Pneumothorax is the condition of filling the pleural space with air. The air may enter the pleural cavity either from outside or through the leakage of air from the lungs. In both the cases, the pleural cavity forces the air filled in the lungs to escape leading to lung collapse. If the pressure is progressively increased to such an extent that the vena cava gets compressed, then the condition is known as tension pneumothorax. When the air enters the pleural cavity by the open wound and chest wall gets ruptured, it is known as open pneumothorax and when the air is present in the pleural cavity, but chest wall is intact then the condition is known as closed pneumothorax.
What Is Closed Pneumothorax?
The difference between the open and closed pneumothorax depends upon the type of trauma that causes an open wound or a closed wound. In open pneumothorax, chest wall is punctured, and the air enters the pleural cavity from outside as in the cases such as stabbing, gun wounds etc. The connection between the lung and the pleural cavity is ruptured and the air leaks in to the pleural cavity. This causes the lungs to deflate while the air pressure in pleural cavity does not allow the lungs to expand leading to the collapse of the lungs. The pleural tear is intact, and the pleural cavity pressure is less than the atmospheric pressure. It occurs in conditions such as crashes, falls, CPR, COPD, and fractured ribs that penetrate the pleura. Generally, the thin people are at greater risk as compared to fat people due to the absence of the cushion provided by adipose tissue. In the closed pneumothorax, chest wall remains intact, and the rupture of lungs and visceral pleura lets air to infiltrate into pleural space.
Symptoms of Closed Pneumothorax
The patient of pneumothorax may be asymptomatic or may have mild to moderate symptoms. Sometime, the condition may be life threatening. The condition of the patient will depend upon the extent of pneumothorax i.e. whether it is localized or generalized. If the respiration is dysfunctional then immediate medical attention is required. Following are the symptoms of closed pneumothorax:
- Severe chest pain
- Shortness of breath
- Reduction in breathing sounds
- Limited lung expansion
Causes of Closed Pneumothorax
Following may be the causes of closed pneumothorax:
- Underlying lung disease such as COPD, chronic asthma, cystic fibrosis, emphysema.
- Chronic infections such as tuberculosis or pneumonia.
- Disease of the lung such as idiopathic pulmonary fibrosis.
- Connective tissue abnormality such as rheumatoid arthritis.
- Cancer such as lung cancer
Diagnosis of Closed Pneumothorax
The closed pneumothorax is diagnosed through various diagnostic techniques. The approach taken in diagnosis is to find the presence of air in the pleural cavity and the extent of the lung collapse. The mild pneumothorax is hard to diagnose. Following are the diagnostic techniques used to diagnose closed pneumothorax:
Treatment for Closed Pneumothorax
The strategy of the treatment is decided on the basis of amount of air present and the symptoms of the patient. If the patient experience severe breathlessness, immediate medical help should be provided. Closed pneumothorax in a healthy asymptomatic patient requires only monitoring. The patient requires treatment who has greater than 50 percent of pneumothoraces or if the patient is on mechanical ventilation. The air should be drained through thoracostomy, if required and to prevent recurrence, tetracycline is sometimes used to produce pleurodesis.
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