Pnömotoraks
Özet
Pnömotoraks, plevral boşlukta hava birikmesiyle karakterize, akciğerin çökmesine yol açan ve solunumu bozan bir durumdur. Etiyolojik olarak primer/sekonder spontan ve travmatik; patofizyolojik olarak ise açık, kapalı ve tansiyon pnömotoraks olarak sınıflandırılır. Altta yatan bir akciğer hastalığı olmadan gençlerde görülen primer spontan pnömotoraks (PSP) subplevral bleblerin rüptüründen kaynaklanırken, yaşlılarda KOAH gibi nedenlerle sekonder spontan pnömotoraks (SSP) gelişir. Son dönemde COVID-19 hastalarında da invaziv mekanik ventilasyona bağlı sekonder pnömotoraks insidansında artış gözlenmiştir. Tanı aşamasında göğüs ağrısı ve nefes darlığı en sık semptomlar olup, teşhis ayakta çekilen inspirium göğüs radyografisi veya bilgisayarlı tomografi ile doğrulanır. Tedavi yaklaşımı pnömotoraksın boyutundan ziyade hastanın klinik durumuna göre belirlenir. Asemptomatik küçük PSP vakalarında oksijen desteği ve yatak istirahati içeren konservatif gözlem tercih edilirken, semptomatik veya geniş vakalarda iğne aspirasyonu ya da tüp torakostomisi (kapalı su altı drenajı) uygulanır. Tekrarlayan ataklar veya uzamış hava kaçaklarında ise bül rezeksiyonu ve plevral boşluğun obliterasyonunu (plörektomi, abrazyon veya talk plöredezi) hedefleyen cerrahi müdahaleler (VATS veya torakotomi) elzemdir. Tansiyon pnömotoraks ise acil iğne dekompresyonu gerektiren kritik bir tıbbi acildir.
Pneumothorax is defined as the accumulation of air within the pleural space, leading to partial or complete lung collapse and severely impairing respiratory gas exchange. It is etiologically classified into spontaneous (primary and secondary) and traumatic, and pathophysiologically into open, closed, or tension pneumothorax. Primary spontaneous pneumothorax (PSP) typically affects young individuals without underlying lung diseases, primarily due to subpleural bleb rupture or pleural porosity. Conversely, secondary spontaneous pneumothorax (SSP) occurs in older patients with pre-existing conditions like COPD, significantly increasing mortality. Recently, hospitalized COVID-19 patients on invasive mechanical ventilation have shown a notable incidence of secondary pneumothorax. Clinical presentation involves sharp chest pain and dyspnea, with diagnosis confirmed via inspiratory chest X-rays or computed tomography. Management strategy relies heavily on clinical symptoms rather than size alone. Small, asymptomatic PSP cases are managed conservatively with observation and oxygen therapy, which accelerates air resorption. For symptomatic or large pneumothoraces, intervention involves needle aspiration or tube thoracostomy. In cases of recurrence, persistent air leaks, or bilateral presentations, surgical options such as video-assisted thoracoscopic surgery (VATS) or thoracotomy are indicated to perform wedge resection and pleural obliteration (pleurectomy, mechanical abrasion, or chemical pleurodesis). Tension pneumothorax remains a life-threatening medical emergency requiring immediate needle decompression.
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