic pneumothorax is divided into two categories. The first type is lung deflation due to injury. It occurs as a result of injury to the lung, such as a stab wound or broken rib. Traumatic lung deflation is iatrogenic pneumothorax. This occurs when the lung is punctured, for example by placement of a central venous line or biopsy.
This is when air can enter the lungs but cannot leave. It causes pressure build-up inside the lungs due to the one-way valve effect. Tension pneumothorax is a health problem that requires urgent medical intervention.
Menstrual pneumothorax is a rare condition that affects women with endometriosis. Because endometrial tissue growing outside the uterus can form cysts that bleed into the pleural cavity. This bleeding can cause the lungs to collapse.
Causes of lung deflation (pneumothorax)
Lung deflation can be caused by certain conditions and diseases. Basically, there are 2 types of conditions that cause lung deflation.
The first of these conditions occurs in people who do not have a previous diagnosis of lung disease, but who have any disease that can cause complications of lung deflation, such as asthma, cystic fibrosis, COPD, tuberculosis, emphysema and whooping cough. Lung deflation is seen in 70% of COPD patients. Other medical conditions that can cause it include the following:
- Lung collection
- Collagen vascular disease
- Idiopathic pulmonary fibrosis
- Lung cancer
- Acute respiratory distress syndrome
The second cause of lung deflation is traumatic causes. Lung deflation can be seen due to causes that disrupt lung tissue integrity such as stab wounds, gunshot wounds and rib fractures. In addition, some medical procedures such as biopsies or venous catheterization can also cause traumatic lung deflation. Trauma is also one of the causes of tic lung deflation:
- Blunt force trauma
- Nerve block
- Mechanical ventilation
In addition, small bubbles that form between the lung and the outer surface of the lung are formed during embryogenesis and usually affect young men. These bubbles can also cause spontaneous lung collapse.
Another rare cause of lung deflation is laughing lung deflation during women's menstrual periods. This condition, called menstrual pneumothorax, occurs when endometrial tissue connects to the lungs and forms a cyst. These cysts can cause the lungs to deflate by releasing blood and air into the pleural cavity.
In addition to these reasons, some lifestyle factors can also cause lung deflation. These reasons include the following:
- Drug use
- Flights involving significant changes in air pressure
- Scuba or deep sea diving
Factors that increase the risk of lung deflation include the following.
- Lung deflation is 7 times more common in men than in women
- Taller men increase the risk of lung deflation.
- Smoking is considered to be the biggest risk for lung deflation.
- Finally, one out of every 10 people with a family history of lung deflation has lung deflation.
- Being pregnant
- Marfan syndrome
Symptoms of lung deflation (pneumothorax)
Symptoms associated with lung deflation can be seen during waking, resting, sleeping or chest trauma. In cases where the hole is small, self-healing is possible because there are no symptoms. If the hole in the lungs is large, symptoms include the following.
- Fast heart rate
- Blue or ashy skin color due to lack of oxygen
- Easy fatigue
- Feeling of tightness in the chest
- Shortness of breath or feeling that you can't breathe enough
- Sharp chest pain that can radiate to the shoulder, arm or back, especially when coughing and breathing deeply
- Dilation of the neck veins
- Enlarged nostrils
- Low blood pressure
Because the severity of symptoms varies between patients, it can take several days for patients to realize that something is wrong. However, it is extremely important to seek urgent medical attention if any signs of a collapsed lung appear. Because lung deflation is one of the most life-threatening diseases.
How is lung deflation (pneumothorax) diagnosed?
Physical examination is extremely important in the diagnosis of lung deflation. By listening to the breath sounds on the affected side of the lung, experts can determine whether there is a lung deflation. Because these patients may have little or no breath sounds on the affected side of the lung. In addition, during normal breathing, both sides of the chest should rise and fall equally. In people with lung deflation, one side of the chest may not rise. Other tests performed to confirm the diagnosis of lung deflation are as follows.
- Chest X-ray
- Computed tomography
- Arterial blood gas test
Treatment methods for lung deflation (pneumothorax)
Especially in cases where the puncture in the lung is small, the condition will heal on its own, but if it is a large puncture, the patient will need to be hospitalized. The main goal in the treatment of lung deflation is to remove the air and re-inflate the lung. A procedure called needle aspiration is used for this.
In needle aspiration, a needle is inserted between the ribs into the space between the lung and the chest wall. Patients may then have a chest tube inserted and the chest tube may remain in place for several days until the cause of the lung deflation has healed. In cases where this procedure does not work, thoracic surgery is performed.
Needle aspiration can be a painful process for patients. For this reason, regional painkillers or anesthesia can be applied. Antibiotic treatment can also be started to prevent possible infections. Patients treated in the emergency department may be referred to pulmonology or thoracic surgery for further care.
Pleurodesis can be performed to prevent the lungs from collapsing again. For this, the surgeon makes an incision and then inserts a tube. In the next stage, they eliminate the hole by using various chemicals to connect the lungs to the chest cavity.
Surgery for lung deflation (pneumothorax)
The above-mentioned treatment methods are usually sufficient to treat lung deflation. However, in some cases surgical procedures are needed to repair the damage. Surgery is recommended for patients who do not respond to other treatments and have the following conditions
- Traumatic lung injuries
- Deflation of both lungs
- Recurrent lung bridge
- Expansion of the lung despite chest tube insertion
- Continuous air leakage from the chest tube
Methods of surgery for lung deflation (pneumothorax)
One of the treatment methods that can be applied in patients with white lung deflation is surgical procedures. Surgeries performed after the lung are divided into two as open and closed.
Patients with lung deflation are also intervened with surgical methods. Among these procedures, VATS is the most commonly used and closed type of surgery. In this procedure, the chest is entered through a single 2-centimeter incision. The hole in the lung is then repaired with a camera and surgical equipment. Since it is the least damaging method to healthy tissue, patients' postoperative recovery processes are faster and more comfortable.
These are among the characteristics of people who will undergo the closed VATS method, also called the endoscopic stapling method.
- Patients with recurrence of lung deflation
- Detection of a bulla or air sac
- Those in the occupational risk group
The surgery for the treatment of lung deflation takes 45 minutes on average. In atelectasis-type lung deflation, the duration of the procedure is limited to 10-15 minutes. After the surgery, it is sufficient for patients to stay in the hospital for 2 to 3 days.
Although it is rarely preferred today, open surgery is one of the treatment methods for lung deflation. In this surgery, a 7- to 8-centimeter long incision is made between the third and fourth ribs. The air sacs in the lung are then removed with a special procedure. It is also possible to remove the outer part of the lung during this procedure. Afterwards, a reaction called pleurodesis is created to make the lungs adhere.
At the end of the operation, a resistance is inserted into the chest cavity and anatomically closed. The inserted resistance is removed 1 to 2 days after surgery.
Complications of pneumothorax surgery
Some risky situations arise after lung deflation surgeries. The likelihood of these complications varies between 2% and 10% in closed surgery. Complications that may occur after lung deflation surgery include the following.
- Air leakage in the lung
- Relapse of the disease
Life After Pneumothorax Surgery
The first point that people with lung deflation should be careful about after treatment is not to fly or scuba dive. It is extremely important that patients avoid these activities, especially for 2 weeks after treatment. Patients with recurrent lung deflation need to perform these activities with extreme caution
Patients are at extremely high risk of having a second pneumothorax after not experiencing lung deflation. For this reason, patients should be extremely careful, especially in the first 30 days. During the first year after treatment, the likelihood of relapse is extremely high. Studies have shown that patients are between 20% and 60% more likely to experience a re-extinguished lung in the first 3 years. In addition, there are usually no long-term complications after lung deflation has healed.
Other points that patients should pay attention to after lung deflation include the following.
- Patients should not neglect their monthly medical check-ups.
- They should not lift heavy loads.
- They should avoid physical and sports activities that require straining or exertion for at least 6 months after surgery.
- Regular walking should be done.
- Smoking should be avoided and people should not be in smoking environments.
- They should take care of their bowel health and eat fiber-rich foods to prevent constipation.
- The medicines given should be used regularly.
Lung deflation (pneumothorax) recovery process
People with lung deflation require hospitalization for several days for treatment and monitoring. During this time, doctors closely monitor the condition of the patients and oxygen can be administered if necessary.
Usually the lung deflation heals within 2 weeks. This is because the body can absorb the extra air around the lungs and make them inflate again. In addition, the majority of people with punctured lungs recover without the need for treatment.
Complications of lung deflation
There is usually an uneventful recovery after treatment for lung deflation. However, serious complications can occur in some cases. These complications include the following.
- Heart failure
- Respiratory failure
- Treatment-induced damage or infection pulmonary edema