Respiratory System Case Study: Pneumothorax
Case Presentation
John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening
when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions.
He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As
luck would have it, John passed a hospital each day on his way home and was able to get himself to
the hospital’s emergency room. The emergency room physician listened to John’s breathing with a
stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor’s
questions. The doctor noted that John had no history of respiratory problems but was a heavy
smoker.
After viewing the chest radiograph, the doctor informed John that he had experienced a
spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that
a hole had opened in John’s right lung and that this hole had allowed air to leak into the cavity
surrounding the lung. Then, as a result of the lung’s own elastic nature, the lung had collapsed. The
doctor said he could not be certain of the cause of the pneumothorax, but smoking cigarettes had
certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax
was small, which meant that relatively little air had escaped from the lung into the surrounding
cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying
in nonpressurized aircraft, and scuba diving. He also had John make an appointment for a re-check
and another chest x-ray.
Case Background
Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air
from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally
greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will
recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference
between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung
causes the opening to seal.
The pneumothorax decreases the efficiency of the respiratory system, which in turn results in
decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the
pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung
once the opening has sealed shut. If the pneumothorax is large, a needle or chest tube may have to
be inserted into the pleural cavity to draw the air out and allow for the reexpansion of the lung.