Pneumothorax: puncturing visceral pleura make a difference?

[theWUbear]

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So pneumothorax is caused by a rupture in the parietal pleura that creates a "real" space from the pleural cavity. Is there a difference in pathology of a pneumothorax that is just creates a rip of any sort in the parietal pleura, from one that damages both the parietal pleura and the visceral pleura (which, I guess, would expose lung parenchyma)?

 

[Anastomoses]

I'm only speculating but I'd guess that lobe would be damaged and blood would be involved so it's probably a pneumohemothorax. Pressure change should still lead to the same collapse of lung and shift of mediastinum.

 

[alpinism]

Depends. For a tension pneumothorax you need a tear in the parietal pleura that creates a flap (allows air in but not out). Not all ruptures in the parietal pleura cause a pneumothorax. If you rupture both the parietal and visceral pleural you can also have a tension pneumothorax/hemopneumothorax if the visceral pleura seals off but the parietal flap remains open.

 

[colbgw02]

Why do you think that pneumothoraces are only caused from a parietal pleura defect? They definitely do, but barotrauma can cause a PTX by just rupturing the visceral pleura.

 

[SouthernSurgeon]

Yeah I think you're somewhat misunderstanding the problem.

A pneumothorax is caused anytime air turns the potential space between the parietal/visceral pleura into an actual space.

This air can come from the outside in (e.g. a trauma, in which the subcutaneous tissue is injured and that injury carries all the way through the parietal pleura, or a pneumothorax from a central line placement). Realistically however in both those instances (i.e. an outside-in injury) both the parietal and visceral pleura will probably be 'penetrated' or injured (and often the underlying lung parenchyma). It's not a clean process.

A pneumothorax can also occur with an inside to out injury - the above example of barotrauma from a ventilator being a great one. In these cases it is the visceral, not parietal, pleura that is primarily insulted.

 

[Rendar5]

Pneumothoraces are defined by their mechanism (primary secondary, spontaneous, iatrogenic). not by which pleura is violated. Tension and open memos are additional physiologic categories. These also have nothing to do with which plea is violated, but rather with where there is a flap, and whether the resistance ia greater pulling air from the trachea or the would .

 

[IonClaws]

A pneumothorax can also occur with an inside to out injury - the above example of barotrauma from a ventilator being a great one. In these cases it is the visceral, not parietal, pleura that is primarily insulted.

So my understanding of the potential space being turned into a real space is that some physical pathway must be created between the interpleural space and an area of higher pressure. If only the visceral pleura is torn, does that mean that the space between the lung parenchyma and the visceral pleura has a higher pressure than the interpleural space?

and whether the resistance ia greater pulling air from the trachea or the would .

What does the trachea have to do with pneumothoraces? Do you mean "world" instead of "would"? Do you mean whether flow is easier (i.e. resistance is lesser) between the physical pathway from the area of higher pressure (outside world) vs. the trachea?

 

[Rendar5]

Autocorrect sucks . Yes I meant would. Airways resistance only applies to open pneumo in which the disruption of a traumatic ptx is so great that air goes into the wound instead of the trachea. Perhaps it would have been best if i hadn't even brought up that type of pneumo. I guess my point is that the different types of pneumothoraces really have nothing to do with the specific layer and always have to do with the mechanism and the pathophys.

 

[Rendar5]

The pleural space is a negative pressure space . Any pleura gets disrupted. and air goes in.