It is called air accumulation between the lung membranes. It is divided into two as Spontaneous and Traumatic. Spontaneous Pneumothoraces are divided into two as Primary and Secondary.
Primary Spontaneous Pneumothorax (PSP)
It is often seen in thin, tall men between the ages of 20-30, before puberty and rarely after the age of 40. It is seen in 20,000 people every year in America and causes an economic loss of 130 million dollars. It is seen 5-6 times more in men. There is a familial predisposition in some of them, and the predisposition is higher in women for pneumothoraces. The most common cause of PSP is the rupture of the air sacs in the apex (upper part) of the lung. The rupture of the sac can occur during exertion or at rest. It is not known exactly why these air sacs (bleps) occur. There are some theories, but none of them are definitive.
• More negative pressure in the upper part of the lung,
• Ischemic causes,
• Smoking
• Infections.
In tall, thin asthenic types, there is more air and more negative pressure in the apex. SPS is more common in smokers. There is a direct proportion between the amount of cigarettes and the frequency of SPS. It is more common in heavy smokers. The recurrence rate was found to be 70% in those who continue to smoke and 40% in those who quit. It is also more common in bronchial anomalies. This factor is an independent cause of smoking. It is more common in periods when there is a change in atmospheric pressure. It can cause bursting during air travel in people with bullae in their lungs. Clinical Chest pain is usually sudden in onset. It is localized to the bursting part. Pain occurs at rest. If there is shortness of breath, moderate tachycardia, hypotension, cyanosis, tension pneumothorax is considered. In physical examination: There is a decrease in breath sounds on the side with pneumothorax and little participation in respiration. Trachea pushed to the opposite side (shift), Opening in intercostal spaces on the side with pneumothorax, Decrease in vocal fremitus, hyper-resonance. ECG changes, shadow of visceral pleura separated from the chest wall is observed on standing direct chest radiograph. Pleural fluid is present in some of them. Small pneumothoraces and bullae are also observed on Computed Thoracic Tomography.
Treatment includes evacuating air, controlling air leakage and reducing the possibility of recurrence. Observation and nasal oxygen therapy, aspiration, tube thoracostomy, video-assisted surgery, thoracotomy can be applied.
Surgical Indications: Air leak lasting for the longest time in 7 days, recurrent pneumothorax, bilateral (two-sided) pneumothorax, history of pneumothorax on the opposite side, in patients with pneumonectomy (including those with one lung removed), occupational reasons (pilots and divers, long-distance captains, bus drivers, mountain climbers), people living far from the hospital, those who perform very important duties in terms of their profession.