November 29, 2015
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Chest Pain (cont.)

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The lung is held against the chest wall by negative pressure in the pleura. If this seal is broken the lung can shrink down, or collapse (known as pneumothorax). This may be associated with a rib injury or it may occur spontaneously. Though commonly seen in those who are tall and thin, other risk factors for a collapsed lung include emphysema or asthma. Small blebs or weak spots in the lung can break and cause the air leak that breaks the negative pressure seal.

The common presentation is the acute onset of sharp chest pain associated with shortness of breath, with no preceding illness or warning. Physical examination reveals decreased air entry on the affected side. Percussion may show increased resonance with tapping. Chest X-ray confirms the diagnosis.

Treatment is dependent upon what percentage of the lung is collapsed. If it is a small amount and vital signs are stable with a normal O2 sat, the pneumothorax may be allowed to expand on its own with close monitoring. If there is a larger collapse, a chest tube may have to be placed into the pleural space through the chest wall to suck the air out and re-establish the negative pressure. On occasion, thoracoscopy (thoraco=chest +scopy=see with a camera) may be considered to identify the bleb and to staple it shut. For more, please read the Pneumothorax article.

Tension pneumothorax is a relatively rare life-threatening event often associated with trauma. Instead of a simple collapse of the lung, a scenario can exist in which the damaged lung tissue acts as a one way valve allowing air to enter into the pleural space but not allowing it to escape. The pneumothorax size increases with each breath and can prevent blood from returning to the heart and allowing the heart to pump it back to the body. If not corrected quickly with placement of a chest tube, it can be fatal.

Medically Reviewed by a Doctor on 11/2/2015

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