Pneumothorax

What is pneumothorax?

Pneumothorax is a lung disorder in which air in the lungs leaks out through holes in the lung tissue into the spaces outside the lung airways. Pneumothorax is one type of lung disorders called air leak syndrome. A baby can have more than one form of air leak. Types of air leaks include the following:

• Pneumothorax - air leaks into the space between the chest wall and the outer tissues of the lungs.

• Pneumomediastinum - air leaks into the mediastinum (the space in the thoracic cavity behind the sternum and between the two pleural sacs containing the lungs).

• Pneumopericardium - air leaks into the sac surrounding the heart.

• Pulmonary interstitial emphysema (PIE) - air leaks and becomes trapped between the alveoli, the tiny air sacs of the lungs.

Air leaks may occur suddenly or may develop gradually. The degree of illness depends on the location of the leak and the amount of air.

What causes pneumothorax?

Air leaks occur when the alveoli (tiny air sacs) become overdistended and burst. Pressure of the air delivered by mechanical ventilators (breathing machines) is the most common cause. Meconium aspiration (inhalation of the first stools passed in utero) can also trap air and lead to overdistention (the lungs expand too much) and air leaks. Air leaks often occur in the first 24 to 36 hours when lung disease is at its peak. Some otherwise healthy babies can develop a "spontaneous" air leak that does not cause symptoms or distress.

Who is affected by pneumothorax and air leak syndrome?

The following babies are most at risk for pneumothorax:

• Babies with other lung diseases such as respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD)

• Babies on mechanical ventilators

• Premature babies whose lung tissues are more fragile

• Babies with meconium aspiration because the meconium plugs the airways and can weaken the tissues

What are the symptoms of pneumothorax and other air leaks?

The following are the most common symptoms of pneumothorax. However, each baby may experience symptoms differently. Symptoms may include:

• Increasing respiratory distress, including rapid breathing, grunting, nostril flaring, and chest wall retractions

• Difficulty hearing breath sounds when listening with a stethoscope

• Change in the location of heart or lung sounds when the organs are moved by the presence of air

• Changes in arterial blood gas levels

The symptoms of pneumothorax may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How are pneumothorax and other air leaks diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pneumothorax may include:

• Chest x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. X-rays may show the following:

  • Air in places outside the normal lung airways

  • Collapse of the lung

  • Movement or shifting of other organs in the chest away from the air leak side

• Transillumination - a fiberoptic light probe placed on the baby's chest wall (the side of the chest with the air leak transmits brighter light). This procedure is often used in an emergency.

Treatment for pneumothorax and other air leaks

Specific treatment for pneumothorax and air leak syndrome will be determined by your baby's physician based on:

• Your baby's gestational age, overall health, and medical history

• Extent of the condition

• Your baby's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment for pneumothorax may include:

• Supplemental oxygen

• Removal of the collected air by insertion of a chest tube (a needle or catheter placed through the chest wall into the air space). The air may be withdrawn with a syringe or the tube connected to a drainage system to help remove the air until the leak can seal.

Spontaneous air leaks that do not cause symptoms or distress may get better on their own without treatment. As the leak seals over, air is absorbed into the body.

There are no specific treatments for pneumomediastinum and pulmonary interstitial emphysema (PIE), as these air leaks are in spaces that cannot be treated with chest tubes. High frequency ventilation is sometimes used for babies with PIE.

Prevention of pneumothorax and other air leaks

Despite careful regulation of the air pressure and the settings on mechanical ventilators, air leaks can still occur. Your baby's physician and other health care providers in the newborn intensive care unit (NICU) will watch your baby carefully for signs of air leak so that treatment can be started as quickly as possible.