A collapsed lung, or pneumothorax, is the collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath.

Causes

A collapsed lung may result from chest trauma, such as gunshot or knife wounds, rib fracture, or after certain medical procedures.

In some cases, a collapsed lung occurs without any cause. This is called a spontaneous pneumothorax. A small area in the lung that is filled with air, called a bleb, ruptures, and the air leaks into the space around the lung.

Certain activities may lead to a collapsed lung. These include scuba diving, smoking marijuana or cigarettes, high altitude hiking, and flying.

Tall, thin people are more likely to a collapsed lung.

Lung diseases such as COPD, asthma, cystic fibrosis, tuberculosis, and whooping cough also increase your risk for a collapsed lung.

Symptoms

Almost everyone who has a collapsed lung has the following symptoms:

Sharp chest pain, made worse by a deep breath or a cough Shortness of breath

A larger pneumothorax will cause more severe symptoms, including:

Chest tightness Easy fatigue Rapid heart rate Bluish color of the skin caused by lack of oxygen

Note: Symptoms may begin during rest or sleep.

Other symptoms that can occur with a collapsed lung include:

Nasal flaring Low blood pressure (hypotension)

Exams and Tests

There are decreased or no breath sounds on the affected side when heard through a stethoscope.

Tests include:

Chest x-ray to tell whether there is air outside the lung Arterial blood gases

Treatment

A small pneumothorax may go away on its own. You may only need oxygen and rest. The health care provider may use a needle to pull the extra air out from around the lung so it can expand more fully. You may be allowed to go home if you live near the hospital.

If you have a large pneumothorax, a chest tube will be placed between the ribs into the space around the lungs to help drain the air and allows the lung to re-expand.

The chest tube can be left in place for several days. You must stay in the hospital while the chest tube is in place.

Some patients with a collapsed lung need extra oxygen, which helps the air around the lung be reabsorbed more quickly.

Lung surgery may be needed to treat your pneumothorax or to prevent future episodes. The area where the leak occurred may be repaired. Sometimes, a special chemical is placed into the area of the collapsed lung. This chemical causes a scar to form.

Outlook (Prognosis)

If you have a collapsed lung, you are more likely to have another one in the future if you:

Are tall and thin Continue to smoke Have had two collapsed lungs in the past

How well a person does after having a collapsed lung depends on what caused it.

Possible Complications

Another collapsed lung in the future Shock

Prevention

There is no known way to prevent a collapsed lung, but you can decrease your risk by not smoking.

Alternative Names

Air around the lung; Air outside the lung; Pneumothorax; Spontaneous pneumothorax

pneumothorax

 Definition

Pneumothorax is a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse.

Description

Normally, the pressure in the lungs is greater than the pressure in the pleural space surrounding the lungs. However, if air enters the pleural space, the pressure in the pleura then becomes greater than the pressure in the lungs, causing the lung to collapse partially or completely. Pneumothorax can be either spontaneous or due to trauma.

If a pneumothorax occurs suddenly or for no known reason, it is called a spontaneous pneumothorax. This condition most often strikes tall, thin men between the ages of 20 to 40. In addition, people with lung disorders, such as emphysema, cystic fibrosis, and tuberculosis, are at higher risk for spontaneous pneumothorax. Traumatic pneumothorax is the result of accident or injury due to medical procedures performed to the chest cavity, such as thoracentesis or mechanical ventilation. Tension pneumothorax is a serious and potentially life-threatening condition that may be caused by traumatic injury, chronic lung disease, or as a complication of a medical procedure. In this type of pneumothorax, air enters the chest cavity, but cannot escape. This greatly increased pressure in the pleural space causes the lung to collapse completely, compresses the heart, and pushes the heart and associated blood vessels toward the unaffected side.

— Lorraine Steefel, RN—

pneumothorax Condition in which air accumulates in the pleural sac, causing it to expand and thus compress the underlying lung, which may then collapse. (The pleural sac is a cavity formed by the two pleural membranes that line the thoracic cavity and cover the lungs.) Traumatic pneumothorax is the accumulation of air caused by penetrating wounds (knife stabbing, gunshot) or other injuries to the chest wall, after which air is sucked through the opening and into the pleural sac. Spontaneous pneumothorax is the passage of air into the pleural sac from an abnormal connection created between the pleura and the bronchial system as a result of tuberculosis or some other lung disease. The symptoms of spontaneous pneumothorax are a sharp pain in one side of the chest and shortness of breath.Sponsored Links

An accumulation of air or gas in the pleural cavity. The air enters by way of an external wound, a lung perforation, a burrowing abscess, or rupture of a superficial lung cavity. Pneumothorax is accompanied by sudden, severe pain and rapidly increasing dyspnea.

Sponsored LinksMortara AustraliaWorld Leaders in ECG and also exclusive Embla, Medical Graphicswww.mortara.com.auElsevier publicationsRespiratory medicine and Allergy Free top articles from 22 journalswww.respiratorycontent.comSports Science and Medicine:

pneumothoraxTop Home > Library > Health > Sports Science and Medicine

The entrance of air into the pleural cavity, which may lead to lung collapse. It may result from a perforation of the chest wall, but a spontaneous pneumothorax has an internal cause, such as the rupture of the alveoli, which can occur if a diver ascends too rapidly with air trapped in the lungs.

Sponsored LinksAllergies & AsthmaStop Surfing. Ask Top Experts Now! Get Your Free, Private ConsultationHealthBeautyFreedom.comColumbia Encyclopedia:

pneumothoraxTop Home > Library > Miscellaneous > Columbia Encyclopediapneumothorax (nūmōthôr'ăks), collapse of a lung with escape of air into the pleural cavity between the lung and the chest wall. The cause may be traumatic (e.g., gunshot or stab wound), spontaneous (rupture due to disease or localized weakness of the lung lining), or environmental (extreme change in atmospheric pressure). The only symptom may be a sudden pain in the chest. Physical and radiological examination reveals characteristic signs of lung collapse. Simple pneumothorax of only one lung generally requires only rest; the break in the pleura usually heals quickly after collapse of the lung has taken place. In tension pneumothorax (where there is high intrapleural pressure), or if both lungs are collapsed, it is mandatory to remove the air from the pleural cavity immediately. An artificial pneumothorax is one deliberately induced, as in the treatment of tuberculosis of the lung before modern drugs became available, or in the diagnosis of lung disease.

 

Veterinary Dictionary:

pneumothoraxTop Home > Library > Animal Life > Veterinary Dictionary

Entry of air into the pleural cavity in sufficient quantity to cause collapse of the lung and consequent respiratory embarrassment. If it is unilateral there is a mediastinal shift with displacement of the heart to the other side of the chest. Breath sounds are absent from the affected side.

Pneumothorax. By permission from Ettinger SJ, Feldman E, Textbook of Veterinary Internal Medicine, Saunders, 2004

closed p. — air leaks from a discontinuity in the lung into the pleural cavity. false p. — artifactual increased radiolucency of the thorax resembling free air in

the pleural cavity. iatrogenic p. — may occur following intrathoracic surgery or in association with

procedures which involve entry into the pleural cavity, such as thoracentesis or placement of a chest drain.

open p. — caused by an open wound in the chest wall. spontaneous p. — due to an unknown cause. tension p. — a particularly dangerous form of pneumothorax that occurs when air

escapes into the pleural cavity from a bronchus but cannot regain entry into the bronchus. As a result, continuously increasing air pressure in the pleural cavity causes progressive collapse of the lung tissue. If not relieved, it can lead to lung collapse and mediastinal shift.

 Wikipedia:

PneumothoraxTop Home > Library > Miscellaneous > Wikipedia

This article needs additional citations for verification.Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (March 2009)

"Collapsed lung" redirects here. For the band, see Collapsed Lung (band). For other forms of lung collapse, see Atelectasis.

Pneumothorax

Classification and external resources

Chest X-ray of Left-sided Tension Pneumothorax

ICD-10 J 93. , P 25.1 , S 27.0

ICD-9 512, 860

DiseasesDB 10195

MedlinePlus 000087

eMedicine emerg/469

MeSH D011030

In medicine (pulmonology), a pneumothorax is a potential medical emergency wherein air or gas is present in the pleural cavity. A pneumothorax can occur spontaneously. It can also occur as the result of disease or injury to the lung, or due to a puncture to the chest wall. A pneumothorax can result in a collapsed lung, or can be created therapeutically to collapse a lung.

Contents [hide] 1 Etiology 2 Signs and symptoms 3 Diagnosis 4 Differential diagnosis 5 Pathophysiology 6 First aid

o 6.1 Chest wound o 6.2 Blast injury or tension o 6.3 Pre-hospital care

7 Clinical treatment 8 Spontaneous pneumothorax

o 8.1 Primary spontaneous pneumothorax o 8.2 Secondary spontaneous pneumothorax

9 History 10 Image gallery 11 References

12 See also

Etiology

CT scan of the chest showing a pneumothorax on the patient's left side (right side on the image). A chest tube is in place (small black mark on the right side of the image), the air-filled pleural cavity (black) and ribs (white) can be seen. The heart can be seen in the center.

It most commonly arises:

Spontaneously (more commonly in tall slim young males and in Marfan syndrome)

Following a penetrating chest wound Following barotrauma to the lungs[1][2]

It may also be due to:

Chronic lung pathologies including emphysema, asthma Acute infections Chronic infections, such as tuberculosis Lung damage caused by cystic fibrosis Lung Cancer Rare diseases that are unique to women such as Catamenial pneumothorax (due to

endometriosis in the chest cavity) and lymphangioleiomyomatosis (LAM).

Pneumothoraces are divided into tension and non-tension pneumathoraces. A tension pneumothorax is a medical emergency as air accumulates in the pleural space with each breath. The increase in intrathoracic pressure results in massive shifts of the mediastinum away from the affected lung compressing intrathoracic vessels. A non-tension pneumothorax by contrast is of lesser concern because there is no ongoing accumulation of air and hence no increasing pressure on the organs within the chest.

The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the problem, creating a hemopneumothorax.

Signs and symptoms

Pneumothorax presents mainly as a sudden shortness of breath, dry coughs, cyanosis (turning blue) and pain felt in the chest, back and/or arms. In penetrating chest wounds, the sound of air flowing through the puncture hole may indicate pneumothorax, hence the term "sucking" chest wound. The flopping sound of a punctured lung is also occasionally heard. Subcutaneous emphysema is another symptom.

If untreated, hypoxia may lead to hypercapnia, respiratory acidosis, and loss of consciousness. In a tension pneumothorax, shifting of the mediastinum away from the site of the injury can obstruct the superior and inferior vena cava resulting in reduced venous return. This in turn decreases cardiac preload and cardiac output.

Spontaneous pneumothorax has been reported in young people with a marfanoid habitus. The reason for this association, while unknown, is hypothesized to be the presence of subtle abnormalities in connective tissue, though not necessarily in elastin per se. Most spontaneous pneumothorax result from "blebs", expanded alveoli just under the superficial surface of the lung, that rupture allowing the escape of air into the pleural cavity.

Pneumothorax can also occur as part of medical procedures, such as the insertion of a central venous catheter into the subclavian vein. Other causes include mechanical ventilation, endotracheal intubation, laparoscopic surgery, emphysema and less commonly other lung diseases bacterial or viral (pneumonia), metastatic tumors especially sarcomas, lymphangioleiomyomatosis, eosinophilic granuloma, cystic fibrosis, alpha1-antitrypsin deficiency, spontaneous or traumatic esophageal rupture, Pneumocystis carinii pneumonia, lung abscess, and asthma[3].

Diagnosis

The absence of audible breath sounds through a stethoscope can indicate that the lung is not unfolded in the pleural cavity. This accompanied by hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis. The "coin test" may be positive. Two coins when tapped on the affected side, produce a tinkling resonant sound which is audible on auscultation.[4]

If the signs and symptoms are doubtful, an X-ray of the chest can be performed, but in severe hypoxia, or evidence of tension pneumothorax emergency treatment has to be administered first. An x-ray can illustrate the collapse of the lung as extra black space, indicating the presence of air, will be seen in the x-ray around the lung. The lung shrivels up away from the affected side and the mediastinum (trachea and other components) will shift towards the affected side.[5]

In a supine chest X-ray the deep sulcus sign is diagnostic[6], which is characterized by a low lateral costophrenic angle on the affected side.[7] In layman's terms, the place where rib and diaphragm meet appears lower on an X-ray with a deep sulcus sign and suggests the diagnosis of pneumothorax.

In Neonates the use of a transilluminator to suspected area will help visualize the air as radiating rings from light source out.

Differential diagnosis

When presented with this clinical picture, other possible causes include:

Acute Myocardial Infarction : presents with shortness of breath and chest pain, though MI chest pain is characteristically crushing, central and radiating to the jaw, left arm or stomach. Whilst not a lung condition, patients having an MI often happen to also have lung disease.

Emphysema : here, delicate functional lung tissue is lost and replaced with air spaces, giving shortness of breath, and decreased air entry and increased resonance on examination. However, it is usually a chronic condition, and signs are diffuse (not localised as in pneumothorax).

Careful history taking and examination and a chest X-ray will allow accurate diagnosis.

Pathophysiology

Mechanics of a sucking chest wound. A. Air enters the chest through the opening in the chest wall during inspiration (a). The lung collapses on the affected side (b), air passes out of affected bronchus. Air enters the bronchus from the collapsed lung (c) and passes to the intact lung. The mediastinum shifts toward the uninvolved side (d), and hemothorax occurs (e). B. During expiration, air escapes through the wound (a). The collapsed lung expands (b). Air passes from the uninvolved side to the lung on involved side and out the trachea (c). The mediastinum shifts to the involved side (d), and hemothorax occurs (e).

The lungs are located inside the chest cavity, which is a hollow space. Air is drawn into the lungs by the diaphragm (a powerful abdominal muscle). The pleural cavity is the region between the chest wall and the lungs. If air enters the pleural cavity, either from the outside (open pneumothorax) or from the lung (closed pneumothorax), the lung collapses and it becomes mechanically impossible for the injured person to breathe, even with an open airway. If a piece of tissue forms a one-way valve that allows air to enter the pleural cavity from the lung but not to escape, overpressure can build up with every breath; this is known as tension pneumothorax. It may lead to severe shortness of breath as well as circulatory collapse, both life-threatening conditions. This condition requires urgent intervention.

First aid

Chest wound

Penetrating wounds (also known as 'sucking chest wounds') require immediate coverage with an occlusive dressing, field dressing, or pressure bandage made air-tight with petroleum jelly or clean plastic sheeting. The sterile inside of a plastic bandage packaging

is good for this purpose; however in an emergency situation any airtight material, even the cellophane of a cigarette pack, can be used. A small opening, known as a flutter valve, may be left open so the air can escape while the lung reinflates. Any patient with a penetrating chest wound must be closely watched at all times and may develop a tension pneumothorax or other immediately life-threatening respiratory emergency at any moment. They cannot be left alone.

Blast injury or tension

If the air in the pleural cavity is due to a tear in the lung tissue (in the case of a blast injury or tension pneumothorax), it needs to be released. A thin needle can be used for this purpose, to relieve the pressure and allow the lung to reinflate.

Pre-hospital care

Many paramedics can perform needle thoracocentesis to relieve intrathoracic pressure. Intubation may be required, even of a conscious patient, if the situation deteriorates. Advanced medical care and immediate evacuation are strongly indicated.

An untreated pneumothorax is an absolute contraindication of evacuation or transportation by flight.

Clinical treatment

Small pneumothoraces are often managed conservatively as they will resolve on their own.[8] Repeat observation via chest X-rays and oxygen administered.[9]

Pneumothoraces which are too small to require tube thoracostomy and too large to leave untreated, may be aspirated with a small catheter.

Larger pneumothoraces may require tube thoracostomy, also known as chest tube placement. If a thorough anesthetizing of the parietal pleura and the intercostal muscles is performed, the only major pain experienced should be either the injury that caused the pneumothorax or the re-expanding of the lung. Proper anesthetizing will come about by the following procedure: the needle should be inserted into the chest cavity and a negative pressure created in the syringe. While air bubbles rise into the syringe, the needle should be slowly pulled out of the cavity until the bubbles cease. The tip of the syringe that contains the anesthetic is now in the intercostal muscles just next to the parietal pleura. A proper and sizable injection should ensue (5 to 10 ml). This will allow the patient to be fairly comfortable despite a hemostat or finger being inserted into the chest cavity. A tube is then inserted through the chest wall into the pleural space and air is extracted using a simple one way valve or vacuum and a water valve device. This allows the lung to re-expand within the chest cavity. The rate of re-expansion will vary widely. It is important not to connect the chest tube to suction right away, as rapid expansion may lead to pulmonary edema. The pneumothorax is followed up with repeated X-rays. If the pneumothorax has resolved and there is no further air leak, the chest tube is removed. If, during the time that the tube is still in the chest, the lung manages to sustain the re-expansion, but once suction is turned off, the lung collapses, a Heimlich valve may be used. This flutter valve allows air and fluid in the pleural cavity to escape the pleura into a drainage bag while not letting any air or fluid back in. This method was developed by the military in order to get soldiers with lung injuries stable and out of the battlefield faster. It is a rarely used medical device in the treatment of patients these days, but may be used in order to allow the patient to leave the hospital.

It is critical that the chest tube be managed in such a way that it does not become kinked or occluded with clot or other fibrinous material. Chest tube clogging can result in build up of air in the pleural space. At the very least, this will lead to a recurrent pneumothorax. In the worse case, the patient can have a tension pneumothorax if the air builds up under pressure and impairs venous return to the heart. This can be fatal. The tubes have a tendency to form clot from blood and other fibrinous material that can occlude them. To keep them open they must be stripped, milked or even replaced if they totally occlude. Smaller tubes are less traumatic, but more prone to clogging, although this can also occur with larger tubes. One sign the chest tube is clogged is subcutaneous emphysema. Another is a loss of respiratory variation in the fluid level at the water seal valve in the drainage canister.

In the situation that the chest tube is not sufficient in healing of the lung (for example, a continued air leak despite chest tube drainage), or if CT scans show the presence of large "bullae" on the surface of the lung, thoracoscopic surgery, or video assisted thorascopic surgery (VATS), may be done in order to staple the leak shut and to irritate the pleura to

promote adhesions between the lung and pleura (pleurodesis). Two or three small incisions are made in the side of the chest and back, one for a small camera and the other (s) for tools used to seal the lung and abrade or remove the pleura. When finished the wound is covered with a steri-strip and bandaged up.

In case of penetrating wounds, these require attention, but generally only after the airway has been secured and a chest drain inserted. Supportive therapy may include mechanical ventilation.

Recurrent pneumothorax may require further corrective and/or preventive measures such as pleurodesis. If the pneumothorax is the result of ruptured bullae, then bullectomy (the removal or stapling of bullae or other faults in the lung) is preferred. Chemical pleurodesis is the injection of a chemical irritant that triggers an inflammatory reaction, leading to adhesion of the visceral pleura, which is in contact with the lung, to the parietal pleura. Substances used for pleurodesis include talc, blood, tetracycline and bleomycin. Mechanical pleurodesis is done by abrading the pleura and does not use chemicals. The surgeon "roughens" up the inside chest wall ("parietal pleura") so the lung attaches to the wall with scar tissue. This can also include a partial "parietal" pleurectomy, which is the removal of the "parietal" pleura; "parietal" pleura is the serous membrane lining the inner surface of the thoracic cage and facing the "visceral" pleura, which lies all over the lung surface. Both operations can be performed using keyhole surgery (VATS) to minimise discomfort to the patient. Sometimes pneumothorax occurs bilaterally in sequence or, more rarely, simultaneously; that is often associated to bilateral apical blebs and obviously requires bilateral treatment [10].[11]

Spontaneous pneumothorax

Spontaneous Pneumothorax can be classified as primary spontaneous pneumothorax and secondary spontaneous pneumothorax. In primary spontaneous pneumothorax, it is usually characterized by a rupture of a bleb in the lung while secondary spontaneous pneumothorax mostly occurs due to chronic obstructive pulmonary disease (COPD).

Primary spontaneous pneumothorax

A primary spontaneous pneumothorax may occur without either trauma to the chest or any kind of blast injury. This type of pneumothorax is caused when a bleb (an imperfection in the lining of the lung) bursts causing the lung to deflate. The lung is reinflated by the surgical insertion of a chest tube. A minority of patients will suffer a second instance. In this case, thoracic surgeons often recommend thorascopic pleurodesis

to improve the contact between the lung and the pleura. If multiple and/or bilateral occurrences continue, surgeons may opt for a far more invasive bullectomy and pleurectomy to permanently adhere the lung to the interior of the rib cage with scar tissue, making collapse of that lung physically impossible. Primary spontaneous pneumothorax is most common in tall, thin men between 17 and 40 years of age, without any history of lung disease. Though less common, it also occurs in women, usually of the same age and body type. The tendency for primary spontaneous pneumothorax sufferers to be tall and thin is not due to weight, diet or lifestyle, but because the genetic predisposition toward those traits often coincides with a genetic predisposition toward high volume lungs with large, burstable blebs. A small portion of primary spontaneous pneumothoraxes occur in persons outside the typical range of age and body type.

Secondary spontaneous pneumothorax

In secondary spontaneous pneumothorax, a known lung disease is the cause of the collapse[12]. The most common cause is chronic obstructive pulmonary disease (COPD) with emphysematous bullae. However, there are several other diseases that may also lead to spontaneous pneumothorax:

Tuberculosis Pneumonia Asthma Cystic fibrosis Lung cancer Interstitial lung disease Marfan syndrome Lymphangioleiomyomatosis (LAM)[13]

History

Jean Marc Gaspard Itard, a student of René Laennec, first recognised pneumothorax in 1803, and Laennec himself described the full clinical picture in 1819.[14]

Prior to the advent of anti-tuberculous medications, iatrogenic pneumothoraces were intentionally given to tuberculosis patients in an effort to collapse a lobe, or entire lung around a cavitating lesion. This was known as 'resting the lung'.

Image gallery

The previous pneumothorax after placement of a pig

Right sided spontaneous pneumothorax with an arrow indicating the collapsed right lung.

tail drain in the second intercostal space mid clavicular line. Arrow indicated the pig tail drain.

References1. ̂ Broome JR, Smith DJ (November 1992). "Pneumothorax as a complication of

recompression therapy for cerebral arterial gas embolism". Undersea Biomed Res 19 (6): 447–55. PMID 1304671. http://archive.rubicon-foundation.org/2600. Retrieved 2008-06-05.

2. ̂ Chen CW, Perng WC, Li MH, Yan HC, Wu CP (December 2006). "Hemorrhage from an enlarged emphysematous bulla during commercial air travel". Aviat Space Environ Med 77 (12): 1275–7. PMID 17183925. http://www.ingentaconnect.com/content/asma/asem/2006/00000077/00000012/art00010. Retrieved 2008-06-05.

3. ̂ Shields, T.W.; Locicero, J.; Ponn, R.B.; Rusch, V.W. (2005). General Thoracic Surgery. New York: Lippincott Williams & Wilkins. pp. 794-805. ISBN 0-7817-3889-X.

4. ̂ Wallach SL (2000). "Spontaneous pneumothorax". N. Engl. J. Med. 343 (4): 300; author reply 300–1. doi:10.1056/NEJM200007273430413. PMID 10928880.

5. ̂ Davies, Andrew, and Carl Moores. The Respiratory System. Systems of the body. Edinburgh: Churchill Livingstone, 2003. ISBN 0443062315.

6. ̂ Kong A (2003). "The deep sulcus sign". Radiology 228 (2): 415–6. doi:10.1148/radiol.2282020524. PMID 12893899.

7. ̂ Gordon R (1980). "The deep sulcus sign". Radiology 136 (1): 25–7. PMID 7384513.

8. ̂ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 59. ISBN 1-4051-4166-2.

9. ̂ Andrew K Chang, MD. "eMedicine.com: Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum " . http://www.emedicine.com/emerg/topic469.htm.

10. ̂ "Transmediastinal Access For Bilateral Open Treatment Of Spontaneous Pneumothorax". http://www.fondazionecarrel.org/carrel/thorac/files/transm/transm.htm.

11. ̂ Nazari S, Buniva P, Aluffi A, Salvi S (2000). "Bilateral open treatment of spontaneous pneumothorax: a new access". Eur J Cardiothorac Surg 18 (5): 608–10. doi:10.1016/S1010-7940(00)00566-2. PMID 11053826. http://linkinghub.elsevier.com/retrieve/pii/S1010-7940(00)00566-2.

12. ̂ "Spontaneous Pneumothorax Fact Sheet". American Lung Association site. http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=4294229&ct=3052603. Retrieved 11 Dec 2008.

13. ̂ McCormack FX (2006). "Lymphangioleiomyomatosis". MedGenMed : Medscape general medicine 8 (1): 15. PMID 16915145. Full text at PMC: 1682009

14. ̂ Laennec RTH. Traité de l'auscultation médiate et des maladies des poumons et du coeur. Part II. Paris, 1819.

See also Tension pneumothorax Pleural effusion Hydrothorax Pulmonary contusion Traumatic aortic rupture Pneumohemothorax

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Pneumothorax: Prognosis

Pleural Biopsy: Risks

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