What Is a Pneumothorax?
“Pneumothorax” is the medical term for a collapsed lung. Pneumothorax occurs when air enters the space around your lungs, or the pleural space. Air can find its way into the pleural space when there’s an open injury in your chest wall or a tear or rupture in your lung, disrupting the pressure that keeps your lungs inflated.
It’s known as a tension pneumothorax when the lung wall is affected, or an open pneumothorax when the chest wall is affected. Causes of ruptured or injured chest or lung walls can include lung disease, injury from a sport, or even changes in air pressure that you experience when scuba diving or mountain climbing. Sometimes, the cause of pneumothorax is unknown.
The change in pressure caused by the opening in your chest or lung wall can cause the lung to collapse and put pressure on the heart.
The condition ranges in severity. If there’s only a small amount of air trapped in the pleural space, as can be the case in a tension pneumothorax, it can often heal on its own if there have been no further complications. More serious cases that involve large volumes of air can become fatal if left untreated.
The treatment can include “watchful waiting” combined with bed rest, insertion of chest tubes, or more invasive surgical procedures to resolve and prevent further collapse of the lung. Oxygen may be administered.
Types and Causes of Pneumothorax
The two basic types of pneumothorax are traumatic pneumothorax (TP) and non-traumatic pneumothorax (NTP). Either type can lead to a tension or an open pneumothorax, depending on whether your chest or your lung wall was impacted.
TP usually occurs after trauma to the chest or lung wall has occurred. The trauma can damage these structures, and this allows air to leak into the pleural space.
Examples of traumas that can cause TP include:
- air bag impact in a vehicle accident
- a hard hit to the chest from a contact sport, such as from a football tackle
- a stab wound to the chest
- medical procedures that can damage the lung, such as chest tube insertions, ventilator use, lung biopsies, and CPR
Changes in air pressure from scuba diving or mountain climbing can also cause TP. The change in altitude can cause air blisters to develop on your lungs and then rupture. This can cause your lung to collapse
Quick treatment of TP is critical. The symptoms are often severe, and they could contribute to potentially fatal complications such as cardiac arrest, respiratory failure, and shock.
NTP doesn’t occur after injury. Instead, it happens spontaneously. There are two major types of NTP. Primary spontaneous pneumothorax (PSP) occurs in people who have never been diagnosed with lung disease. Secondary spontaneous pneumothorax (SSP) occurs in people with known lung problems.
Some conditions that increase your risk of SSP include:
- chronic obstructive pulmonary disease, such as emphysema or chronic bronchitis
- acute or chronic infection, such as tuberculosis or pneumonia
- lung cancer
- cystic fibrosis, which is a genetic lung disease that causes mucus to build up in the lungs
- asthma, which is a chronic obstructive airway disease that causes inflammation
Spontaneous hemopneumothorax (SHP) is a rare subtype of spontaneous pneumothorax. It occurs when blood and air fill the pleural cavity without any recent trauma or history of lung disease.
Symptoms of a Pneumothorax
The symptoms of TP may appear at the time of chest trauma or shortly afterward. The onset of NTP symptoms normally occurs when you’re at rest. A sudden attack of chest pain is usually the first symptom.
Other symptoms may include:
- a steady ache in the chest
- shortness of breath, or dyspnea
- breaking out in a cold sweat
- tightness in the chest
- turning blue, or cyanosis
- severe tachycardia, or a fast heart rate
Risk Factors for a Pneumothorax
The risk factors are different for TP and NTP.
Risk factors for TP include:
- playing hard contact sports, such as football
- performing stunts that may cause damage to the chest
- having a history of violent fighting
The people at highest risk for PSP, which is a type of NTP, are those who are:
- between the ages of 10 and 30
- affected by congenital disorders like Marfan’s syndrome
- exposed to environmental or occupational factors, such as silicosis
- exposed to changes in atmospheric pressure and severe weather changes
The primary risk factor for SSP, which is another type of NTP, is having previously been diagnosed with a lung disease. It’s most common in people over 40.
How Is a Pneumothorax Diagnosed?
Diagnosis is based on the presence of air in the space around the lungs. Detecting this can be difficult. Some imaging tests may be compromised by the air’s position between the chest wall and lung.
Imaging tests commonly used to diagnose pneumothorax include:
- an upright posteroanterior chest radiograph
- a CT scan
- lung sonography
- a thoracic ultrasound
How Is Pneumothorax Treated?
Treatment will depend on the severity of your condition. It will also depend on whether you’ve experienced pneumothorax before. Both surgical and nonsurgical treatments are available.
Bed rest may also be referred to as “observation” or “watchful waiting.” Bed rest is the likely treatment for a case of pneumothorax that involves only a small area of the lung. In this case, your doctor will monitor your condition on a regular basis as the air absorbs from the pleural space. Frequent X-rays will be taken to check if your lung has expanded again. Your doctor will instruct you to rest to help healing. Vigorous activity might delay or stop the re-expansion process.
Pneumothorax can cause oxygen levels to drop in some people. This condition is called “hypoxemia.” If this is the case, your doctor will order oxygen supplementation along with bed rest.
Draining Excess Air
Needle aspiration and chest tube insertion are two nonsurgical treatments designed to remove excess air from the pleural space in the chest. Your doctor will insert a hollowed out tube between your ribs and will use either a syringe or a mechanical suction device to clear the air from the pleural space. The chest tube may remain installed for a few days if a large area of your lung has collapsed.
Pleurodesis is a more invasive form of treatment for pneumothorax. This procedure is used to both treat a collapsed lung and to help prevent it from recurring. During pleurodesis, your doctor essentially destroys the pleural space so that air and fluids can no longer accumulate. The term “pleura” refers to the membrane surrounding each lung. Pleurodesis is performed to make your lungs’ membranes stick together. Once the pleura are conjoined, the pleural space disappears and prevents pneumothorax.
Mechanical pleurodesis is performed manually. Your surgeon gently rubs the pleura to cause inflammation. Chemical pleurodesis is another form of treatment. Your doctor will deliver chemical irritants to the pleura through a chest tube. The irritation and inflammation cause the pleura to stick together.
Surgical treatment for pneumothorax is required in certain situations. You may need surgery if you’ve had repeated NTP. A large amount of air trapped in your chest cavity may also warrant surgical repair.
There are several types of surgery for pneumothorax. One option is a thoracotomy. During this surgery, your doctor will create an incision in the pleural space to help your surgeon see the problem. Once your surgeon has performed a thoracotomy, they’ll decide what must be done to help you heal.
During a thoracoscopy, your doctor inserts a tiny camera through your chest wall to help them see inside your chest. A thoracoscopy can help your surgeon decide on the treatment for your pneumothorax. The possibilities include sewing blisters closed, closing air leaks, or removing the collapsed portion of your lung, which is called a lobectomy.
What Is the Long-Term Outlook?
Your long-term outlook depends on how quickly your pneumothorax was diagnosed. In general, fast treatment is associated with full recovery. However, in severe cases, late treatment may result in circulatory or respiratory failure. Delays in emergency surgery also require longer recovery. This is often accompanied by worse outcomes.
Having one pneumothorax increases the odds for a second. Get medical attention as soon as possible if your symptoms occur again. Only 5 percent of people who’ve had surgery to repair pneumothorax have their pneumothorax develop again.