Causes

The cause of a primary pneumothorax is usually a rupture of the pulmonary alveoli (especially in emphysema). Pneumonia (pneumonia) and lung cancer (bronchial carcinoma) can cause, among other things, a secondary pneumothorax. This clinical picture can also be caused by improper pleural puncture (e.g. in the context of cerebrospinal fluid diagnostics) or acupuncture treatments in the lung area.

Internal pneumothoraxLung collapse is caused, among other things, by the bursting of pulmonary alveoli (e.g. due to a lack of protein), while external pneumothorax is caused, for example, by a broken rib when the lung tissue is punctured. Likewise, when the needle is inserted as part of a ganglion stellate blockage, the tip of the lung can be injured and a pneumothorax can be caused. The insertion of the needle during a ganglion stellate blockage can also injure the tip of the lung and cause a pneumothorax.

SymptomsComplaints

Among the symptoms are: In a tension pneumothorax, the lungs are compressed (squeezed) and the middle part of the thoracic cavity in which the heart is located (mediastinum-mediastinal shift) is shifted to the opposite healthy side. The compression of the lungs also causes breathing difficulties (dyspnoea). Another symptom of the tension pneumothorax is shock. It should be noted at this point that this is an emergency.

Shortness of breath
Chest pain and
Rapid breathing (tachypnea).

Diagnosis

During the physical examination, a darker (so-called hypersonic) knocking sound and a missing or even weakened breathing sound is detected above the affected area. On X-ray, the pneumothorax can be a very impressive finding. It is best to see the findings after exhalation (expiratory image).

The collapsed lung is represented by a reduction in transparency (less blackness) compared to the healthy side. The pleural gap, which is now filled with air, is dark black. A vessel drawing (white lines) is not visible.

In the case of a tension pneumothorax, the mediastinal shift can also be seen here: The heart shadow is displaced. CT (computed tomography) shows a similar picture: the affected side is darker (black) than the healthy side, on which the intact lung tissue is visible as whitish drawings.Air appears as uniformly black both in X-rays and in CT (computed tomography). In acute situations, conventional X-rays offer the fastest way to find the cause of the patient’s symptoms, such as shortness of breath or circulatory crisis.

Only if the cause of the pneumothorax is unclear should further diagnostic procedures be considered. The X-ray image is taken in a standing position in two planes, i.e. from the front or back and from the side of the patient. Even after a thoracic drainage system has been installed, an x-ray serves to check the optimal position of the tube in the thorax.

Left lung (unremarkable)
Heart
Collapsed right lung
Air in between the lung fur

Computed tomography (CT) can be helpful as a diagnostic tool in case of ambiguities in conventional X-rays. If, for example, there is a suspicion of an underlying disease that is responsible for the pneumothorax, computed tomography can be a groundbreaking tool for determining the cause. With regard to the spontaneous pneumothorax already mentioned above, CT can provide a more precise prognosis as to whether such a case can recur, because in this case subtle changes in the lung can be better visualized than in conventional X-rays.

Compared to conventional X-rays, the slice images of computed tomography allow a more precise localization of the cause. Ultrasound examination in a patient with suspected pneumothorax is not very effective at first. Due to the technical properties of the ultrasound procedure, air in the ultrasound sometimes interferes with the actual examination.

It behaves differently if there is increased fluid in the pleural gap. This can be easily detected. In general, the two examinations already mentioned can be preferred if there is a justified suspicion of a pneumothorax. The normal X-ray simply provides the best overview of the problem.