Materiały źródłowe

• #1 10.Pneumothorax( | PPT

  https://www.slideshare.net/slideshow/10pneumothorax-2993417/2993417

  Pathogenesis and mechanisms In normal people, the pressure in pleural space is negative during the entire respiratory cycle. Two opposite forces result in negative pressure in pleural space: inherent outward pull of the chest wall and inherent elastic recoil of the lung. The negative pressure will be disappeared if any communication develops. […] When a communication develops between an alveolus or other intrapulmonary air space and pleural space air will flow into the pleural space until there is no longer a pressure difference or until the communication is sealed. […] When a communication develops through the chest wall between the atmosphere and the pleural space air will enter the pleural space until the pressure gradient is eliminated or the communication is closed. […] Pneumothorax: Negative pressure eliminated. The lung recoil-small lung-volume decrease V/Q decrease-shunt increase. Positive pressure compress blood vessels and heart decreased cardiac output. Impaired venous return. Hypotension. Shock. Result in a decrease in vital capacity. A decrease in PaO2.

• #2 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical criteria and chest x-ray. Most pneumothoraces require transcatheter aspiration or tube thoracostomy. […] Intrapleural pressure is normally negative (less than atmospheric pressure) because of inward lung and outward chest wall recoil. In pneumothorax, air enters the pleural space from outside the chest or from the lung itself via mediastinal tissue planes or direct pleural perforation. Intrapleural pressure increases, and lung volume decreases. […] Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension, respiratory arrest, and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration.

• #3 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. […] The pressure gradient inside the thorax changes with a pneumothorax. Usually, the pressure of the pleural space is negative when compared to atmospheric pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between the parietal and visceral pleurae. Lungs tend to collapse due to elastic recoil. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit equilibrium is achieved, or the rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases.

• #4 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  Pneumothorax is categorized as either spontaneous-pulmonary collapse without any cause-or induced by trauma. […] Primary pneumothorax develops following bullae ruptures in healthy people with no underlying pulmonary disease. Secondary pneumothorax is caused by rupture of damaged pulmonary tissue, and occurs primarily in patients diagnosed with pulmonary disease, such as pulmonary emphysema. […] In pneumothorax, the pulmonary alveoli or airway becomes connected to pleural cavity, and air migrates from the alveoli to the pleural cavity until the pressures of both areas are in equilibrium. […] The main physiological change in pneumothorax is a reduction of arterial oxygen tension in addition to the reduced vital capacity. […] Reduced oxygen tension may be caused by an anatomic shunt and, in some cases, alveolar hypoventilation in the pneumothorax area created from the reduced ventilation-perfusion ratio in the pulmonary alveoli.

• #5 Pneumothorax In Emergency Department | RECAPEM

  https://recapem.com/pneumothorax-in-emergency-department/

  Pneumothorax arises when free air enters the potential space between the visceral and parietal lung pleura. Air can enter the pleural space by two main routes: Communication between alveoli and pleura. Communication (direct or indirect) between atmosphere and pleura. The air accumulation can apply pressure on the lung and make it collapse. […] The mechanism that creates tension physiology has been postulated in two groups of patients: In spontaneously breathing patients, the pleural defect functions as a one-way valve, allowing the air to enter the pleural cavity on inspiration but does not allow the air to exit on expiration. This causes increasing positive intrapleural pressure. The progressively rising intrapleural pressure causes further ipsilateral lung collapse and exerts a mass effect on the contralateral lung and possibly mediastinum (compression of vessels and heart).

• #6 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  Pneumothorax is categorized as either spontaneous-pulmonary collapse without any cause-or induced by trauma. […] Primary pneumothorax develops following bullae ruptures in healthy people with no underlying pulmonary disease. Secondary pneumothorax is caused by rupture of damaged pulmonary tissue, and occurs primarily in patients diagnosed with pulmonary disease, such as pulmonary emphysema. […] In pneumothorax, the pulmonary alveoli or airway becomes connected to pleural cavity, and air migrates from the alveoli to the pleural cavity until the pressures of both areas are in equilibrium. […] The main physiological change in pneumothorax is a reduction of arterial oxygen tension in addition to the reduced vital capacity. […] Reduced oxygen tension may be caused by an anatomic shunt and, in some cases, alveolar hypoventilation in the pneumothorax area created from the reduced ventilation-perfusion ratio in the pulmonary alveoli.

• #7 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical criteria and chest x-ray. Most pneumothoraces require transcatheter aspiration or tube thoracostomy. […] Intrapleural pressure is normally negative (less than atmospheric pressure) because of inward lung and outward chest wall recoil. In pneumothorax, air enters the pleural space from outside the chest or from the lung itself via mediastinal tissue planes or direct pleural perforation. Intrapleural pressure increases, and lung volume decreases. […] Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension, respiratory arrest, and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration.

• #8 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  Pneumothorax is categorized as either spontaneous-pulmonary collapse without any cause-or induced by trauma. […] Primary pneumothorax develops following bullae ruptures in healthy people with no underlying pulmonary disease. Secondary pneumothorax is caused by rupture of damaged pulmonary tissue, and occurs primarily in patients diagnosed with pulmonary disease, such as pulmonary emphysema. […] In pneumothorax, the pulmonary alveoli or airway becomes connected to pleural cavity, and air migrates from the alveoli to the pleural cavity until the pressures of both areas are in equilibrium. […] The main physiological change in pneumothorax is a reduction of arterial oxygen tension in addition to the reduced vital capacity. […] Reduced oxygen tension may be caused by an anatomic shunt and, in some cases, alveolar hypoventilation in the pneumothorax area created from the reduced ventilation-perfusion ratio in the pulmonary alveoli.

• #9 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  Pneumothorax develops when air enters the pleural space as the result of disease or injury. This leads to a loss of negative pressure between the two pleural membranes, which can result in the partial or complete collapse of the lung. […] Increased intrapleural pressure alveolar collapse decreased V/Q ratio and increased right-to-left shunting. […] Spontaneous pneumothorax: rupture of blebs and bullae air moves into pleural space with increasing positive pressure ipsilateral lung is compressed and collapses. […] Tension pneumothorax: Disrupted visceral pleura, parietal pleura, or tracheobronchial tree. One-way valve mechanism, in which air enters the pleural space on inspiration but cannot exit. Progressive accumulation of air in the pleural space and increasing positive pressure within the chest. Collapse of ipsilateral lung; compression of contralateral lung, trachea, heart, and superior vena cava; angulation of inferior vena cava. Impaired respiratory function, reduced venous return to the heart. Reduced cardiac output. Hypoxia and hemodynamic instability.

• #10 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Air in the pleural cavity is termed pneumothorax. When this occurs in the absence of trauma or medical intervention, it is called spontaneous pneumothorax. Primary spontaneous pneumothorax typically occurs in young patients without known lung disease. However, the idea that these patients have “normal” lungs is outdated. This article will review evidence of inflammation and respiratory bronchiolitis on surgical specimens, discuss the identification of emphysema-like change (i.e., blebs and bullae), the concept of pleural porosity and review recent data on the overexpression of matrix metalloproteinases in the lungs of patients who have had pneumothorax. […] Spontaneous pneumothorax occurs in the absence of preceding trauma or iatrogenic injury. Therefore, the air present in the pleural space must have arisen from an abnormal communication between the air-containing alveolar spaces of the lung and the pleura. Spontaneous pneumothoraces are subdivided into primary spontaneous pneumothorax (PSP) that occurs in patient without known lung disease and apparently “normal lungs”; those arising in patients with known underlying lung disease (such as chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis) are called secondary spontaneous pneumothoraces (SSP). In PSP, the exact pathogenesis of the abnormal communication between alveoli and pleura is not clear.

• #11 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Although PSP was traditionally thought to occur in the absence of lung disease, there is increasing evidence that these patients do not have “normal lungs.” This evidence comprises a number of sources including patient-related risk factors (such as body morphology and smoking), radiographic abnormalities, and histological changes on examination of lung resection specimens. […] Microscopic examination of lung parenchyma from 20 patients with PSP who had undergone surgical resection in a study from 1971 showed chronic distal airway inflammation: lymphocyte and macrophage infiltration with some fibrotic changes. It could be that this chronic inflammation leads to the formation of ELCs in otherwise healthy lungs. However, this has not been proven. […] Another study found histopathologic evidence of respiratory bronchiolitis (RB) in 88.6% of patients undergoing surgery for PSP. RB is the accumulation of pigmented macrophages in the lumen and walls of bronchioles. All the patients in this study were smokers, and smoking is a known cause of RB; so it is unclear whether RB is a causal step in the pathway of pneumothorax development, or simply a marker of the patient’s smoking status.

• #12 Jornal Brasileiro de Pneumologia – Etiology of primary spontaneous pneumothorax

  https://www.jornaldepneumologia.com.br/details/2545/en-US/etiology-of-primary-spontaneous-pneumothorax

  With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). […] The pathogenesis of primary spontaneous pneumothorax can be best understood by understanding emphysematous lung lesions. The anatomical lesion known as a bleb was first described in 1947 by Miller, who established an anatomical distinction between a bleb and a bulla (bullous emphysema). […] Distension of an emphysematous bulla leads to an extreme thinning of its structure. The absence of pleural mesothelial cells on histological examination has been demonstrated by scanning electron microscopy, occurring primarily on the thin outer surface of type I bullae and in some areas on the surface of type II bullae. Therefore, distension of emphysematous bullae is due to a reduction in the surface tension of their walls, and this can be explained by Laplace’s law. In addition, there is evidence of a congenital etiology; however, the pathogenesis of bullae remains controversial. […] Bullae are found in approximately 85% of all patients with primary spontaneous pneumothorax undergoing surgery. However, there is no consensus in the literature regarding the anatomical classification of emphysematous lung lesions on the basis of surgical findings.

• #13 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Spontaneous pneumothorax in most patients occurs due to the rupture of bullae or blebs. Primary spontaneous pneumothorax is defined as occurring in patients without underlying lung disease, but these patients had asymptomatic bullae or blebs on thoracotomy. Primary spontaneous pneumothorax occurs in tall and thin young people due to increased shear forces or more negative pressure at the apex of the lung. Lung inflammation and oxidative stress are essential to the pathogenesis of primary spontaneous pneumothorax. Current smokers have increased inflammatory cells in small airways and are at increased risk of pneumothorax. […] Secondary spontaneous pneumothorax occurs in the presence of underlying lung disease, primarily chronic obstructive pulmonary disease; others may include tuberculosis, sarcoidosis, cystic fibrosis, malignancy, idiopathic pulmonary fibrosis, and pneumocystis jiroveci pneumonia.

• #14 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  The slow recovery rate of the shunt was likely associated with the duration of the pneumothorax. […] Most PSP cases result from spontaneous rupture of a subpleural bleb or bulla, which leaks air into the pleural cavity. […] There are two purposed mechanisms for bleb or bulla formation. One mechanism is congenital; the upper pulmonary lobe grows more quickly than the vasculature, causing a lack of blood supply and development of a bullae. The second mechanism is related to the pleural cavity pressure, which becomes more negative at the apical region of the lungs. […] In a tall individual, the negative pleural cavity pressure is increased at the upper pulmonary lobe, and the alveolar pressure similarly increases. […] Secondary spontaneous pneumothorax (SSP), unlike PSP, develops in patients diagnosed with a pulmonary disorder.

• #15 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Therefore, it could follow that these smaller “blebs” (consistent with Reid description of “type I bulla”), with absence of mesothelilal cells and nearby pores, are at greater risk of air leaking than the often larger bullae (described as Reid “type II bullae”) with intact mesothelial cells. These areas of disrupted mesothelial cells at the visceral pleural are replaced by an inflammatory elastofibrotic layer, which may contribute to an increased tendency to leak air. This idea is known as “pleural porosity.” […] However, if this were true, there would be evidence of ruptured blebs/bullae at medical thoracoscopy or video-assisted thoracoscopy surgery (VATS). In reality, visible air leaks from ELCs are highly variable, with many blebs or bullae remaining intact and, in some cases, no macroscopic lesions are seen at all. This supports the idea of pleural porosity, i.e., that pneumothorax occurs in PSP when air leaks from thinned visceral pleural rather than rupture of a bleb or bullae.

• #16 Pneumothorax, Chylothorax, Hemothorax, and Fibrothorax | Thoracic Key

  https://thoracickey.com/pneumothorax-chylothorax-hemothorax-and-fibrothorax/

  The traditional concept was that air leaked from one bleb supplied by a single airway. More recent data have challenged this concept; a study using inhaled fluorescein suggested that air may leak from more areas than just the blebs, raising the possibility of pleural porosity, in which the air leaks from multiple pores on the visceral pleura. […] The development of a spontaneous neonatal pneumothorax is related to the mechanical problems of expanding the lung for the first time. During the first few breaths of life, the transpulmonary pressures average 40cm H 2 O, with occasional pressures as high as 100cm H 2 O. […] The pathogenesis of catamenial pneumothorax is unclear. When the syndrome was initially described, it was hypothesized that air gained access to the peritoneal cavity during menstruation and then entered the pleural cavity through a diaphragmatic defect.

• #17 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Although PSP was traditionally thought to occur in the absence of lung disease, there is increasing evidence that these patients do not have “normal lungs.” This evidence comprises a number of sources including patient-related risk factors (such as body morphology and smoking), radiographic abnormalities, and histological changes on examination of lung resection specimens. […] Microscopic examination of lung parenchyma from 20 patients with PSP who had undergone surgical resection in a study from 1971 showed chronic distal airway inflammation: lymphocyte and macrophage infiltration with some fibrotic changes. It could be that this chronic inflammation leads to the formation of ELCs in otherwise healthy lungs. However, this has not been proven. […] Another study found histopathologic evidence of respiratory bronchiolitis (RB) in 88.6% of patients undergoing surgery for PSP. RB is the accumulation of pigmented macrophages in the lumen and walls of bronchioles. All the patients in this study were smokers, and smoking is a known cause of RB; so it is unclear whether RB is a causal step in the pathway of pneumothorax development, or simply a marker of the patient’s smoking status.

• #18 Pneumothorax: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/424547-overview

  Tension pneumothorax occurs anytime a disruption involves the visceral pleura, parietal pleura, or the tracheobronchial tree. This condition develops when injured tissue forms a one-way valve, allowing air inflow with inhalation into the pleural space and prohibiting air outflow. The volume of this nonabsorbable intrapleural air increases with each inspiration because of the one-way valve effect. As a result, pressure rises within the affected hemithorax. In addition to this mechanism, the positive pressure used with mechanical ventilation can cause air trapping. […] Lung inflammation and oxidative stress are hypothesized to be important to the pathogenesis of PSP. Current smokers, at increased risk for PSP, have increased numbers of inflammatory cells in the small airways. […] A growing body of evidence suggests that genetic factors may be important in the pathogenesis of many cases of PSP. Familial clustering of this condition has been reported. Genetic disorders that have been linked to PSP include Marfan syndrome, homocystinuria, and Birt-Hogg-Dube (BHD) syndrome.

• #19 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Two studies of surgical resection specimens of patients undergoing surgery for PSP demonstrated overexpression of MMPs. One study compared lung tissue from 15 PSP patients with that from 20 control patients (with early-stage lung cancer). Immunohistochemistry on slides of the lung tissue showed overexpression of MMP-2, -7 and -9 in the PSP patients compared to controls. The other study of 91 pneumothorax patients (without a control group) also found high MMP-2 and MMP-9 expression. Moreover, patients with recurrent pneumothorax episodes had higher levels of MMP expression. […] There is increasing evidence that the lungs of patients with PSP are not “normal” as traditionally described in textbooks. There appears to be an association between low BMI and smoking and risk of developing pneumothorax. Blebs are a common finding on CT scan on patients with pneumothorax, but the significance as a prognostic marker of pneumothorax recurrence is not yet proven. Analysis of surgical specimens has shown inflammation and respiratory bronchiolitis. More recently, matrix metalloproteinases have been identified as possible pathological factors. Further research is required to accurately define the true pathogenic pathway leading to the formation of pneumothorax in this patient group. However, identifying causative agents may allow more accurate stratification of patients at increased risk and identify possible future treatment targets.

• #20 Pneumothorax: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/424547-overview

  Tension pneumothorax occurs anytime a disruption involves the visceral pleura, parietal pleura, or the tracheobronchial tree. This condition develops when injured tissue forms a one-way valve, allowing air inflow with inhalation into the pleural space and prohibiting air outflow. The volume of this nonabsorbable intrapleural air increases with each inspiration because of the one-way valve effect. As a result, pressure rises within the affected hemithorax. In addition to this mechanism, the positive pressure used with mechanical ventilation can cause air trapping. […] Lung inflammation and oxidative stress are hypothesized to be important to the pathogenesis of PSP. Current smokers, at increased risk for PSP, have increased numbers of inflammatory cells in the small airways. […] A growing body of evidence suggests that genetic factors may be important in the pathogenesis of many cases of PSP. Familial clustering of this condition has been reported. Genetic disorders that have been linked to PSP include Marfan syndrome, homocystinuria, and Birt-Hogg-Dube (BHD) syndrome.

• #21 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  The slow recovery rate of the shunt was likely associated with the duration of the pneumothorax. […] Most PSP cases result from spontaneous rupture of a subpleural bleb or bulla, which leaks air into the pleural cavity. […] There are two purposed mechanisms for bleb or bulla formation. One mechanism is congenital; the upper pulmonary lobe grows more quickly than the vasculature, causing a lack of blood supply and development of a bullae. The second mechanism is related to the pleural cavity pressure, which becomes more negative at the apical region of the lungs. […] In a tall individual, the negative pleural cavity pressure is increased at the upper pulmonary lobe, and the alveolar pressure similarly increases. […] Secondary spontaneous pneumothorax (SSP), unlike PSP, develops in patients diagnosed with a pulmonary disorder.

• #22 SciELO Brazil – Etiology of primary spontaneous pneumothorax Etiology of primary spontaneous pneumothorax

  https://www.scielo.br/j/jbpneu/a/9C6jW6BFBxdKqDffhhqDKYt/

  The pathogenesis of primary spontaneous pneumothorax can be best understood by understanding emphysematous lung lesions. […] The anatomical lesion known as a bleb was first described in 1947 by Miller, who established an anatomical distinction between a bleb and a bulla (bullous emphysema). […] Later, in 1967, Reid divided bullous emphysema, which causes bullae, into three types: type I, a small amount of hyperinflated lung tissue that is narrow (pedunculated) and contains no lung parenchyma; type II, a relatively smaller amount of hyperinflated lung tissue that is broad (sessile) and usually contains vanishing lung; and type III, a large amount of hyperinflated lung tissue extending to the pulmonary hilum, with ill-defined margins and vanishing parenchyma in each bulla. […] The absence of pleural mesothelial cells on histological examination has been demonstrated by scanning electron microscopy, occurring primarily on the thin outer surface of type I bullae and in some areas on the surface of type II bullae. […] Therefore, distension of emphysematous bullae is due to a reduction in the surface tension of their walls, and this can be explained by Laplace’s law. […] In addition, there is evidence of a congenital etiology; however, the pathogenesis of bullae remains controversial.

• #23 SciELO Brazil – Etiology of primary spontaneous pneumothorax Etiology of primary spontaneous pneumothorax

  https://www.scielo.br/j/jbpneu/a/9C6jW6BFBxdKqDffhhqDKYt/

  The pathogenesis of primary spontaneous pneumothorax can be best understood by understanding emphysematous lung lesions. […] The anatomical lesion known as a bleb was first described in 1947 by Miller, who established an anatomical distinction between a bleb and a bulla (bullous emphysema). […] Later, in 1967, Reid divided bullous emphysema, which causes bullae, into three types: type I, a small amount of hyperinflated lung tissue that is narrow (pedunculated) and contains no lung parenchyma; type II, a relatively smaller amount of hyperinflated lung tissue that is broad (sessile) and usually contains vanishing lung; and type III, a large amount of hyperinflated lung tissue extending to the pulmonary hilum, with ill-defined margins and vanishing parenchyma in each bulla. […] The absence of pleural mesothelial cells on histological examination has been demonstrated by scanning electron microscopy, occurring primarily on the thin outer surface of type I bullae and in some areas on the surface of type II bullae. […] Therefore, distension of emphysematous bullae is due to a reduction in the surface tension of their walls, and this can be explained by Laplace’s law. […] In addition, there is evidence of a congenital etiology; however, the pathogenesis of bullae remains controversial.

• #24 Pneumothorax (spontaneous)

  https://emed.ie/Respiratory/Pneumothorax.php

  Primary pneumothaces occur in otherwise healthy people without any lung disease. […] Secondary pneumothoraces arise in subjects with underlying lung disease. […] Much higher incidence (12% v 0.1% lifetime risk) in smokers (subpleural blebs / bullae likely role in pathogenesis). […] Strong emphasis should be placed on the relationship between the recurrence of pneumothorax and smoking in an effort to encourage patients to stop smoking.

• #25 10.Pneumothorax( | PPT

  https://www.slideshare.net/slideshow/10pneumothorax-2993417/2993417

  The probable cause of pneumothorax is rupture of an apical bleb or bulla because the compliance of blebs or bullae in the apices is lower compared with that of similar lesions situated in the lower parts of the lungs. […] Smoking causes a 9-fold increase in the relative risk of a pneumothorax in females. A 22-fold increase in male smokers with a dose-response relationship between the number of cigarettes smoked per day and occurrence of PSP. […] The rate of resolution/reabsorption of spontaneous pneumothoraces is 1.25-1.8% of volume of hemithorax every 24 hours. The addition of high flow oxygen therapy has been shown to result in a 4-fold increase in the rate of pneumothorax reabsorption during the periods of oxygen supplementation. […] Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It can be primary or secondary and spontaneous or traumatic. Diagnosis is made through chest x-ray or CT scan. Treatment depends on size and includes observation, oxygen therapy, needle aspiration, catheter drainage, or chest tube placement. The goal is to promote lung re-expansion and prevent recurrence.

• #26 Primary spontaneous pneumothorax: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/primary-spontaneous-pneumothorax/

  Primary spontaneous pneumothorax most often occurs in people without an identified gene mutation. The cause of the condition in these individuals is often unknown. Tall young men are at increased risk of developing primary spontaneous pneumothorax; researchers suggest that rapid growth of the chest during growth spurts may increase the likelihood of forming blebs. Long-term smoking also greatly increases the risk of developing primary spontaneous pneumothorax in both men and women.

• #27 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Spontaneous pneumothorax in most patients occurs due to the rupture of bullae or blebs. Primary spontaneous pneumothorax is defined as occurring in patients without underlying lung disease, but these patients had asymptomatic bullae or blebs on thoracotomy. Primary spontaneous pneumothorax occurs in tall and thin young people due to increased shear forces or more negative pressure at the apex of the lung. Lung inflammation and oxidative stress are essential to the pathogenesis of primary spontaneous pneumothorax. Current smokers have increased inflammatory cells in small airways and are at increased risk of pneumothorax. […] Secondary spontaneous pneumothorax occurs in the presence of underlying lung disease, primarily chronic obstructive pulmonary disease; others may include tuberculosis, sarcoidosis, cystic fibrosis, malignancy, idiopathic pulmonary fibrosis, and pneumocystis jiroveci pneumonia.

• #28 Pneumothorax

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3982243/

  The most common associated etiology is chronic obstructive pulmonary disease (COPD), also known as chronic bronchitis or pulmonary emphysema. […] In tension pneumothorax, air flows into the pleural cavity during inhalation but is retained in the pleural cavity during exhalation and thus cannot exit, leading to a gradual increase in intra-pleural cavity pressure.

• #29 Pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pneumothorax?lang=us

  Pneumothorax (PTX) refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. The clinical consequences range from negligible to hemodynamic collapse and death. […] In tension pneumothorax a check-valve mechanism results in progressive enlargement of the pneumothorax which exerts pressure on the diaphragm and mediastinum, narrowing the superior vena cava and other blood vessels. Obstructed venous return may cause cardiovascular collapse and death. […] A primary spontaneous pneumothorax occurs in a patient with no known underlying lung disease. Tall and thin habitus are more likely to develop a primary spontaneous pneumothorax. […] When the underlying lung is abnormal, a pneumothorax is referred to as secondary spontaneous. There are many pulmonary diseases which predispose to pneumothorax including cystic lung disease, parenchymal necrosis, and other conditions. […] Iatrogenic/traumatic causes include percutaneous biopsy, barotrauma (e.g. divers), and trauma such as pulmonary laceration and tracheobronchial rupture.

• #30 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Spontaneous pneumothorax in most patients occurs due to the rupture of bullae or blebs. Primary spontaneous pneumothorax is defined as occurring in patients without underlying lung disease, but these patients had asymptomatic bullae or blebs on thoracotomy. Primary spontaneous pneumothorax occurs in tall and thin young people due to increased shear forces or more negative pressure at the apex of the lung. Lung inflammation and oxidative stress are essential to the pathogenesis of primary spontaneous pneumothorax. Current smokers have increased inflammatory cells in small airways and are at increased risk of pneumothorax. […] Secondary spontaneous pneumothorax occurs in the presence of underlying lung disease, primarily chronic obstructive pulmonary disease; others may include tuberculosis, sarcoidosis, cystic fibrosis, malignancy, idiopathic pulmonary fibrosis, and pneumocystis jiroveci pneumonia.

• #31 Pneumothorax – Pleural Diseases – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.18.

  Pneumothorax is the presence of air in the pleural space. The air enters the pleural space as a result of damage to the visceral pleura or parietal pleura, causing positive intrapleural pressure and compressing the lung. This in turn leads to impairment of gas exchange. […] a) Spontaneous pneumothorax is likely caused by rupture of an emphysematous bulla or subpleural alveoli. It may be primary (in previously healthy patients, ie, without any features of lung disease) or secondary (in the course of pulmonary diseases such as chronic obstructive pulmonary disease, cystic fibrosis, pulmonary Langerhans cell histiocytosis, or lymphangioleiomyomatosis). […] c) Tension pneumothorax: A one-way valve is formed in a hole through which air flows into the pleural space. During each inspiration air enters the pleural space but cannot leave it during expiration. As a consequence, the intrapleural pressure exceeds the atmospheric pressure and is constantly increasing, thereby causing not only ipsilateral compression of the lung but also contralateral displacement of the mediastinum, compression of the contralateral lung, compression of the large veins, decrease in the venous return, and reduction in cardiac output. These changes lead to sudden hypotension, hypoxemia, and potentially cardiac arrest. Tension pneumothorax is a life-threatening condition that requires immediate intervention.

• #32 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical criteria and chest x-ray. Most pneumothoraces require transcatheter aspiration or tube thoracostomy. […] Intrapleural pressure is normally negative (less than atmospheric pressure) because of inward lung and outward chest wall recoil. In pneumothorax, air enters the pleural space from outside the chest or from the lung itself via mediastinal tissue planes or direct pleural perforation. Intrapleural pressure increases, and lung volume decreases. […] Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension, respiratory arrest, and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration.

• #33 Pneumothorax – Wikipedia

  https://en.wikipedia.org/wiki/Pneumothorax

  A pneumothorax is collection of air in the pleural space between the lung and the chest wall. […] Once air enters the pleural cavity, the intrapleural pressure increases, resulting in the difference between the intrapulmonary pressure and the intrapleural pressure (defined as the transpulmonary pressure) to equal zero, which cause the lungs to deflate in contrast to a normal transpulmonary pressure of ~4 mm Hg. […] Tension pneumothorax occurs when the opening that allows air to enter the pleural space functions as a one-way valve, allowing more air to enter with every breath but none to escape.

• #34

  https://step2.medbullets.com/pulmonary/120665/tension-pneumothorax

  Tension pneumothorax results from positive pressure build-up secondary to a flap valve mechanism (or one-way valve) resulting in total lung collapse […] Increased intrathoracic pressure restricts cardiac output […] may result in shock and death.

• #35 Tension pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tension-pneumothorax?lang=us

  Tension pneumothoraces occur when progressive accumulation of intrapleural gas causes hemodynamic compromise. […] A one-way valve mechanism is responsible for tension pneumothorax. This allows gas to enter the pleural space during inspiration but limits the release of gas during expiration thereby decreasing ventilatory capacity. Increasingly positive pleural pressure on the affected side causes mass effect, collapsing the ipsilateral lung, squashing the contralateral lung, displacing mediastinal structures and obstructing venous return.

• #36 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  Pneumothorax develops when air enters the pleural space as the result of disease or injury. This leads to a loss of negative pressure between the two pleural membranes, which can result in the partial or complete collapse of the lung. […] Increased intrapleural pressure alveolar collapse decreased V/Q ratio and increased right-to-left shunting. […] Spontaneous pneumothorax: rupture of blebs and bullae air moves into pleural space with increasing positive pressure ipsilateral lung is compressed and collapses. […] Tension pneumothorax: Disrupted visceral pleura, parietal pleura, or tracheobronchial tree. One-way valve mechanism, in which air enters the pleural space on inspiration but cannot exit. Progressive accumulation of air in the pleural space and increasing positive pressure within the chest. Collapse of ipsilateral lung; compression of contralateral lung, trachea, heart, and superior vena cava; angulation of inferior vena cava. Impaired respiratory function, reduced venous return to the heart. Reduced cardiac output. Hypoxia and hemodynamic instability.

• #37 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1140991

  Tension pneumothorax occurs when a one-way valve is created between the lung and pleura. Air accumulates in the pleural cavity with every breath, and intrapleural pressure is elevated. This leads to a shrinkage in the ipsilateral lung, and the mediastinum is pushed to the opposite side. This reduces venous return, resulting in a cardiac arrest. During tension pneumothorax, chest radiological findings show a hemi-diapragmatic depression, increased rib separation, increased thoracic volume, ipsilateral flattening at the heart border, and a contralateral mediastinal deviation.189 In our case, tension pneumothorax, where the ipsilateral hemidiaphragm is pushed down was not shown in the initial postoperative chest radiograph, but instead was found later (Fig. 2, 3). In such case, a prompt decompression is crucial wherein a needle thoracostomy followed by a tube thoracostomy must be performed.

• #38 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical criteria and chest x-ray. Most pneumothoraces require transcatheter aspiration or tube thoracostomy. […] Intrapleural pressure is normally negative (less than atmospheric pressure) because of inward lung and outward chest wall recoil. In pneumothorax, air enters the pleural space from outside the chest or from the lung itself via mediastinal tissue planes or direct pleural perforation. Intrapleural pressure increases, and lung volume decreases. […] Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Air continues to get into the pleural space but cannot exit. Without appropriate treatment, the impaired venous return can cause systemic hypotension, respiratory arrest, and cardiac arrest (pulseless electrical activity) within minutes. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration.

• #39 Pneumothorax (Tension) – Injuries; Poisoning – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-tension

  Tension pneumothorax develops when a lung or chest wall injury is such that it allows air into the pleural space but not out of it (a one-way valve). […] As a result, air accumulates and compresses the lung, eventually shifting the mediastinum, compressing the contralateral lung, and increasing intrathoracic pressure enough to decrease venous return to the heart, causing shock. […] Causes include mechanical ventilation (most commonly) and simple (uncomplicated) pneumothorax with lung injury that fails to seal following penetrating or blunt chest trauma or failed central venous cannulation. […] Tension pneumothorax should be diagnosed by clinical findings. […] Treatment should not be delayed pending radiographic confirmation. […] Tension pneumothorax can be differentiated clinically by its unilateral absence of breath sounds and hyperresonance to percussion.

• #40 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Iatrogenic pneumothorax occurs due to a complication of a medical or surgical procedure. Thoracentesis is the most common cause. […] Traumatic pneumothoraces can result from blunt or penetrating trauma; these often create a one-way valve in the pleural space (letting the airflow in but not flow out) and hence hemodynamic compromise. Tension pneumothorax most commonly occurs in ICU settings in positive-pressure ventilated patients.

• #41 The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia | Saudi Medical Journal

  https://smj.org.sa/content/41/3/247

  Conclusion: The incidence of traumatic pneumothorax is sizable and highly associated with the mechanism of injury. Efforts to reduce motor vehicle collision burden should be directly associated with decreasing the burden of traumatic pneumothorax. […] Traumatic pneumothorax is a potentially life-threatening condition which occurs when air enters the pleural space as a result of a blunt or penetrating chest injury. It accounts for one fifth of major trauma victims. It is a very common cause of chest trauma which can have a good prognosis if recognized and treated early in pre-hospital and emergency department settings. Vassiliu Degiannis reported that the annual incidence of traumatic pneumothorax is estimated to be 81 per 100,000 people, and the condition accounts for 20.6% of major trauma patients.

• #42 The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia | Saudi Medical Journal

  https://smj.org.sa/content/41/3/247

  Blunt chest trauma occurs as a result of a blow to the chest or an accident that causes damage to the chest components. It is responsible for approximately 25% of all traumatic deaths and represents the underlying cause in the vast majority of all traumatic pneumothorax cases. Nevertheless, penetration trauma also has a substantial influence on developing pneumothorax. McPherson et al reported that approximately 3 to 4% of fatally wounded combat casualties died from a tension pneumothorax. […] Despite the continuing efforts in advancing trauma management, the overall mortality attributed to chest trauma is as high as 60% with an incidence accounting for 10% of trauma admissions. A study conducted in India reported that motor vehicle collisions (MVC) accounted for 50% of chest trauma cases, and 44% of the thoracic trauma patients were diagnosed with pneumothorax. The predictors of pneumothorax among trauma patients other than MVC include the presence of penetrating chest injuries and rib fractures. It is reported that penetrating injuries have a higher mortality rate compared to blunt trauma.

• #43 Open Pneumothorax – Injuries and Poisoning – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/injuries-and-poisoning/chest-injuries/open-pneumothorax

  When people with an unsealed opening in the chest wall inhale, the negative pressure generated by the inhalation sucks air into the space between the lung and chest wall (pleural space) from 2 different sources at once, the trachea (windpipe) and the opening in the chest wall. […] However, when the opening in the chest wall is about two thirds the diameter of the trachea or larger, more air passes into the pleural space through the chest wall opening than through the trachea, causing the lung to collapse and preventing inhaled air from flowing into the lungs. […] Larger openings can lead to complete collapse of the lung.

• #44 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Iatrogenic pneumothorax occurs due to a complication of a medical or surgical procedure. Thoracentesis is the most common cause. […] Traumatic pneumothoraces can result from blunt or penetrating trauma; these often create a one-way valve in the pleural space (letting the airflow in but not flow out) and hence hemodynamic compromise. Tension pneumothorax most commonly occurs in ICU settings in positive-pressure ventilated patients.

• #45 Pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pneumothorax?lang=us

  Pneumothorax (PTX) refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. The clinical consequences range from negligible to hemodynamic collapse and death. […] In tension pneumothorax a check-valve mechanism results in progressive enlargement of the pneumothorax which exerts pressure on the diaphragm and mediastinum, narrowing the superior vena cava and other blood vessels. Obstructed venous return may cause cardiovascular collapse and death. […] A primary spontaneous pneumothorax occurs in a patient with no known underlying lung disease. Tall and thin habitus are more likely to develop a primary spontaneous pneumothorax. […] When the underlying lung is abnormal, a pneumothorax is referred to as secondary spontaneous. There are many pulmonary diseases which predispose to pneumothorax including cystic lung disease, parenchymal necrosis, and other conditions. […] Iatrogenic/traumatic causes include percutaneous biopsy, barotrauma (e.g. divers), and trauma such as pulmonary laceration and tracheobronchial rupture.

• #46 Pneumothorax pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pneumothorax_pathophysiology

  Pneumothorax is air in the pleural space under pressure resulting in lung collapse. The pathophysiology of each type depends on the underlying disease/etiology. Primary spontaneous pneumothorax most commonly results from the bleb (small air-filled lesions under pleural surface) rupture allowing the air to leak into the pleural space. […] The pathophysiology of pneumothorax depends on the underlying disease causing it. […] Tension pneumothorax develops when a disruption involves the visceral pleura, parietal pleura, or the tracheobronchial tree. […] The disruption occurs when a one-way valve forms, allowing air inflow into the pleural space, and prohibiting air outflow. […] Iatrogenic pneumothorax causes penetrating or non-penetrating injury to the pleura resulting in abrupt increase in the alveolar pressure, which can lead to alveolar rupture. […] A pneumothorax occurs when either the visceral or the mediastinal pleura ruptures that allows air to enter the pleural space.

• #47 Catamenial Hemopneumothorax: An Unusual Presentation of Spontaneous Pneumothorax | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n2/hernandez-catamenial/

  A catamenial pneumothorax is defined as a spontaneous and often recurrent pneumothorax with a temporal relationship to menstruation. […] Most commonly, the underlying pathophysiological process is the ectopic implantation of endometrial tissue (endometriosis) in the thorax. […] However, more recent data suggests that catamenial pneumothorax may have a higher incidence, with rates accounting for as many as 25 to 35 percent of spontaneous pneumothoraces in healthy women. […] Although not fully understood, it is thought that the most common underlying pathophysiological process of catamenial pneumothorax is endometriosis (the presence of endometrial glands and stroma outside the confines of the uterine cavity). […] The exact mechanism of how ectopic endometrial tissue reaches the thorax is still widely debated, but there are several competing theories.

• #48 Catamenial Hemopneumothorax: An Unusual Presentation of Spontaneous Pneumothorax | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n2/hernandez-catamenial/

  A catamenial pneumothorax is defined as a spontaneous and often recurrent pneumothorax with a temporal relationship to menstruation. […] Most commonly, the underlying pathophysiological process is the ectopic implantation of endometrial tissue (endometriosis) in the thorax. […] However, more recent data suggests that catamenial pneumothorax may have a higher incidence, with rates accounting for as many as 25 to 35 percent of spontaneous pneumothoraces in healthy women. […] Although not fully understood, it is thought that the most common underlying pathophysiological process of catamenial pneumothorax is endometriosis (the presence of endometrial glands and stroma outside the confines of the uterine cavity). […] The exact mechanism of how ectopic endometrial tissue reaches the thorax is still widely debated, but there are several competing theories.

• #49 Catamenial Hemopneumothorax: An Unusual Presentation of Spontaneous Pneumothorax | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n2/hernandez-catamenial/

  One explanation is that similar to its intra-uterine counterpart, ectopic endometrial tissue undergoes the phases of the menstrual cycle and may release air or blood into the pleural space, causing a recurrent spontaneous hemothorax or pneumothorax. […] Diagnosis of catamenial pneumothorax is typically delayed due to a lack of clinical suspicion for this process as the cause of pneumothorax. […] Definitive diagnosis can be made by high-resolution CT scan which may show pleural or parenchymal nodules, pneumothorax, pleural effusions, cavitation, or bullae. […] Both surgical approaches and hormonal therapy used in combination, or as separate entities, are employed in the treatment of catamenial pneumothorax. […] Optimal management involves VATS with surgical blebectomy and pleurodesis along with 6 to 12 months of hormonal suppression to prevent recurrence of pneumothorax.

• #50 Pneumothorax, Chylothorax, Hemothorax, and Fibrothorax | Thoracic Key

  https://thoracickey.com/pneumothorax-chylothorax-hemothorax-and-fibrothorax/

  The traditional concept was that air leaked from one bleb supplied by a single airway. More recent data have challenged this concept; a study using inhaled fluorescein suggested that air may leak from more areas than just the blebs, raising the possibility of pleural porosity, in which the air leaks from multiple pores on the visceral pleura. […] The development of a spontaneous neonatal pneumothorax is related to the mechanical problems of expanding the lung for the first time. During the first few breaths of life, the transpulmonary pressures average 40cm H 2 O, with occasional pressures as high as 100cm H 2 O. […] The pathogenesis of catamenial pneumothorax is unclear. When the syndrome was initially described, it was hypothesized that air gained access to the peritoneal cavity during menstruation and then entered the pleural cavity through a diaphragmatic defect.

• #51 10.Pneumothorax( | PPT

  https://www.slideshare.net/slideshow/10pneumothorax-2993417/2993417

  The probable cause of pneumothorax is rupture of an apical bleb or bulla because the compliance of blebs or bullae in the apices is lower compared with that of similar lesions situated in the lower parts of the lungs. […] Smoking causes a 9-fold increase in the relative risk of a pneumothorax in females. A 22-fold increase in male smokers with a dose-response relationship between the number of cigarettes smoked per day and occurrence of PSP. […] The rate of resolution/reabsorption of spontaneous pneumothoraces is 1.25-1.8% of volume of hemithorax every 24 hours. The addition of high flow oxygen therapy has been shown to result in a 4-fold increase in the rate of pneumothorax reabsorption during the periods of oxygen supplementation. […] Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It can be primary or secondary and spontaneous or traumatic. Diagnosis is made through chest x-ray or CT scan. Treatment depends on size and includes observation, oxygen therapy, needle aspiration, catheter drainage, or chest tube placement. The goal is to promote lung re-expansion and prevent recurrence.

• #52 Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? – Park – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/17314/html

  Oxygen therapy is one of the conservative treatments for spontaneous pneumothorax. It is widely accepted that oxygen therapy increases the resolution rate of spontaneous pneumothorax. The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies. In two clinical studies, the resolution rate increased by three or four times during periods of oxygen therapy. However, these two studies were based on small populations with secondary pneumothorax. There is a lack of clinical evidence for the effectiveness of oxygen therapy for primary spontaneous pneumothorax (PSP), which usually occurs in young adults or adolescents. Our study suggested that the resolution rate of PSP was related to initial pneumothorax size, the time interval between radiographs, and oxygen therapy. The purposes of oxygen therapy for PSP are to maintain oxygen saturation and to increase the resolution rate. It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax. The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution. In addition, some animal studies have shown that increasing the fraction of inspired oxygen accelerates the resolution rate. Our study demonstrated the effect of oxygen therapy in the resolution of PSP. The resolution rate was (4.27%1.97%)/day in the O2 group vs. (2.06%0.97%)/day in the room air group. Although the difference between these rates is statistically significant, its clinical usefulness is uncertain for the following reasons. First, the absolute difference in resolution rate is not great. Second, PSP is also resolved in room air. Third, oxygen therapy has potential adverse effects. Fourth, patients with small pneumothoraces usually maintain adequate oxygenation without oxygen therapy. The resolution rate of PSP was increased with oxygen supplementation. However, taking into consideration current concerns about adverse outcomes of hyperoxia, the routine use of oxygen therapy in patients with small pneumothoraces should be considered carefully.

• #53 Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? – Park – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/17314/html

  Oxygen therapy is one of the conservative treatments for spontaneous pneumothorax. It is widely accepted that oxygen therapy increases the resolution rate of spontaneous pneumothorax. The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies. In two clinical studies, the resolution rate increased by three or four times during periods of oxygen therapy. However, these two studies were based on small populations with secondary pneumothorax. There is a lack of clinical evidence for the effectiveness of oxygen therapy for primary spontaneous pneumothorax (PSP), which usually occurs in young adults or adolescents. Our study suggested that the resolution rate of PSP was related to initial pneumothorax size, the time interval between radiographs, and oxygen therapy. The purposes of oxygen therapy for PSP are to maintain oxygen saturation and to increase the resolution rate. It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax. The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution. In addition, some animal studies have shown that increasing the fraction of inspired oxygen accelerates the resolution rate. Our study demonstrated the effect of oxygen therapy in the resolution of PSP. The resolution rate was (4.27%1.97%)/day in the O2 group vs. (2.06%0.97%)/day in the room air group. Although the difference between these rates is statistically significant, its clinical usefulness is uncertain for the following reasons. First, the absolute difference in resolution rate is not great. Second, PSP is also resolved in room air. Third, oxygen therapy has potential adverse effects. Fourth, patients with small pneumothoraces usually maintain adequate oxygenation without oxygen therapy. The resolution rate of PSP was increased with oxygen supplementation. However, taking into consideration current concerns about adverse outcomes of hyperoxia, the routine use of oxygen therapy in patients with small pneumothoraces should be considered carefully.

• #54 “Nitrogen Wash-Out” in Non-Hypoxaemic Patients with Spontaneous Pneumothorax: A Narrative Review

  https://www.mdpi.com/2077-0383/12/13/4300

  The above gradient could be theoretically increased by replacing nitrogen, by breathing highly concentrated oxygen. With the proportion of nitrogen in the sum of partial pressures in arterial blood leaving the pulmonary capillaries decreasing, there is an enhanced diffusion gradient between the pleural cavity and blood. […] It must be acknowledged, however, that the pneumothorax was induced artificially by injuring the pleura. Thus, the findings may not be applicable to the nature and pathophysiology of a spontaneous pneumothorax in humans. […] Overall, the recommendation of the British Thoracic Society summarise the physiological risks of hyperoxia due to supplemental oxygen therapy as follows: Worsening V/Q mismatch, Absorption atelectasis, Coronary and cerebral vasoconstriction, Reduced cardiac output, Damage from oxygen free radicals, Increased systemic vascular resistance. […] According to previous animal models there appears to be a therapeutic effect of oxygen therapy for the treatment of pneumothorax, based upon the nitrogen wash-out theory. The transfer from the findings in the animal model to humans, however, may be less clear.

• #55 Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? – Park – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/17314/html

  Oxygen therapy is one of the conservative treatments for spontaneous pneumothorax. It is widely accepted that oxygen therapy increases the resolution rate of spontaneous pneumothorax. The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies. In two clinical studies, the resolution rate increased by three or four times during periods of oxygen therapy. However, these two studies were based on small populations with secondary pneumothorax. There is a lack of clinical evidence for the effectiveness of oxygen therapy for primary spontaneous pneumothorax (PSP), which usually occurs in young adults or adolescents. Our study suggested that the resolution rate of PSP was related to initial pneumothorax size, the time interval between radiographs, and oxygen therapy. The purposes of oxygen therapy for PSP are to maintain oxygen saturation and to increase the resolution rate. It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax. The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution. In addition, some animal studies have shown that increasing the fraction of inspired oxygen accelerates the resolution rate. Our study demonstrated the effect of oxygen therapy in the resolution of PSP. The resolution rate was (4.27%1.97%)/day in the O2 group vs. (2.06%0.97%)/day in the room air group. Although the difference between these rates is statistically significant, its clinical usefulness is uncertain for the following reasons. First, the absolute difference in resolution rate is not great. Second, PSP is also resolved in room air. Third, oxygen therapy has potential adverse effects. Fourth, patients with small pneumothoraces usually maintain adequate oxygenation without oxygen therapy. The resolution rate of PSP was increased with oxygen supplementation. However, taking into consideration current concerns about adverse outcomes of hyperoxia, the routine use of oxygen therapy in patients with small pneumothoraces should be considered carefully.

• #56 Re-expansion pulmonary oedema in pneumothorax | BMJ Case Reports

  https://casereports.bmj.com/content/12/3/e229303

  Re-expansion pulmonary oedema (REPE) can occur after a pneumothorax is drained. […] The mechanism of REPE is thought to be a combination of damage to the pulmonary interstitium combined with an imbalance of hydrostatic forces. The pulmonary interstitium is a space bordered by visceral pleura and contains a barrier between the alveoli and the capillaries. Changes in intrapleural pressure directly affect that space. Rapid re-expansion of the underlying collapsed lung causes pressure-related mechanical damage to the pulmonary blood vessels leading to increased permeability. Sudden reversal of hypoxic vasoconstriction is a proinflammatory process precipitating oxidative stress and fluid production. The foregoing is combined with increased negative intrapleural pressures that occur when large volumes of air or fluid are removed, reducing the pressure in the pulmonary interstitium. This creates an increased gradient for fluid movement across the alveolar-capillary barrier. […] The pathophysiology is complex and poorly understood.

• #57 Re-expansion pulmonary oedema in pneumothorax | BMJ Case Reports

  https://casereports.bmj.com/content/12/3/e229303

  Re-expansion pulmonary oedema (REPE) can occur after a pneumothorax is drained. […] The mechanism of REPE is thought to be a combination of damage to the pulmonary interstitium combined with an imbalance of hydrostatic forces. The pulmonary interstitium is a space bordered by visceral pleura and contains a barrier between the alveoli and the capillaries. Changes in intrapleural pressure directly affect that space. Rapid re-expansion of the underlying collapsed lung causes pressure-related mechanical damage to the pulmonary blood vessels leading to increased permeability. Sudden reversal of hypoxic vasoconstriction is a proinflammatory process precipitating oxidative stress and fluid production. The foregoing is combined with increased negative intrapleural pressures that occur when large volumes of air or fluid are removed, reducing the pressure in the pulmonary interstitium. This creates an increased gradient for fluid movement across the alveolar-capillary barrier. […] The pathophysiology is complex and poorly understood.

• #58 Re-expansion pulmonary oedema in pneumothorax | BMJ Case Reports

  https://casereports.bmj.com/content/12/3/e229303

  Re-expansion pulmonary oedema (REPE) can occur after a pneumothorax is drained. […] The mechanism of REPE is thought to be a combination of damage to the pulmonary interstitium combined with an imbalance of hydrostatic forces. The pulmonary interstitium is a space bordered by visceral pleura and contains a barrier between the alveoli and the capillaries. Changes in intrapleural pressure directly affect that space. Rapid re-expansion of the underlying collapsed lung causes pressure-related mechanical damage to the pulmonary blood vessels leading to increased permeability. Sudden reversal of hypoxic vasoconstriction is a proinflammatory process precipitating oxidative stress and fluid production. The foregoing is combined with increased negative intrapleural pressures that occur when large volumes of air or fluid are removed, reducing the pressure in the pulmonary interstitium. This creates an increased gradient for fluid movement across the alveolar-capillary barrier. […] The pathophysiology is complex and poorly understood.

• #59

  https://link.springer.com/article/10.1007/s13665-021-00272-4

  Subcutaneous emphysema is a recognised complication of pneumothorax and is found more commonly in association with pneumothorax than other pathologies. […] Subcutaneous emphysema is thought to arise in spontaneous pneumothorax through the Macklin Effect. The rupture of alveoli in a spontaneous pneumothorax is followed by an air leak into the loose connective tissue surrounding the pulmonary vasculature. This air tracks centripetally along the broncho-vascular sheath to the mediastinum. From here, aberrant air is free to follow a continuum of fascial planes that connect the mediastinum and soft tissues. This has been demonstrated in animal studies and can be observed on CT imaging. […] In traumatic pneumothorax, and in patients treated with an intercostal drain, SCE can result when the parietal pleura is breached. This creates a direct pathway for air into the subcutaneous tissue.

• #60

  https://link.springer.com/article/10.1007/s13665-021-00272-4

  Subcutaneous emphysema is a recognised complication of pneumothorax and is found more commonly in association with pneumothorax than other pathologies. […] Subcutaneous emphysema is thought to arise in spontaneous pneumothorax through the Macklin Effect. The rupture of alveoli in a spontaneous pneumothorax is followed by an air leak into the loose connective tissue surrounding the pulmonary vasculature. This air tracks centripetally along the broncho-vascular sheath to the mediastinum. From here, aberrant air is free to follow a continuum of fascial planes that connect the mediastinum and soft tissues. This has been demonstrated in animal studies and can be observed on CT imaging. […] In traumatic pneumothorax, and in patients treated with an intercostal drain, SCE can result when the parietal pleura is breached. This creates a direct pathway for air into the subcutaneous tissue.

• #61

  https://link.springer.com/article/10.1007/s13665-021-00272-4

  Subcutaneous emphysema is a recognised complication of pneumothorax and is found more commonly in association with pneumothorax than other pathologies. […] Subcutaneous emphysema is thought to arise in spontaneous pneumothorax through the Macklin Effect. The rupture of alveoli in a spontaneous pneumothorax is followed by an air leak into the loose connective tissue surrounding the pulmonary vasculature. This air tracks centripetally along the broncho-vascular sheath to the mediastinum. From here, aberrant air is free to follow a continuum of fascial planes that connect the mediastinum and soft tissues. This has been demonstrated in animal studies and can be observed on CT imaging. […] In traumatic pneumothorax, and in patients treated with an intercostal drain, SCE can result when the parietal pleura is breached. This creates a direct pathway for air into the subcutaneous tissue.

• #62 Aetiology of Primary Spontaneous Pneumothorax

  https://www.mdpi.com/2077-0383/11/3/490

  Two studies of surgical resection specimens of patients undergoing surgery for PSP demonstrated overexpression of MMPs. One study compared lung tissue from 15 PSP patients with that from 20 control patients (with early-stage lung cancer). Immunohistochemistry on slides of the lung tissue showed overexpression of MMP-2, -7 and -9 in the PSP patients compared to controls. The other study of 91 pneumothorax patients (without a control group) also found high MMP-2 and MMP-9 expression. Moreover, patients with recurrent pneumothorax episodes had higher levels of MMP expression. […] There is increasing evidence that the lungs of patients with PSP are not “normal” as traditionally described in textbooks. There appears to be an association between low BMI and smoking and risk of developing pneumothorax. Blebs are a common finding on CT scan on patients with pneumothorax, but the significance as a prognostic marker of pneumothorax recurrence is not yet proven. Analysis of surgical specimens has shown inflammation and respiratory bronchiolitis. More recently, matrix metalloproteinases have been identified as possible pathological factors. Further research is required to accurately define the true pathogenic pathway leading to the formation of pneumothorax in this patient group. However, identifying causative agents may allow more accurate stratification of patients at increased risk and identify possible future treatment targets.

• #63 ABSTRACT

  https://www.ejcrim.com/index.php/EJCRIM/article/download/4217/3853?inline=1

  We describe, to the best of our knowledge, the first case of pneumothorax induced by a Valsalva manoeuvre in a COVID-19 infection. […] The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. […] Valsalva-induced barotrauma could be the result of the large pressure gradient being generated against a closed glottis. […] The rise of intra-alveolar pressure provokes a rupture of the alveolar wall, leading the air to propagate to the mediastinum through the perivascular and bronchovascular sheaths. […] Thus, the Valsalva manoeuvre, due to any reasons (cough or constipation for example in our case) can be an overlooked cause of pneumothorax in patients with COVID-19. […] One factor that could explain the predisposition to develop barotrauma is the extensive use of non-invasive and invasive ventilation during the pandemic in severe respiratory forms of COVID-19.

• #64 ABSTRACT

  https://www.ejcrim.com/index.php/EJCRIM/article/download/4217/3853?inline=1

  We describe, to the best of our knowledge, the first case of pneumothorax induced by a Valsalva manoeuvre in a COVID-19 infection. […] The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. […] Valsalva-induced barotrauma could be the result of the large pressure gradient being generated against a closed glottis. […] The rise of intra-alveolar pressure provokes a rupture of the alveolar wall, leading the air to propagate to the mediastinum through the perivascular and bronchovascular sheaths. […] Thus, the Valsalva manoeuvre, due to any reasons (cough or constipation for example in our case) can be an overlooked cause of pneumothorax in patients with COVID-19. […] One factor that could explain the predisposition to develop barotrauma is the extensive use of non-invasive and invasive ventilation during the pandemic in severe respiratory forms of COVID-19.

• #65 ABSTRACT

  https://www.ejcrim.com/index.php/EJCRIM/article/download/4217/3853?inline=1

  We describe, to the best of our knowledge, the first case of pneumothorax induced by a Valsalva manoeuvre in a COVID-19 infection. […] The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. […] Valsalva-induced barotrauma could be the result of the large pressure gradient being generated against a closed glottis. […] The rise of intra-alveolar pressure provokes a rupture of the alveolar wall, leading the air to propagate to the mediastinum through the perivascular and bronchovascular sheaths. […] Thus, the Valsalva manoeuvre, due to any reasons (cough or constipation for example in our case) can be an overlooked cause of pneumothorax in patients with COVID-19. […] One factor that could explain the predisposition to develop barotrauma is the extensive use of non-invasive and invasive ventilation during the pandemic in severe respiratory forms of COVID-19.

• #66 ABSTRACT

  https://www.ejcrim.com/index.php/EJCRIM/article/download/4217/3853?inline=1

  Barotraumas are frequent in mechanically ventilated patients suffering from ARDS. […] Another postulated explanation is the alveolar damage secondary to infection and inflammation. […] These changes in pulmonary parenchyma could weaken the alveoli membrane and thus lead to alveolar rupture, provoking air leaks and barotrauma formation as explained by the Macklin effect. […] Our case describes a barotrauma induced by a Valsalva manoeuvre in a COVID-19 patient, an association not previously described in the literature. […] Emphasising constipation prevention and treatment is crucial to mitigate this complication in severe COVID-19 cases, where barotrauma is common and could significantly exacerbate hypoxemia, prolong hospital stays and increase mortality.

• #67 Pneumothorax, Chylothorax, Hemothorax, and Fibrothorax | Thoracic Key

  https://thoracickey.com/pneumothorax-chylothorax-hemothorax-and-fibrothorax/

  The traditional concept was that air leaked from one bleb supplied by a single airway. More recent data have challenged this concept; a study using inhaled fluorescein suggested that air may leak from more areas than just the blebs, raising the possibility of pleural porosity, in which the air leaks from multiple pores on the visceral pleura. […] The development of a spontaneous neonatal pneumothorax is related to the mechanical problems of expanding the lung for the first time. During the first few breaths of life, the transpulmonary pressures average 40cm H 2 O, with occasional pressures as high as 100cm H 2 O. […] The pathogenesis of catamenial pneumothorax is unclear. When the syndrome was initially described, it was hypothesized that air gained access to the peritoneal cavity during menstruation and then entered the pleural cavity through a diaphragmatic defect.

• #68 Spontaneous pneumothorax as a first sign of pulmonary carcinoma | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/1477-7819-7-57

  Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. […] Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. […] The mechanism producing pneumothorax from lung cancer is not well understood, but a number of theories have been advanced. The first is that it may be the result of tumor necrosis rupture of the necrotic neoplastic tissue in the pleural cavity; the second, that it may be caused by the rupture of the necrotic tumor nodule or necrosis of subpleural metastases. A third is cancer of the check valve mechanism: the tumor at the lung periphery can obstruct bronchioles and lead to local overdistention and rupture of the lung. The fourth is that most patients with lung cancer have chronic bronchitis or emphysema bullae and these bullae may rupture following the disturbance of the lung architecture due to bronchial cancer. […] Pneumothorax should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

• #69 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  The occurrence of spontaneous pneumothorax in primary lung cancer patients is infrequent. No exact theory could explain its mechanism of association. […] Pneumothorax as a first manifestation for lung cancer is infrequent. Its relation to the prognosis has not been yet clear. […] Several theories have been published in the literature regarding the mechanisms of the occurrence of the SPnx in patients with primary lung cancer. The first theory explained that pneumothorax could be due to necrosis of the cancer that directly ruptured into the pleural space. […] The second theory stated that endo-bronchial neoplasm could act as a check-valve that leads to dilatation and eventual rupture of the distal alveolar spaces. […] The third theory stated that pneumothorax may arise from rupture of small sub-pleural blebs, and this may explain the occurrence of pneumothorax in the three patients included in group III.

• #70 Spontaneous pneumothorax as a first sign of pulmonary carcinoma | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/1477-7819-7-57

  Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. […] Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. […] The mechanism producing pneumothorax from lung cancer is not well understood, but a number of theories have been advanced. The first is that it may be the result of tumor necrosis rupture of the necrotic neoplastic tissue in the pleural cavity; the second, that it may be caused by the rupture of the necrotic tumor nodule or necrosis of subpleural metastases. A third is cancer of the check valve mechanism: the tumor at the lung periphery can obstruct bronchioles and lead to local overdistention and rupture of the lung. The fourth is that most patients with lung cancer have chronic bronchitis or emphysema bullae and these bullae may rupture following the disturbance of the lung architecture due to bronchial cancer. […] Pneumothorax should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

• #71 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  The occurrence of spontaneous pneumothorax in primary lung cancer patients is infrequent. No exact theory could explain its mechanism of association. […] Pneumothorax as a first manifestation for lung cancer is infrequent. Its relation to the prognosis has not been yet clear. […] Several theories have been published in the literature regarding the mechanisms of the occurrence of the SPnx in patients with primary lung cancer. The first theory explained that pneumothorax could be due to necrosis of the cancer that directly ruptured into the pleural space. […] The second theory stated that endo-bronchial neoplasm could act as a check-valve that leads to dilatation and eventual rupture of the distal alveolar spaces. […] The third theory stated that pneumothorax may arise from rupture of small sub-pleural blebs, and this may explain the occurrence of pneumothorax in the three patients included in group III.

• #72 Spontaneous pneumothorax as a first sign of pulmonary carcinoma | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/1477-7819-7-57

  Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. […] Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. […] The mechanism producing pneumothorax from lung cancer is not well understood, but a number of theories have been advanced. The first is that it may be the result of tumor necrosis rupture of the necrotic neoplastic tissue in the pleural cavity; the second, that it may be caused by the rupture of the necrotic tumor nodule or necrosis of subpleural metastases. A third is cancer of the check valve mechanism: the tumor at the lung periphery can obstruct bronchioles and lead to local overdistention and rupture of the lung. The fourth is that most patients with lung cancer have chronic bronchitis or emphysema bullae and these bullae may rupture following the disturbance of the lung architecture due to bronchial cancer. […] Pneumothorax should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

• #73 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  Fourth theory proposed that most patients with lung cancer have chronic obstructing pulmonary disease (COPD) or emphysematous bullae that may rupture following the disturbance of the pulmonary architecture due to bronchial carcinoma. […] In the majority of our patients, it was noted that the stage of lung cancer is advanced, stage IIIB and stage IIIA. […] However, this could not be confirmed at our study.

• #74 Spontaneous pneumothorax as a first sign of pulmonary carcinoma | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/1477-7819-7-57

  Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. […] Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. […] The mechanism producing pneumothorax from lung cancer is not well understood, but a number of theories have been advanced. The first is that it may be the result of tumor necrosis rupture of the necrotic neoplastic tissue in the pleural cavity; the second, that it may be caused by the rupture of the necrotic tumor nodule or necrosis of subpleural metastases. A third is cancer of the check valve mechanism: the tumor at the lung periphery can obstruct bronchioles and lead to local overdistention and rupture of the lung. The fourth is that most patients with lung cancer have chronic bronchitis or emphysema bullae and these bullae may rupture following the disturbance of the lung architecture due to bronchial cancer. […] Pneumothorax should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

• #75 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  Fourth theory proposed that most patients with lung cancer have chronic obstructing pulmonary disease (COPD) or emphysematous bullae that may rupture following the disturbance of the pulmonary architecture due to bronchial carcinoma. […] In the majority of our patients, it was noted that the stage of lung cancer is advanced, stage IIIB and stage IIIA. […] However, this could not be confirmed at our study.

• #76 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  The occurrence of spontaneous pneumothorax in primary lung cancer patients is infrequent. No exact theory could explain its mechanism of association. […] Pneumothorax as a first manifestation for lung cancer is infrequent. Its relation to the prognosis has not been yet clear. […] Several theories have been published in the literature regarding the mechanisms of the occurrence of the SPnx in patients with primary lung cancer. The first theory explained that pneumothorax could be due to necrosis of the cancer that directly ruptured into the pleural space. […] The second theory stated that endo-bronchial neoplasm could act as a check-valve that leads to dilatation and eventual rupture of the distal alveolar spaces. […] The third theory stated that pneumothorax may arise from rupture of small sub-pleural blebs, and this may explain the occurrence of pneumothorax in the three patients included in group III.

• #77 Spontaneous pneumothorax associated with primary lung cancer: a retrospective study | The Cardiothoracic Surgeon | Full Text

  https://cts.springeropen.com/articles/10.1186/s43057-020-00020-5

  Fourth theory proposed that most patients with lung cancer have chronic obstructing pulmonary disease (COPD) or emphysematous bullae that may rupture following the disturbance of the pulmonary architecture due to bronchial carcinoma. […] In the majority of our patients, it was noted that the stage of lung cancer is advanced, stage IIIB and stage IIIA. […] However, this could not be confirmed at our study.

• #78 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Tension pneumothorax is a medical emergency and should be diagnosed clinically; time should not be wasted confirming the diagnosis with a chest x-ray. It should be treated immediately by needle thoracostomy, which involves inserting a 14- or 16-gauge needle deep enough to fully penetrate the chest wall with a catheter through the chest wall in the 2nd intercostal space at the midclavicular line. The sound of high-pressure air escaping confirms diagnosis. The catheter can be left open to air or attached to a Heimlich valve. Emergency decompression must be followed immediately by tube thoracostomy, after which the catheter is removed.

• #79 Pneumothorax (Tension) – Injuries; Poisoning – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-tension

  Treatment of tension pneumothorax is immediate needle decompression by inserting a large-bore (eg, 14- or 16-gauge) needle into the second intercostal space in the midclavicular line. […] Because needle decompression causes a simple pneumothorax, tube thoracostomy should be done immediately thereafter.

• #80 Pneumothorax

  https://www.ests.org/about_ests/patient_information/diseases/pneumothorax.aspx

  When a pneumothorax collapses a great part of the lung, aspiration or definitive chest tube insertion will be needed to help the air be evacuated and normality restored. […] The aim of surgery is to decrease the risk of new pneumothorax events. […] Although there are still some controversies, adding a procedure to increase the amount of pleural adherences between the lung and the pleura that covers the interior side of the ribs can also be helpful to reduce the number of future pneumothorax events or its clinical consequences. This procedure is known as pleurodesis. […] As previously mentioned, SSP is related to the presence of certain diseases of the lung. Because of the underlying lung disease, small size pneumothoraces can have critical clinical repercussion like important shortness of breath (respiratory insufficiency). Treatment should aim to control new events through surgery. In these cases, pleurodesis is a must. […] A completely different situation is the catamenial pneumothorax. Although we dont know the precise mechanism allowing the air into the pleural space along with the monthly menses, the fact is that these women experience a pneumothorax and all its symptoms every time they menstruate.

• #81 Catamenial Hemopneumothorax: An Unusual Presentation of Spontaneous Pneumothorax | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v2n2/hernandez-catamenial/

  One explanation is that similar to its intra-uterine counterpart, ectopic endometrial tissue undergoes the phases of the menstrual cycle and may release air or blood into the pleural space, causing a recurrent spontaneous hemothorax or pneumothorax. […] Diagnosis of catamenial pneumothorax is typically delayed due to a lack of clinical suspicion for this process as the cause of pneumothorax. […] Definitive diagnosis can be made by high-resolution CT scan which may show pleural or parenchymal nodules, pneumothorax, pleural effusions, cavitation, or bullae. […] Both surgical approaches and hormonal therapy used in combination, or as separate entities, are employed in the treatment of catamenial pneumothorax. […] Optimal management involves VATS with surgical blebectomy and pleurodesis along with 6 to 12 months of hormonal suppression to prevent recurrence of pneumothorax.

• #82 Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? – Park – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/17314/html

  Oxygen therapy is one of the conservative treatments for spontaneous pneumothorax. It is widely accepted that oxygen therapy increases the resolution rate of spontaneous pneumothorax. The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies. In two clinical studies, the resolution rate increased by three or four times during periods of oxygen therapy. However, these two studies were based on small populations with secondary pneumothorax. There is a lack of clinical evidence for the effectiveness of oxygen therapy for primary spontaneous pneumothorax (PSP), which usually occurs in young adults or adolescents. Our study suggested that the resolution rate of PSP was related to initial pneumothorax size, the time interval between radiographs, and oxygen therapy. The purposes of oxygen therapy for PSP are to maintain oxygen saturation and to increase the resolution rate. It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax. The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution. In addition, some animal studies have shown that increasing the fraction of inspired oxygen accelerates the resolution rate. Our study demonstrated the effect of oxygen therapy in the resolution of PSP. The resolution rate was (4.27%1.97%)/day in the O2 group vs. (2.06%0.97%)/day in the room air group. Although the difference between these rates is statistically significant, its clinical usefulness is uncertain for the following reasons. First, the absolute difference in resolution rate is not great. Second, PSP is also resolved in room air. Third, oxygen therapy has potential adverse effects. Fourth, patients with small pneumothoraces usually maintain adequate oxygenation without oxygen therapy. The resolution rate of PSP was increased with oxygen supplementation. However, taking into consideration current concerns about adverse outcomes of hyperoxia, the routine use of oxygen therapy in patients with small pneumothoraces should be considered carefully.

• #83 10.Pneumothorax( | PPT

  https://www.slideshare.net/slideshow/10pneumothorax-2993417/2993417

  The probable cause of pneumothorax is rupture of an apical bleb or bulla because the compliance of blebs or bullae in the apices is lower compared with that of similar lesions situated in the lower parts of the lungs. […] Smoking causes a 9-fold increase in the relative risk of a pneumothorax in females. A 22-fold increase in male smokers with a dose-response relationship between the number of cigarettes smoked per day and occurrence of PSP. […] The rate of resolution/reabsorption of spontaneous pneumothoraces is 1.25-1.8% of volume of hemithorax every 24 hours. The addition of high flow oxygen therapy has been shown to result in a 4-fold increase in the rate of pneumothorax reabsorption during the periods of oxygen supplementation. […] Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It can be primary or secondary and spontaneous or traumatic. Diagnosis is made through chest x-ray or CT scan. Treatment depends on size and includes observation, oxygen therapy, needle aspiration, catheter drainage, or chest tube placement. The goal is to promote lung re-expansion and prevent recurrence.

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