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==Overview==
==Overview==
Pneumothorax can also occur as part of medical procedures, such as the insertion of a [[central venous catheter]] (an [[intravenous]] catheter) in the[[subclavian vein]] or [[jugular vein]]. While rare, it is considered a serious complication and needs immediate treatment. Other causes include[[mechanical ventilation]], [[emphysema]] and rarely other lung diseases ([[pneumonia]]).
Pneumothorax can occur as part of medical procedures, such as the insertion of a [[central venous catheter]] in the [[subclavian vein]] or [[jugular vein]]. While rare, it is considered a serious complication and needs immediate treatment. Other causes include [[mechanical ventilation]], [[emphysema]] and rarely other lung diseases such as [[pneumonia]].
 
==Classification Scheme==
Pneumothoraces are divided into tension and non-tension pneumathoraces. 
*A [[tension pneumothorax]] is a [[medical emergency]] as air accumulates in the pleural space with each breath.  The increase in intrathoracic pressure results in massive shifts of the mediastinum away from the affected lung compressing intrathoracic vessels.
*A non-tension pneumothorax by contrast is a less severe pathology because there is no ongoing accumulation of air and hence no increasing pressure on the organs within the chest.


The accumulation of blood in the [[thoracic cavity]] ([[hemothorax]]) exacerbates the problem, creating a [[pneumohemothorax]].
==Causes==
Pneumothorax can occur as part of medical procedures, such as the insertion of a [[central venous catheter]] in the [[subclavian vein]] or [[jugular vein]]. While rare, it is a serious complication and needs immediate treatment. Other causes include [[mechanical ventilation]], [[emphysema]] and rarely other lung diseases such as [[pneumonia]].<ref name="pmid25815301">{{cite journal| author=Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A et al.| title=Pneumothorax as a complication of central venous catheter insertion. | journal=Ann Transl Med | year= 2015 | volume= 3 | issue= 3 | pages= 40 | pmid=25815301 | doi=10.3978/j.issn.2305-5839.2015.02.11 | pmc=4356862 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25815301  }} </ref><ref name="BenseEklund1987">{{cite journal|last1=Bense|first1=László|last2=Eklund|first2=Gunnar|last3=Wiman|first3=Lars-Gösta|title=Smoking and the Increased Risk of Contracting Spontaneous Pneumothorax|journal=Chest|volume=92|issue=6|year=1987|pages=1009–1012|issn=00123692|doi=10.1378/chest.92.6.1009}}</ref><ref name="pmid1864347">{{cite journal| author=Lippert HL, Lund O, Blegvad S, Larsen HV| title=Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 3 | pages= 324-31 | pmid=1864347 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1864347  }} </ref><ref name="Lindskog1957">{{cite journal|last1=Lindskog|first1=Gustaf E.|title=Spontaneous Pneumothorax|journal=A.M.A. Archives of Surgery|volume=75|issue=5|year=1957|pages=693|issn=0096-6908|doi=10.1001/archsurg.1957.01280170003001}}</ref><ref name="pmid7300447">{{cite journal| author=Melton LJ, Hepper NG, Offord KP| title=Influence of height on the risk of spontaneous pneumothorax. | journal=Mayo Clin Proc | year= 1981 | volume= 56 | issue= 11 | pages= 678-82 | pmid=7300447 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7300447  }} </ref><ref name="pmid9371212">{{cite journal| author=Sadikot RT, Greene T, Meadows K, Arnold AG| title=Recurrence of primary spontaneous pneumothorax. | journal=Thorax | year= 1997 | volume= 52 | issue= 9 | pages= 805-9 | pmid=9371212 | doi= | pmc=1758641 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9371212  }} </ref><ref name="GUOXIE2005">{{cite journal|last1=GUO|first1=Yubiao|last2=XIE|first2=Canmao|last3=RODRIGUEZ|first3=R. Michael|last4=LIGHT|first4=Richard W.|title=Factors related to recurrence of spontaneous pneumothorax|journal=Respirology|volume=10|issue=3|year=2005|pages=378–384|issn=1323-7799|doi=10.1111/j.1440-1843.2005.00715.x}}</ref><ref name="pmid16970292">{{cite journal| author=Gupta D, Mishra S, Faruqi S, Aggarwal AN| title=Aetiology and clinical profile of spontaneous pneumothorax in adults. | journal=Indian J Chest Dis Allied Sci | year= 2006 | volume= 48 | issue= 4 | pages= 261-4 | pmid=16970292 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16970292  }} </ref>


==Types==
===Common Causes===
===Spontaneous Pneumothorax===
*[[Emphysema]]
Spontaneous Pneumothorax can be classified as primary spontaneous pneumothorax and secondary spontaneous pneumothorax.  In primary spontaneous pneumothorax, it is usually characterized by a rupture of a [[bleb]] in the lung while secondary spontaneous pneumothorax mostly occurs due to chronic obstructive pulmonary disease (COPD).
*[[Trauma]]
*[[Mechanical ventilation]]
*[[Marfan's syndrome]]


===Primary spontaneous pneumothorax===
===Less Common Causes===
A primary spontaneous pneumothorax may occur without either trauma to the chest or any kind of blast injury. This type of pneumothorax is caused when a[[bleb]] (an imperfection in the lining of the lung) bursts causing the lung to deflate. If a patient suffers two or more instances of a spontaneous pneumothorax, surgeons often recommend a bullectomy and pleurectomy.
*Female gender
Primary spontaneous pneumothorax is most evident to people without any previous history of lung disease and in tall, thin men whose age is between 20 to 40 years old. But it can often occur in teenagers and young adults.
*Low body weight
*[[Homocystinuria]]
*[[Cannabis (drug)|Marijuana]] smoking
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | [[Pulmonary embolism]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | [[Dermatomyositis]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" |  [[Cidofovir]], [[Dornase Alfa|dornase alfa]], [[pentamidine isethionate|pentamidine isethionate]], [[pramipexole]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | [[Birt-Hogg-Dube syndrome]], [[Ehlers-Danlos syndrome]], [[homocystinuria]], [[Marfan syndrome]], [[pseudoxanthoma elasticum]], [[cystic fibrosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Acupuncture]], [[cardiopulmonary resuscitation]], [[central venous catheter]], lung biopsy, [[mechanical ventilation]], [[positive end expiratory pressure ]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | Bacterial pneumonia with abscess, [[coccidiomycosis]], [[echinococcosis]], [[lung abscess]], [[lung infection]], [[measles]], [[paragonimiasis]], [[pneumoconiosis]], [[pneumocystis carinii pneumonia]], [[pneumonia]], [[tuberculosis ]], [[whooping cough]], hydatid lung disease
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Polymyositis]], [[dermatomyositis]], [[Ehlers-Danlos syndrome]], [[Marfan syndrome]], [[ankylosing spondylitis]], [[rib fracture]]
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | [[Homocystinuria]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | [[Catamenial pneumothorax |Catamenial pneumothorax ,]] [[endometriosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | [[Bronchogenic carcinoma]], [[lung cancer]]
|-
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | [[Adult respiratory distress syndrome]], [[bronchial asthma]], [[bronchogenic carcinoma]], chronic obstructive pulmonary disease, [[coal worker pneumoconiosis]], [[congenital cystic adenomatoid malformation]], congenital lobar emphysema, [[cystic fibrosis]], [[emphysema]], [[eosinophilic granuloma]], [[histiocytosis X]], hydatid lung disease, [[lung cancer]], lung cavity, lung fistula , [[lymphangioleiomyomatosis]], [[meconium aspiration syndrome]], [[pleuropulmonary blastoma]], [[pulmonary embolism]], [[pulmonary fibrosis]], pulmonary hemosiderosis, pulmonary lymphangiomatoid granulomatosis, [[respiratory distress syndrome (neonatal)]], [[rheumatoid lung disease]], [[rupture of cysts]], [[sleep apnea]], subpleural blebs, primary spontaneous pneumothorax, [[Birt-Hogg-Dube syndrome]], [[lung abscess]], [[Lung infection]], [[catamenial pneumothorax ]], [[tension pneumothorax]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" | [[Bilateral renal agenesis]], [[Birt-Hogg-Dube syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Ankylosing spondylitis]], [[sarcoidosis]], [[systemic sclerosis]], rheumatoid lung disease
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | [[Barotrauma]], [[blunt trauma]], [[flail chest]], [[gunshot wound]], lung injury, penetrating chest injury, [[rib fracture]], [[tension pneumothorax]]
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | Air travel, [[decompression sickness]], deployment of vehicle's air bag, excessively deep breath, forceful outburst of laughing, foreign body inhalation, [[idiopathic]], mountain climbing at high altitudes, scuba diving, sudden chest compression
|-
|}


===Secondary spontaneous pneumothorax===
===Causes in Alphabetical Order===
A known lung disease is present in secondary spontaneous pneumothorax<ref>http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35772</ref>. The most common cause is chronic obstructive pulmonary disease (COPD).
{{columns-list|
However, there are several diseases that may lead to spontaneous pneumothorax:
*[[Acupuncture]]
*[[COPD]]
*[[Adult respiratory distress syndrome]]
*[[Tuberculosis]]
*Air travel
*[[Pneumonia]]
*[[Ankylosing spondylitis]]
*[[Asthma]]
*Bacterial pneumonia with abscess
*[[Barotrauma]]
*[[Bilateral renal agenesis]]
*[[Birt-Hogg-Dube syndrome]]
*[[Blunt trauma]]
*[[Bronchial asthma]]
*[[Bronchogenic carcinoma]]
*[[Cardiopulmonary resuscitation]]
*[[Catamenial pneumothorax ]]
*[[Central venous catheter]]
*[[Chronic obstructive pulmonary disease]]
*[[Cidofovir]]
*[[Coal worker pneumoconiosis]]
*[[Coccidiomycosis]]
*[[Congenital cystic adenomatoid malformation]]
*Congenital lobar emphysema
*[[Cystic fibrosis]]
*[[Cystic fibrosis]]
*[[Decompression sickness]]
*Deployment of vehicle's air bag
*[[Dermatomyositis]]
*[[Echinococcosis]]
*[[Ehlers-Danlos syndrome]]
*[[Emphysema]]
*[[Endometriosis]]
*[[Eosinophilic granuloma]]
*Excessively deep breath
*[[Flail chest]]
*Forceful outburst of laughing
*Foreign body inhalation
*[[Gunshot wound]]
*[[Histiocytosis X]]
*[[Homocystinuria]]
*Hydatid lung disease
*[[Idiopathic]]
*[[Lung abscess]]
*Lung biopsy
*[[Lung cancer]]
*[[Lung cancer]]
*[[Interstitial lung disease]]
*Lung cavity
*[[Marfan's Syndrome]]
*Lung fistula
*[[Lung infection]]
*Lung injury
*[[Lymphangioleiomyomatosis]]
*[[Marfan syndrome]]
*[[Measles]]
*[[Mechanical ventilation]]
*[[Meconium aspiration syndrome]]
*Mountain climbing at high altitudes
*[[Paragonimiasis]]
*Penetrating chest injury
*[[Pleuropulmonary blastoma]]
*[[Pneumoconiosis]]
*[[Pneumocystis carinii pneumonia]]
*[[Pneumonia]]
*[[Polymyositis]]
*[[Positive end expiratory pressure ]]
*Primary spontaneous pneumothorax
*[[Pseudoxanthoma elasticum]]
*[[Pulmonary embolism]]
*[[Pulmonary fibrosis]]
*Pulmonary hemosiderosis
*Pulmonary lymphangiomatoid granulomatosis
*[[Respiratory distress syndrome (neonatal)]]
*Rheumatoid lung disease
*[[Rib fracture]]
*Rupture of cysts
*[[Sarcoidosis]]
*Scuba diving
*[[Sleep apnea]]
*Subpleural blebs
*Sudden chest compression
*[[Systemic sclerosis]]
*[[Tension pneumothorax]]
*[[Tuberculosis ]]
*[[Whooping cough]]
}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Chest trauma]]
[[Category:Diseases involving the fasciae]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 22:27, 10 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Pneumothorax can occur as part of medical procedures, such as the insertion of a central venous catheter in the subclavian vein or jugular vein. While rare, it is considered a serious complication and needs immediate treatment. Other causes include mechanical ventilation, emphysema and rarely other lung diseases such as pneumonia.

Causes

Pneumothorax can occur as part of medical procedures, such as the insertion of a central venous catheter in the subclavian vein or jugular vein. While rare, it is a serious complication and needs immediate treatment. Other causes include mechanical ventilation, emphysema and rarely other lung diseases such as pneumonia.[1][2][3][4][5][6][7][8]

Common Causes

Less Common Causes

Causes by Organ System

Cardiovascular Pulmonary embolism
Chemical / poisoning No underlying causes
Dermatologic Dermatomyositis
Drug Side Effect Cidofovir, dornase alfa, pentamidine isethionate, pramipexole
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Birt-Hogg-Dube syndrome, Ehlers-Danlos syndrome, homocystinuria, Marfan syndrome, pseudoxanthoma elasticum, cystic fibrosis
Hematologic No underlying causes
Iatrogenic Acupuncture, cardiopulmonary resuscitation, central venous catheter, lung biopsy, mechanical ventilation, positive end expiratory pressure
Infectious Disease Bacterial pneumonia with abscess, coccidiomycosis, echinococcosis, lung abscess, lung infection, measles, paragonimiasis, pneumoconiosis, pneumocystis carinii pneumonia, pneumonia, tuberculosis , whooping cough, hydatid lung disease
Musculoskeletal / Ortho Polymyositis, dermatomyositis, Ehlers-Danlos syndrome, Marfan syndrome, ankylosing spondylitis, rib fracture
Neurologic No underlying causes
Nutritional / Metabolic Homocystinuria
Obstetric/Gynecologic Catamenial pneumothorax , endometriosis
Oncologic Bronchogenic carcinoma, lung cancer
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Adult respiratory distress syndrome, bronchial asthma, bronchogenic carcinoma, chronic obstructive pulmonary disease, coal worker pneumoconiosis, congenital cystic adenomatoid malformation, congenital lobar emphysema, cystic fibrosis, emphysema, eosinophilic granuloma, histiocytosis X, hydatid lung disease, lung cancer, lung cavity, lung fistula , lymphangioleiomyomatosis, meconium aspiration syndrome, pleuropulmonary blastoma, pulmonary embolism, pulmonary fibrosis, pulmonary hemosiderosis, pulmonary lymphangiomatoid granulomatosis, respiratory distress syndrome (neonatal), rheumatoid lung disease, rupture of cysts, sleep apnea, subpleural blebs, primary spontaneous pneumothorax, Birt-Hogg-Dube syndrome, lung abscess, Lung infection, catamenial pneumothorax , tension pneumothorax
Renal / Electrolyte Bilateral renal agenesis, Birt-Hogg-Dube syndrome
Rheum / Immune / Allergy Ankylosing spondylitis, sarcoidosis, systemic sclerosis, rheumatoid lung disease
Sexual No underlying causes
Trauma Barotrauma, blunt trauma, flail chest, gunshot wound, lung injury, penetrating chest injury, rib fracture, tension pneumothorax
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Air travel, decompression sickness, deployment of vehicle's air bag, excessively deep breath, forceful outburst of laughing, foreign body inhalation, idiopathic, mountain climbing at high altitudes, scuba diving, sudden chest compression

Causes in Alphabetical Order

References

  1. ↑ Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A; et al. (2015). "Pneumothorax as a complication of central venous catheter insertion". Ann Transl Med. 3 (3): 40. doi:10.3978/j.issn.2305-5839.2015.02.11. PMC 4356862. PMID 25815301.
  2. ↑ Bense, László; Eklund, Gunnar; Wiman, Lars-Gösta (1987). "Smoking and the Increased Risk of Contracting Spontaneous Pneumothorax". Chest. 92 (6): 1009–1012. doi:10.1378/chest.92.6.1009. ISSN 0012-3692.
  3. ↑ Lippert HL, Lund O, Blegvad S, Larsen HV (1991). "Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax". Eur Respir J. 4 (3): 324–31. PMID 1864347.
  4. ↑ Lindskog, Gustaf E. (1957). "Spontaneous Pneumothorax". A.M.A. Archives of Surgery. 75 (5): 693. doi:10.1001/archsurg.1957.01280170003001. ISSN 0096-6908.
  5. ↑ Melton LJ, Hepper NG, Offord KP (1981). "Influence of height on the risk of spontaneous pneumothorax". Mayo Clin Proc. 56 (11): 678–82. PMID 7300447.
  6. ↑ Sadikot RT, Greene T, Meadows K, Arnold AG (1997). "Recurrence of primary spontaneous pneumothorax". Thorax. 52 (9): 805–9. PMC 1758641. PMID 9371212.
  7. ↑ GUO, Yubiao; XIE, Canmao; RODRIGUEZ, R. Michael; LIGHT, Richard W. (2005). "Factors related to recurrence of spontaneous pneumothorax". Respirology. 10 (3): 378–384. doi:10.1111/j.1440-1843.2005.00715.x. ISSN 1323-7799.
  8. ↑ Gupta D, Mishra S, Faruqi S, Aggarwal AN (2006). "Aetiology and clinical profile of spontaneous pneumothorax in adults". Indian J Chest Dis Allied Sci. 48 (4): 261–4. PMID 16970292.

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