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What Causes Spontaneous Pneumothorax?
Question: Please refer to query id 147473 for the history.
Summary: Oct 27, 2014 diagnosis of spontaneous pneumothorax on RIGHT side and chest tube for two days. Episodes of chest pain and shortness of breath since. Nov 11, 2014 follow-up x-ray that looked fine even though chest pain has come and gone.
NOW: Nov 19, 2014- Another episode of sharp pain for about one minute followed by the shortness of breath and fatigue. ON LEFT side this time. These episodes have continued. Nov 20, 2014- Last night when laying in the bed to fall asleep at night; chest pain. When in bed it can be described as someone has put their hands on the chest and they are pushing on the chest with force. Feeling of not getting much recovery. Urgent care doesn't want to check any more just says go to ER which for a student far away from home is scary when he has had the whole ER experience.
Summary: Oct 27, 2014 diagnosis of spontaneous pneumothorax on RIGHT side and chest tube for two days. Episodes of chest pain and shortness of breath since. Nov 11, 2014 follow-up x-ray that looked fine even though chest pain has come and gone.
NOW: Nov 19, 2014- Another episode of sharp pain for about one minute followed by the shortness of breath and fatigue. ON LEFT side this time. These episodes have continued. Nov 20, 2014- Last night when laying in the bed to fall asleep at night; chest pain. When in bed it can be described as someone has put their hands on the chest and they are pushing on the chest with force. Feeling of not getting much recovery. Urgent care doesn't want to check any more just says go to ER which for a student far away from home is scary when he has had the whole ER experience.
Brief Answer:
A chest X ray is required to rule out recurrent pneumothorax.
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read through your query in detail.
Sorry to hear the pain and discomfort your son is facing due to his medical condition.
Spontaneous pneumothorax is known to recur in almost more than half of the patients. I have viewed the chest X rays dated Oct 27th 2014 and Nov 11th 2014 and find that the right sided pneumothorax noted in the earlier X ray showed complete resolution with satisfactory lung inflation on the second one.
I would be interested in knowing the details of CT scan chest done just before removing the drainage tubes earlier on. This can tell us if there are predisposing factors in the lungs causing him to have pneumothorax.
Recent research has shown that the risk of a primary spontaneous pneumothorax and recurrence is multifactorial and cannot be attributed to one single factor alone. It is slightly more common in taller men and those who smoke. However, I suppose these factors do not play a significant role for your son should he have a recurrent pneumothorax.
In the absence of any previously detected lung abnormality and without knowing the CT scan lung details, I suggest your son gets at least the chest X ray repeated to confirm with certainty that there is no recurrent pneumothorax. A recurrent pneumothorax surely needs immediate medical attention in any patient.
I understand your concern after reading through the previous query but a single chest X ray is all that is needed to rule out any recurrence.
Wish your son quick recovery and good health.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
A chest X ray is required to rule out recurrent pneumothorax.
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read through your query in detail.
Sorry to hear the pain and discomfort your son is facing due to his medical condition.
Spontaneous pneumothorax is known to recur in almost more than half of the patients. I have viewed the chest X rays dated Oct 27th 2014 and Nov 11th 2014 and find that the right sided pneumothorax noted in the earlier X ray showed complete resolution with satisfactory lung inflation on the second one.
I would be interested in knowing the details of CT scan chest done just before removing the drainage tubes earlier on. This can tell us if there are predisposing factors in the lungs causing him to have pneumothorax.
Recent research has shown that the risk of a primary spontaneous pneumothorax and recurrence is multifactorial and cannot be attributed to one single factor alone. It is slightly more common in taller men and those who smoke. However, I suppose these factors do not play a significant role for your son should he have a recurrent pneumothorax.
In the absence of any previously detected lung abnormality and without knowing the CT scan lung details, I suggest your son gets at least the chest X ray repeated to confirm with certainty that there is no recurrent pneumothorax. A recurrent pneumothorax surely needs immediate medical attention in any patient.
I understand your concern after reading through the previous query but a single chest X ray is all that is needed to rule out any recurrence.
Wish your son quick recovery and good health.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Problem in USA is that one cannot get x-ray without seeing a doctor first. So "Pulmonologist" appointment is scheduled to listen to his breathing and get x-ray prescription but that will not happen till 11/24/2014. Hope I can get x-ray done for my son and upload for your review on that day.
Also, we'll try to get a copy of his CT scan from the hospital.
Thank you.
Also, we'll try to get a copy of his CT scan from the hospital.
Thank you.
Brief Answer:
Please upload chest X ray and CT scan when you have it with you.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
I would be waiting to see the chest X ray of your son at the earliest.
The CT scan report remains important as it will show any pre existing condition in detail.
Please tell your son not to fly or go diving till he is treated. Also it is better to avoid high contact sports and violent games till he is declared fit.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please upload chest X ray and CT scan when you have it with you.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
I would be waiting to see the chest X ray of your son at the earliest.
The CT scan report remains important as it will show any pre existing condition in detail.
Please tell your son not to fly or go diving till he is treated. Also it is better to avoid high contact sports and violent games till he is declared fit.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply.
A new complication has occurred and my son is sitting in the ER as I write this because he has had continuous chest pain and pressure on LEFT side with a high BP of 144/90. He is going to be given BP medication( hopefully soon; he has been waiting for more than one hour). What is this related to? What may be happening?
Please HELP/advise!
Thank you so much for your time.
A new complication has occurred and my son is sitting in the ER as I write this because he has had continuous chest pain and pressure on LEFT side with a high BP of 144/90. He is going to be given BP medication( hopefully soon; he has been waiting for more than one hour). What is this related to? What may be happening?
Please HELP/advise!
Thank you so much for your time.
Brief Answer:
The blood pressure is mildly elevated but chest pain requires evaluation.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
The upper limits of blood pressure being 140/ 90 mm Hg and your son having 144/ 90 shows that he has mild grade I hypertension.Please do not worry because he is being given medications to bring down the blood pressure.
Your son is having a slightly higher than normal blood pressure recording. Blood pressure is a direct consequence of the pumping action of the heart and the pressure exerted by the flowing blood on the walls of blood vessels called arteries.
Since your son also complains of left sided chest pain it is important to know if there is something in the lungs and heart causing this condition. The chest pain requires detailed evaluation.
It is also possible that the blood pressure is shooting up due to anxiety. However, the chest pain on left side which is continuous and has been there for more than a day, makes the possibility of anxiety less likely.
Please do let me know about the opinions of ER doctors after clinical examination and we can discuss further as per your requirement.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
The blood pressure is mildly elevated but chest pain requires evaluation.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
The upper limits of blood pressure being 140/ 90 mm Hg and your son having 144/ 90 shows that he has mild grade I hypertension.Please do not worry because he is being given medications to bring down the blood pressure.
Your son is having a slightly higher than normal blood pressure recording. Blood pressure is a direct consequence of the pumping action of the heart and the pressure exerted by the flowing blood on the walls of blood vessels called arteries.
Since your son also complains of left sided chest pain it is important to know if there is something in the lungs and heart causing this condition. The chest pain requires detailed evaluation.
It is also possible that the blood pressure is shooting up due to anxiety. However, the chest pain on left side which is continuous and has been there for more than a day, makes the possibility of anxiety less likely.
Please do let me know about the opinions of ER doctors after clinical examination and we can discuss further as per your requirement.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Yogesh D
11/22/2014
My son went to ER.
They first did an EKG and a blood test.
His BP came down without medications after about three hours stayed in the range of 125/85.
Then a CT scan was done.
Reports are uploaded.
He has been discharged without any medicine as his BP came down after 3 hours and no pneumothorax was detected, blood test was normal (but the chest pain continued even after he came home and was having hard time falling asleep.) One concerning fact is highlighted in the CT Report. According to ER doctor he has probably had a tension pneumothorax. We don't know what is triggering the chest pain but having it last this long is concerning.
11/23/2014 He is not feeling pain now; this morning when he woke up. He mostly is breathing through his mouth when he realizes that he is getting short of breath and has to take a deep breath.
My son is anxious about the condition and suspects some kind of heart problem that started because of first episode of pneumothorax. He had been a very active, healthy, and athletic young man until then.
Thank you for your reply before and I hope to hear from you soon.
Sincerely,
A worried mother
My son went to ER.
They first did an EKG and a blood test.
His BP came down without medications after about three hours stayed in the range of 125/85.
Then a CT scan was done.
Reports are uploaded.
He has been discharged without any medicine as his BP came down after 3 hours and no pneumothorax was detected, blood test was normal (but the chest pain continued even after he came home and was having hard time falling asleep.) One concerning fact is highlighted in the CT Report. According to ER doctor he has probably had a tension pneumothorax. We don't know what is triggering the chest pain but having it last this long is concerning.
11/23/2014 He is not feeling pain now; this morning when he woke up. He mostly is breathing through his mouth when he realizes that he is getting short of breath and has to take a deep breath.
My son is anxious about the condition and suspects some kind of heart problem that started because of first episode of pneumothorax. He had been a very active, healthy, and athletic young man until then.
Thank you for your reply before and I hope to hear from you soon.
Sincerely,
A worried mother
Brief Answer:
Please find detailed answer below.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Your son's reports have been seen by me. The EKG is fairly normal and the CT scan does not show any serious concern. The particularly highlighted area refers to the thymus which is a normal structure and usually more well seen in children and young adults. The report only makes a mention of it and not something to worry about.
There is no other positive finding in chest CT scan. This means that the lungs have expanded completely following the episode of tension pneumothorax. If the chest pain is associated with a particular position and sharp burning type then it can be due to irritation of pleura which is still undergoing healing after the earlier insertion of chest tubes.
If the pain is like someone placing a heavy stone on his chest and crushing type then getting a complete cardiac work up including echocardiography can help.
As you say that your son is an active healthy individual, it is important to know if the earlier episode was triggered by any low intensity blunt trauma during playing sports or due to a fall.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find detailed answer below.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Your son's reports have been seen by me. The EKG is fairly normal and the CT scan does not show any serious concern. The particularly highlighted area refers to the thymus which is a normal structure and usually more well seen in children and young adults. The report only makes a mention of it and not something to worry about.
There is no other positive finding in chest CT scan. This means that the lungs have expanded completely following the episode of tension pneumothorax. If the chest pain is associated with a particular position and sharp burning type then it can be due to irritation of pleura which is still undergoing healing after the earlier insertion of chest tubes.
If the pain is like someone placing a heavy stone on his chest and crushing type then getting a complete cardiac work up including echocardiography can help.
As you say that your son is an active healthy individual, it is important to know if the earlier episode was triggered by any low intensity blunt trauma during playing sports or due to a fall.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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