Pneumothorax

Pneumothorax (from Greek pneuma — air and thorax — chest) refers to the pathological accumulation of air or gases in the pleural cavity. The presence of free air disrupts the physiological negative pressure in the pleural cavity, leading to partial or complete collapse of the affected lung tissue.

Etiology and pathophysiology

Under normal circumstances, the pleural cavity is perfectly airtight, and the pressure within it is always lower than atmospheric pressure. In the case of closed or open chest trauma, this system becomes unsealed. In traumatology, this is the most common and life-threatening complication of rib or clavicle fractures, where the sharp edge of the broken bone punctures the pleura through.

Air rushes into the pleural cavity, excluding the lung from the respiratory process. The most dangerous is tension, or valvular, pneumothorax. In this condition, damaged soft tissue acts as a one-way valve: air freely enters the cavity with each inhalation but cannot exit during exhalation. This leads to lung collapse on the injured side, followed by mediastinal shift towards the intact lung, subsequently impairing its function. A serious complication is the bending of hollow veins due to the displacement of the heart.

Clinical significance

The clinical triad includes acute, stabbing chest pain, pronounced dyspnea, and rapid heartbeat. On auscultation, breath sounds on the affected side are markedly diminished or completely absent. The patient assumes a forced sitting position and gasps for air.

Diagnosis is reliably confirmed by a chest X-ray. The treatment for traumatic pneumothorax requires immediate drainage of the pleural space to evacuate the accumulated air and fully re-expand the lung.