I. Definition
A. Presence of air in the pleural space resulting from perforation of the chest wall or pleura that causes collapse of the lung
B. Types:
1. Spontaneous: disruption of the visceral pleura
a. Air enters the pleural space from the lung.
b. Occurs in individuals with or without underlying lung disease
2. Traumatic
a. Open: penetrating chest trauma
i. Parietal pleura is disrupted.
ii. Air enters the pleural space from the atmosphere.
b. Closed: blunt chest trauma
i. Visceral pleura is disrupted.
ii. Air enters the pleural space from the lung.
c. Iatrogenic
i. Disruption of the visceral pleura as a complication of an invasive thoracic procedure
ii. May also occur after procedures involving the neck or the abdomen
3. Tension
a. Air enters the pleural space as a result of a spontaneous or traumatic pneumothorax but is unable to exit.
c. Tension pneumothorax is a medical emergency.
II. Etiology/Incidence/Predisposing factors
A. Penetrating or blunt chest trauma
B. Rupture of a subpleural bleb or invasian of visceral pleura by disease (e.g., necrotizing pneumonia)
C. Intrinsic lung disease
1. Chronic obstructive pulmonary disease
2. Tuberculosis
3. Sarcoidosis
4. Pulmonary fibrosis
5. Bronchogenic carcinoma
D. Barotrauma resulting from mechanical ventilation with increased positive end-expiratory pressure
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