Definition of Pneumothorax
A pneumothorax (noo-mo-THOR-acks) is a collapsed lung. Pneumothorax occurs when air leaks into the space between your lungs and chest wall. This air pushes on the outside of your lung and makes it collapse. In most cases, only a portion of the lung collapses.
A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures involving your lungs, or damage from underlying lung disease. Or it may occur for no obvious reason. Symptoms usually include sudden chest pain and shortness of breath.
A small, uncomplicated pneumothorax may quickly heal on its own. When the pneumothorax is larger, doctors usually insert a flexible tube or needle between your ribs to remove the excess air.
Symptoms of Pneumothorax
The main symptoms of a pneumothorax include sudden chest pain and shortness of breath. But these symptoms can be caused by a variety of health problems, and some can be life-threatening. If your chest pain is severe or breathing becomes increasingly difficult, get immediate emergency care.
Pneumothorax can be caused by:
- Chest injuries. Any blunt or penetrating injury to your chest can cause lung collapse. Some injuries may happen during physical assaults or car crashes, while others may inadvertently occur during medical procedures that involve the insertion of a needle into the chest.
- Underlying lung diseases. Damaged lung tissue is more likely to collapse. Lung damage can be caused by many types of underlying diseases, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and pneumonia.
- Ruptured air blisters. Small air blisters (blebs) can develop on the top of your lung. While not considered to be a disease of the lungs, these blebs sometimes burst — allowing air to leak into the space that surrounds the lungs.
- Mechanical ventilation. A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely and the heart may be squeezed to the point that it can’t work properly.
Risk factors for pneumothorax include:
- Your sex. In general, men are far more likely to have a pneumothorax than are women.
- Smoking. The risk increases with the length of time and the number of cigarettes smoked, even without emphysema.
- Age. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is a very tall and underweight man.
- Genetics. Certain types of pneumothorax appear to run in families.
- Lung disease. Having an underlying lung disease — especially chronic obstructive pulmonary disease (COPD) — makes a collapsed lung more likely.
- Mechanical ventilation. People who need mechanical ventilation to assist their breathing are at higher risk of pneumothorax.
- A history of pneumothorax. Anyone who has had one pneumothorax is at increased risk of another, usually within one to two years of the first episode.
Complications of Pneumothorax
Many people who have had one pneumothorax can have another, usually within one to two years of the first. Air may sometimes continue to leak if the opening in the lung won’t close. Surgery may eventually be needed to close the air leak.
Tests and diagnosis
A pneumothorax is generally diagnosed using a chest X-ray. In some cases, computerized tomography (CT) scan may be needed to provide more detailed images. CT scanners combine X-ray images taken from many different directions to produce cross-sectional views of internal structures.
Treatments and drugs
The goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to re-expand, and to prevent recurrences. The best method for achieving this depends on the severity of the lung collapse and sometimes on your overall health.
If only a small portion of your lung is collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the air is completely absorbed and your lung has re-expanded. Normally this takes a week or two. Supplemental oxygen can speed the absorption process.
Needle or chest tube insertion
If a larger area of your lung has collapsed, it’s likely that a needle or chest tube will be used to remove the air. The hollow needle or tube is inserted between the ribs into the air-filled space that is pressing on the collapsed lung. With the needle, a syringe is attached so that the doctor can pull out the excess air — just like a syringe is used to pull blood from a vein. Chest tubes are often attached to a suction device that continuously removes air from the chest cavity.
If a chest tube doesn’t resolve your problem, surgery may be necessary to close the air leak. In most cases, the surgery can be performed through small incisions, using a tiny fiber-optic camera and narrow, long-handled surgical tools. The surgeon will look for the leaking bleb and sew it closed. In some cases, a substance like talc may be blown in through the tube to irritate the tissues around the lung so that they’ll stick together and seal any leaks. Rarely, the surgeon will have to make a larger incision between the ribs to get better access to multiple or larger air leaks.