8.1 types of pneumothorax

Pneumothorax is broadly classified with distinct mechanisms and clinical implications.

• spontaneous

  • primary

  • secondary

• , traumatic,

• and tension pneumothorax,

A spontaneous pneumothorax occurs without an external traumatic event

caused by the rupture of bullae

bullae

air fileld sacs that develope on the surface of the lung

Bullae arise when alveoli develop microscopic leaks

allowing air to seep into the surrounding lung tissue.

Normally, these leaks heal spontaneously, but if rupture occurs,

a direct communication between the lung's airways and the pleural space will occur, allowing air to escape into the pleural cavity. 

Primary Spontaneous Pneumothorax (PSP)

a pneumothorax that occurs in individuals without underlying lung disease.

It mainly occurs in tall and thin young people due to increased shear forces or more negative pressure at the apex of the lung.

Lung inflammation and oxidative stress are essential to the pathogenesis of PSP.

A increased number inflammatory cells in the small airways,

which generally occurs in smokers/vapers increase the risk of pneumothorax.

Secondary Spontaneous Pneumothorax (SSP)

occurs in the presence of underlying lung disease, primarily:

chronic obstructive pulmonary disease;

tuberculosis,

sarcoidosis,

cystic fibrosis,

malignancy,

idiopathic pulmonary fibrosis

, and pneumonia caused by Pneumocystis jiroveci.

Pneumocystis jiroveci.

a yeast like fungus of the genus oneumocystis the causative organism of pneumocystis pmeumonia is an important human pathogen particularly amony immunocompramised hosts

traumatic pneumothorax

result from blunt or penetrating trauma; these often create a one-way valve in the pleural space (letting the airflow in but not flow out) → hemodynamic compromise.

Tension pneumothorax most commonly occurs in ICU settings

in positive-pressure ventilated patients.

Traumatic pneumothorax also includes iatrogenic pneumothorax,

which occurs as a complication of mechanical ventilation, lung biopsies, or thoracentesis.