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X- Ray Diagnostics Of Pneumothorax: Radiographic Representations Of The Lung Tissue In This Respiratory Disorder

Updated on February 6, 2014

Detecting Diseases On X-Rays

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Introduction

Pneumothorax is air in the pleural space leading to partial or complete collapse of the lung and occurs spontaneously or secondary to chest trauma. A 'tension pneumothorax' is rare unless the patient is on a mechanical ventilator or nasal non-invasive ventilation. In this situation, the pleural tear acts as a one-way valve through which air passes during inspiration but is unable to exit on expiration. There is a unilateral increase in intrapleural pressure with increasing respiratory distress and eventually shock and cardiorespiratory arrest. Treatment is immediate decompression by needle thoracocentesis (2nd intercostal space, mid-clavicular line) and then intercostal tube drainage.

Pneumothorax On Chest X-Ray

A pneumothorax (pl. pneumothoraces) is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall and which may interfere with normal breathing.
A pneumothorax (pl. pneumothoraces) is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall and which may interfere with normal breathing. | Source
A primary pneumothorax is one that occurs without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology.
A primary pneumothorax is one that occurs without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology. | Source
 In a minority of cases, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax.
In a minority of cases, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax. | Source
This condition is a medical emergency that can cause steadily worsening oxygen shortage and low blood pressure. Unless reversed by effective treatment, these sequelae can progress and cause death.
This condition is a medical emergency that can cause steadily worsening oxygen shortage and low blood pressure. Unless reversed by effective treatment, these sequelae can progress and cause death. | Source
Pneumothoraces can be caused by physical trauma to the chest (including blast injury), or as a complication of medical or surgical intervention
Pneumothoraces can be caused by physical trauma to the chest (including blast injury), or as a complication of medical or surgical intervention | Source
Symptoms typically include chest pain and shortness of breath. Diagnosis of a pneumothorax by physical examination alone can be difficult or inconclusive (particularly in smaller pneumothoraces), so a chest X-ray or computed tomography (CT) scan is u
Symptoms typically include chest pain and shortness of breath. Diagnosis of a pneumothorax by physical examination alone can be difficult or inconclusive (particularly in smaller pneumothoraces), so a chest X-ray or computed tomography (CT) scan is u | Source
Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. This approach may be most appropriate in subjects who have no significant underlying lung disease.
Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. This approach may be most appropriate in subjects who have no significant underlying lung disease. | Source
 In larger pneumothoraces, or when there are marked symptoms, the air may be extracted with a syringe or a chest tube connected to a one-way valve system.
In larger pneumothoraces, or when there are marked symptoms, the air may be extracted with a syringe or a chest tube connected to a one-way valve system. | Source
Occasionally, surgical interventions are required when tube drainage is unsuccessful, or as a preventive measure, if there have been repeated episodes.
Occasionally, surgical interventions are required when tube drainage is unsuccessful, or as a preventive measure, if there have been repeated episodes. | Source
The surgical treatments usually involve pleurodesis (in which the layers of pleura are induced to stick together) or pleurectomy (the surgical removal of pleural membranes).
The surgical treatments usually involve pleurodesis (in which the layers of pleura are induced to stick together) or pleurectomy (the surgical removal of pleural membranes). | Source
Traditionally a plain radiograph of the chest, ideally with the X-ray beams being projected from the back (posteroanterior, or "PA"), has been the most appropriate first investigation.
Traditionally a plain radiograph of the chest, ideally with the X-ray beams being projected from the back (posteroanterior, or "PA"), has been the most appropriate first investigation. | Source
 These are usually performed during maximal inspiration (holding one's breath); no added information is gathered by obtaining a chest X-ray in expiration (after exhaling)
These are usually performed during maximal inspiration (holding one's breath); no added information is gathered by obtaining a chest X-ray in expiration (after exhaling) | Source
If the PA X-ray does not show a pneumothorax but there is a strong suspicion of one, lateral X-rays (with beams projecting from the side) may be performed, but this is not routine practice
If the PA X-ray does not show a pneumothorax but there is a strong suspicion of one, lateral X-rays (with beams projecting from the side) may be performed, but this is not routine practice | Source
It is not unusual for the mediastinum (the structure between the lungs that contains the heart, great blood vessels and large airways) to be shifted away from the affected lung due to the pressure differences.
It is not unusual for the mediastinum (the structure between the lungs that contains the heart, great blood vessels and large airways) to be shifted away from the affected lung due to the pressure differences. | Source
The size of the pneumothorax (i.e. the volume of air in the pleural space) can be determined with a reasonable degree of accuracy by measuring the distance between the chest wall and the lung. This is relevant to treatment, as smaller pneumothoraces
The size of the pneumothorax (i.e. the volume of air in the pleural space) can be determined with a reasonable degree of accuracy by measuring the distance between the chest wall and the lung. This is relevant to treatment, as smaller pneumothoraces | Source

References

1. All X-ray photos here are from DFM E-Group, in the photo and X-ray section.

2. Notes and explanations: Wikipedia, Essentials of Clinical Medicine by Kumar and Clark's, Medicinenet and Mayor's Clinic.

© 2014 Funom Theophilus Makama

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