What is the proper definition of pneumothorax
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Here is a thorough, textbook-based definition of pneumothorax:
Definition of Pneumothorax
Pneumothorax is defined as the accumulation (or presence) of air in the pleural space - the potential space between the parietal pleura lining the rib cage and the visceral pleura lining the lung surface.
"Pneumothorax refers to the accumulation of air in the pleural space between the parietal pleura lining the rib cage and visceral pleura lining the lung."
- Goldman-Cecil Medicine, 26th ed.
"Pneumothorax, or air in the pleural space, is a common clinical problem."
- Murray & Nadel's Textbook of Respiratory Medicine
"Air in the pleural space is a pneumothorax."
- Grainger & Allison's Diagnostic Radiology
Pathophysiological Basis
Normally, the pleural space is a closed cavity with slightly subatmospheric (negative) pressure - this negative pressure keeps the lung expanded against the chest wall. When air enters this space:
- Positive pressure builds up within the pleural cavity
- This compresses the underlying lung, causing partial or complete collapse
- Respiratory mechanics are disrupted
Classification
| Type | Definition |
|---|---|
| Primary Spontaneous Pneumothorax (PSP) | Occurs without a precipitating event in a person with no underlying lung disease (classically tall, thin, young men) |
| Secondary Spontaneous Pneumothorax (SSP) | Complicates an underlying lung disease (e.g., COPD, cystic fibrosis, emphysema, necrotizing pneumonia, lung cancer, sarcoidosis). More dangerous because pulmonary reserve is already reduced |
| Traumatic Pneumothorax | Results from injury to the chest wall (blunt or penetrating trauma) |
| Iatrogenic Pneumothorax | Results from an invasive medical procedure (e.g., central line insertion, pacemaker placement, thoracentesis, mechanical ventilation) |
| Tension Pneumothorax | A life-threatening variant where a one-way "flap valve" mechanism traps progressively more air with each breath, leading to ipsilateral lung collapse, mediastinal shift, vena cava compression, and hemodynamic collapse |
| Catamenial Pneumothorax | A rare form in women caused by rupture of subpleural endometrial nodules at menstruation, producing recurrent pneumothoraces within 72 hours of the onset of menses |
Key Points
- When both air and blood are present in the pleural space, the condition is called a haemo-pneumothorax (or hemopneumothorax)
- The BTS guideline classifies a pneumothorax as large when there is >2 cm of air between the lung margin and chest wall at the hilum level on chest X-ray
- Patients >50 years or with significant smoking history are typically classified as SSP even with a normal CXR, due to the high likelihood of subclinical lung changes
Sources: Goldman-Cecil Medicine 26th ed.; Murray & Nadel's Textbook of Respiratory Medicine; Rosen's Emergency Medicine; Grainger & Allison's Diagnostic Radiology; S. Das Manual on Clinical Surgery 13th ed.; Roberts and Hedges' Clinical Procedures in Emergency Medicine.
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