Advertisement

Der Pneumologe

, 5:239 | Cite as

Pneumothorax

Klinik, Diagnostik und Behandlung
  • F.J.F. Herth
Leitthema

Zusammenfassung

Der Pneumothorax (von griech. πνευμα, „Luft“ und θώραξ, „Brustkorb, Thorax“) ist ein meistens akut auftretendes, je nach Ausprägung lebensbedrohliches Krankheitsbild, bei dem Luft in den Pleuraspalt gelangt und damit die Ausdehnung eines Lungenflügels oder beider Lungenflügel behindert, sodass diese für die Atmung nicht oder nur noch eingeschränkt zur Verfügung stehen. Entsprechend der Genese unterscheidet man zwischen primärem (idiopathischem) Spontanpneumothorax (PSP), sekundärem Spontanpneumothorax (SSP) sowie iatrogenem und traumatischem Pneumothorax. Die Ausprägung reicht von minimalen Luftmengen, die vom Patienten kaum bemerkt werden, über einen Lungenkollaps bis hin zum Spannungspneumothorax, bei dem beide Lungen und die Herz-Kreislauf-Funktion drastisch eingeschränkt sein können. Bei jeder dieser Formen des Pneumothorax muss von einer akuten Lebensgefahr ausgegangen werden. Bei klinisch stabilen Patienten mit Erstereignis eines PSP ist die einfache Nadelaspiration eine mögliche Therapieoption, bei allen anderen Patienten mit symptomatischem Pneumothorax ist die sofortige Einlage einer Drainage in den Pleuraspalt der bewährte Therapiestandard.

Schlüsselwörter

Pneumothorax Spontanpneumothorax Lungenkollaps Spannungspneumothorax Therapie 

Pneumothorax

Clinical picture, diagnostic work-up and treatment

Abstract

Pneumothorax is defined as air in the pleural space, i.e. between the lung and the chest wall. Primary pneumothoraces (PSP) arise in otherwise healthy people without any lung disease. Secondary pneumothoraces (SSP) arise in subjects with underlying lung disease. Observation alone is recommended only in patients with small primary or secondary pneumothoraces of less than 1 cm depth or isolated apical pneumothoraces in asymptomatic patients. In symptomatic patients observation alone is inappropriate and active intervention is required. Although simple aspiration may be an option for first-line treatment in clinically stable patients with PSP, intercostal tube drainage is recommended in all primary and secondary pneumothoraces requiring intervention. There are two objectives in the surgical management of recurrent pneumothorax. The first widely accepted objective is resection of blebs or the suture of apical perforations to treat the underlying defect. The second objective is to create a pleural symphysis to prevent recurrence. While video-assisted thoracic surgery may be the preferred surgical procedure for young, fit people with complicated or recurrent primary pneumothoraces, it is less reliable in cases of secondary pneumothorax.

Keywords

Pneumothorax Spontaneous pneumothorax Lung collapse Tension pneumothorax Treatment 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Baumann MH, Strange C, Heffner JE et al. (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119: 590–602PubMedCrossRefGoogle Scholar
  2. 2.
    Henry M, Arnold T, Harvey J (2003) BTS guidelines for the management of spontaneous pneumothorax. Thorax 58 (Suppl II): ii39–52PubMedCrossRefGoogle Scholar
  3. 3.
    Ng CS, Lee TW, Wan S, Yim AP (2006) Video assisted thoracic surgery in the management of spontaneous pneumothorax: the current status. Postgrad Med J 82: 179–185PubMedCrossRefGoogle Scholar
  4. 4.
    Fry WA, Paape K (1994) Pneumothorax. In: Shields T (ed) General thoracic surgery. Williams Wilkins, Lippincott, pp 662–673Google Scholar
  5. 5.
    Sunder-Plassmann L (2000) Pneumothorax. Chirurg 71: 1422–1428PubMedCrossRefGoogle Scholar
  6. 6.
    Melton LJ 3rd, Hepper NG, Offord KP (1979) Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis 120: 1379–1382PubMedGoogle Scholar
  7. 7.
    Bense L, Eklund G, Wiman LG (1987) Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 92: 1009–1012PubMedCrossRefGoogle Scholar
  8. 8.
    Lesur O, Delorme N, Fromaget JM et al. (1990) Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest 98: 341–347PubMedCrossRefGoogle Scholar
  9. 9.
    Sahn SA, Heffner JE (2000) Spontaneous pneumothorax. N Engl J Med 342: 868–874PubMedCrossRefGoogle Scholar
  10. 10.
    Schramel FM, Postmus PE, Vanderschueren RG (1997) Current aspects of spontaneous pneumothorax. Eur Respir J 10: 1372–1379PubMedCrossRefGoogle Scholar
  11. 11.
    Currie GP, Alluri R, Christie GL, Legge JS (2007) Pneumothorax: an update Postgrad. Med J 83: 461–465Google Scholar
  12. 12.
    Bouros D, Noppen M (2008) Update on pleural disease: introduction. Respiration 75(1): 2–3PubMedCrossRefGoogle Scholar
  13. 13.
    Treasure T (2007) Minimally invasive surgery for pneumothorax: the evidence, changing practice and current opinion. J R Soc Med 100(9): 419–422PubMedCrossRefGoogle Scholar
  14. 14.
    Augoulea A, Lambrinoudaki I, Christodoulakos G (2008) Thoracic endometriosis syndrome. Respiration. 75(1): 113–119.Google Scholar
  15. 15.
    Keel M, Meier C (2007) Chest injuries – what is new? Curr Opin Crit Care 13(6): 674PubMedCrossRefGoogle Scholar
  16. 16.
    Kang SN (2007) Rib fractures, pneumothorax, haemothorax and chest drain insertion. Br J Hosp Med 68(9): 58–59Google Scholar
  17. 17.
    Franke KJ, Nilius G, Rühle KH (2006) Bronchoscopic diagnosis of peripheral pulmonary foci. Dtsch Med Wochenschr 131(40): 2229–2233PubMedCrossRefGoogle Scholar
  18. 18.
    Makris D, Marquette CH (2007) Management of pneumothorax. Rev Prat 57(5): 503–508PubMedGoogle Scholar
  19. 19.
    Michaels AJ, Draganov PV (2007) Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis. World J Gastroenterol 13(26): 3575–3580PubMedGoogle Scholar
  20. 20.
    Ameh V, Jones S (2007) Best evidence topic report. Central venous catheterisation: internal jugular or subclavian approach? Emerg Med J 24(9): 662–663PubMedCrossRefGoogle Scholar
  21. 21.
    Klopp M, Dienemann H, Hoffmann H (2007) Behandlung des Pneumothorax. Chirurg 78: 655–668PubMedCrossRefGoogle Scholar
  22. 22.
    Zehtabchi S, Rios CL (2008) Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy? Ann Emerg Med 51(1): 91–100PubMedCrossRefGoogle Scholar
  23. 23.
    McGillicuddy D, Rosen P (2007) Diagnostic dilemmas and current controversies in blunt chest trauma. Emerg Med Clin North Am 25(3): 695–711PubMedCrossRefGoogle Scholar
  24. 24.
    Kelly AM (2007) Review of management of primary spontaneous pneumothorax: is the best evidence clearer 15 years on? Emerg Med Australas 19(4): 303–308PubMedCrossRefGoogle Scholar
  25. 25.
    Tschopp JM, RamiPorta R, Noppen M, Astoul P (2006) Management of spontaneous pneumothorax: state of the art. Eur Respir J 28: 637–650PubMedCrossRefGoogle Scholar
  26. 26.
    Lee P, Colt HG (2007) State of the art: pleuroscopy. J Thorac Oncol 2(7): 663–670PubMedCrossRefGoogle Scholar
  27. 27.
    Sawada S, Watanabe Y, Moriyama S (2005) Videoassisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long term outcome compared with conservative treatment and open thoracotomy. Chest 127: 2226–2230PubMedCrossRefGoogle Scholar
  28. 28.
    Hunt I, Barber B, Southon R, Treasure T (2007) Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 6(1): 117–120PubMedCrossRefGoogle Scholar
  29. 29.
    Vanderschueren RG (1981) Pleural talcage in patients with spontaneous pneumothorax. Poumon Coeur 37: 273–276PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Abteilung Pneumologie und BeatmungsmedizinThoraxklinik am Universitätsklinikum HeidelbergHeidelbergDeutschland

Personalised recommendations