Spontaneous pneumothorax and the difference between pneumothorax.

Written by Han Shun Li
Pulmonology
Updated on September 11, 2024
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Simply put, spontaneous pneumothorax is a type of pneumothorax. In the classification of pneumothorax, besides spontaneous pneumothorax, there are also traumatic pneumothorax and iatrogenic pneumothorax. Traumatic pneumothorax is caused by direct or indirect injury to the chest wall, while iatrogenic pneumothorax occurs during medical diagnosis and treatment. Spontaneous pneumothorax often involves underlying lung diseases, such as emphysema, lung bullae, tuberculosis, lung cancer, and pneumoconiosis. It can also occur in healthy individuals without obvious lung abnormalities, typically seen in tall, thin males of young to middle age.

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The fastest method for spontaneous pneumothorax recovery.

Pneumothorax is mainly caused by various reasons that allow air inside the lungs to enter the pleural cavity, resulting in the accumulation of gas and the compression of the lung, reducing its volume. Clinically, for patients with lung compression not exceeding 30%, a conservative approach is typically chosen, which involves allowing the patients to heal naturally. For these patients who wish to accelerate their recovery, it is generally recommended to inhale high concentrations of oxygen, which can aid in the healing of the lungs. Additionally, it is important to increase nutrition and protein intake to enhance lung repair and recovery.

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The difference between tension pneumothorax and open pneumothorax.

The main difference between a tension pneumothorax and an open pneumothorax lies in the relative pressures of the pleural cavity compared to the atmospheric pressure. An open pneumothorax occurs when the pleural cavity is in an open state due to some reason. During inhalation, gas can enter the pleural cavity, and during exhalation, the gas can be expelled through this opening or another opening, resulting in pleural cavity pressure that is roughly equal to the atmospheric pressure. In a tension pneumothorax, due to some reason, a one-way valve is formed. The gas enters the pleural cavity easily but encounters resistance during expulsion, causing the pressure in the patient's pleural cavity to increase progressively. The gas can only enter the pleural cavity and cannot be effectively expelled. Therefore, the main difference between a tension pneumothorax and an open pneumothorax is the level of pleural cavity pressure compared to atmospheric pressure; in a tension pneumothorax, the pressure in the pleural cavity is significantly higher than the atmospheric pressure, while in an open pneumothorax, the pressures are roughly equal.

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Pneumothorax should be seen by which department?

If it is the patient's first pneumothorax occurrence and they are relatively young with no obvious lung bullae on the surface of their lungs, then seeing the emergency department should be sufficient to resolve the issue. Generally, if less than 20% of the lung is compressed, the patient can simply breathe oxygen at home or at a community hospital to gradually recover. However, if the patient is older and the degree of pneumothorax exceeds 20%, even reaching above 30%, it is advisable to insert a small tube between one and two millimeters into the pleural cavity to extract the air. At this point, it is recommended to consult thoracic surgery. After the air is released, a CT scan is also necessary to check for obvious lung bullae or small tears on the lung surface. If a small tear is found, it is best to use minimally invasive thoracoscopy to suture or seal the tear to prevent recurrence. Therefore, if possible, directly consider consulting thoracic surgery for pneumothorax; if thoracic surgery is not available, then consider seeing the emergency department.

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How many days do you usually stay in the hospital for pneumothorax drainage?

This depends on whether the pneumothorax is a simple pneumothorax or is complicated by other diseases. If there are no other lung diseases present and it is just a simple pneumothorax, then typically, drainage by tube for 5 to 7 days can lead to a complete recovery and cure. However, if there are complications such as emphysema, pulmonary heart disease, pneumoconiosis, or lung infections, then it is necessary first to control the infections. During this time, the pneumothorax can easily become a communicating pneumothorax. If it lasts for more than 1 to 2 weeks, it may turn into a refractory pneumothorax. In the case of refractory pneumothorax, besides drainage, minimally invasive surgeries such as pleurodesis or pneumothorax occlusion procedures are required. These surgeries take time. Therefore, if a stubborn pneumothorax forms, especially when complications like emphysema are present, hospital stays often need to be 14 days or even longer.

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Pneumothorax recurrence symptoms

We know that normally there is no air in the pleural cavity, only a small amount of fluid or lubricant exists. However, in certain people, such as those who often smoke, tall and thin young people, and patients with chronic bronchitis, the alveoli in their lungs tend to be more fragile and can easily rupture. People experiencing a pneumothorax for the first time might feel this during certain situations like after a cold, coughing, sneezing, or playing sports, which can lead to a recurrence of the pneumothorax. Early symptoms of a recurrence, due to only a small amount of air compression, might not be very uncomfortable, just a slight sense of difficulty breathing. As the pneumothorax increases, symptoms like chest pain and difficulty breathing can develop. Therefore, the symptoms of a recurring pneumothorax are not identical each time, but there is a pattern; the severity can range from mild breathing difficulty to severe respiratory distress and chest pain.