Pneumothorax

Pneumothorax is the medical term for a collapsed lung. It occurs when air enters the space around your lungs (the pleural space). This can happen when an open injury in your lung tissue causes air to leak into the pleural space. The resulting increased pressure on the outside of your lung causes it to collapse.

Symptoms

Symptoms may include:

  • A sudden, sharp, stabbing pain in the chest

  • Rapid breathing or shortness of breath (dyspnea)

  • Turning blue, known as cyanosis

  • A rapid heart rate

  • Low blood pressure

  • Lung expansion on one side

  • A hollow sound if you tap on the chest

  • An enlarged jugular vein

  • Anxiety

  • Fatigue

Causes

Traumatic pneumothorax

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

Here are some types of injuries that can cause traumatic pneumothorax:

  • Trauma to the chest from a motor vehicle accident

  • Broken ribs

  • A blow to the chest during a contact sport, like football tackle

  • A stab or bullet wound to the chest

  • Accidental damage during a medical procedure like a central line placement, ventilator use, lung biopsies, or CPR

  • Diving, flying, or being at high altitude due to air pressure changes

  • Quick treatment of pneumothorax due to chest trauma is critical as it can lead to fatal complications like cardiac arrest, - Respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax is called spontaneous, as it does not result from trauma.

When primary spontaneous pneumothorax happens, there’s no clear reason why it occurs. It’s more likely to happen:

  • In people who smoke

  • During pregnancy

  • In people with Marfan syndrome

  • In those with a family history of pneumothorax

  • In an otherwise healthy person with a tall, thin body

Secondary spontaneous pneumothorax can happen if a person has:

  • A form of COPD, including emphysema and chronic bronchitis

  • Acute or chronic infection, like tuberculosis or pneumonia

  • Lung cancer

  • Cystic fibrosis

  • Asthma

  • Severe acute respiratory distress syndrome (ARDS)

  • Idiopathic pulmonary fibrosis

  • Collagen vascular disease

  • Inhaling drugs like cocaine or marijuana can also trigger it.

Tension pneumothorax

Tension pneumothorax is not a classification of pneumothorax but a term that reflects the severity of pneumothorax. You may experience it if you have:

  • A blow to the chest

  • A penetrating injury

  • Changes in pressure when diving, flying, or mountaineering

  • A spontaneous pneumothorax progressing to a tension type

  • Some medical procedures

Risk factors

Risk factors for a traumatic pneumothorax include:

  • Contact sports, like football or hockey

  • Employment where there’s a risk of falls or other types of injury

  • Having a medical procedure that involves the chest or lung area

  • Ongoing assisted respiratory care

The people at highest risk of a nontraumatic pneumothorax include those who:

  • Have a history of smoking

  • Have an existing lung condition, like asthma or COPD

  • Have a family history of pneumothorax, which may indicate genetic factors

  • Have tall, slim bodies,at the top of the lung

  • Have inflammation in the small airways

Complications

  • Respiratory failure or inability to breathe

  • Pulmonary edema following treatment for pneumothorax

  • Pneumohemothorax, when blood enters the chest cavity

  • Pneumopericardium, when air enters the cavity around the heart

  • Pneumoperitoneum, when are enters the space around the abdomen

  • Bronchopulmonary fistula, when a passageway opens between the lungs and the space around them

  • Heart attack

Diagnosis

  • An X-ray

  • A CT scan

  • A thoracic ultrasound

Treatment

Observation

  • If pneumothorax results from a small injury, it may heal without treatment within a few days.

  • Check with a doctor before flying or diving after pneumothorax.

  • If you’re having trouble breathing, you may need oxygen.

  • Using oxygen can also help speed the rate at which the lungs reabsorb air from the cavity.

Draining excess air

  • If the damage is significant or symptoms are severe, a surgeon may need to remove the air or carry out surgery.

  • Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. These can be done at the bedside without requiring general anesthesia.

  • In needle aspiration, the doctor inserts a needle into the cavity and extracts the air using a syringe.

  • For a chest tube insertion, the doctor will insert a hollowed tube between your ribs. This allows air to drain and the lung to reinflate. The tube may remain in place for 2 to 5 days or longer.

Surgery

  • The doctor may need to carry out a more invasive procedure to see what’s happening in your lungs, like a thoracotomy or thoracoscopy.

  • During a thoracotomy, your surgeon will create an incision in the pleural space to help them see the problem.

  • During a thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), the doctor inserts a tiny camera through the chest wall to examine the lung.

  • If you’ve had repeated episodes of pneumothorax, you may need a small operation to repair any weak areas in the lung where the air is getting through.

  • The doctor may also carry out pleurodesis, in which they stick the lung to the inside of the chest wall.

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