Pneumothorax

Pneumothorax

Pneumothorax is commonly called a collapsed lung. It is a condition in which air leaks from a lung and builds up between the thin layer of tissue that covers the lungs (visceral pleura) and the interior wall of the chest cavity (parietal pleura).

The air gets trapped outside the lung, between the lung and the chest wall (pleural space). The air takes up space and prevents the lung from fully expanding.

Pneumothorax is gas within the pleural space; this occurs either through a communication between the outside world and the pleural space via a defect in the chest wall or through a communication between the gas-containing bronchi or alveoli and the pleural space via a defect in the visceral pleura.

Free intrapleural gas preferentially moves to the nondependent aspects of the pleural spaces (apicolateral location on upright chest radiography and basilar or anteromedial location on supine chest radiography).

Pneumothorax sometimes occurs suddenly with no apparent cause. The buildup of air may be small or large. A small pneumothorax may go away on its own. A large pneumothorax will require treatment and hospitalization.

What are the causes?

This condition may be caused by:

  • Trauma and injury to the chest wall.
  • Surgery and other medical procedures.
  • A complication of an underlying lung problem, especially chronic obstructive pulmonary disease (COPD) or emphysema.

Sometimes the cause of this condition is not known.

What increases the risk?

You are more likely to develop this condition if:

  • You have an underlying lung problem.
  • You smoke.
  • You are 20-40 years old, male, tall, and underweight.
  • You have a personal or family history of pneumothorax.
  • You have an eating disorder (anorexia nervosa).

This condition can also happen quickly, even in people with no history of lung problems.

What are the symptoms of Pneumothorax?

Sometimes a pneumothorax will have no symptoms. When symptoms are present, they can include:

  • Chest pain.
  • Shortness of breath.
  • Increased rate of breathing.
  • Bluish color to your lips or skin (cyanosis).

How is Pneumothorax diagnosed?

This condition may be diagnosed by:

  • A medical history and physical exam.
  • A chest X-ray, chest CT scan, or ultrasound.

How is Pneumothorax treated?

Treatment depends on how severe your condition is. The goal of treatment is to remove the extra air and allow your lung to expand back to its normal size.

  • For a small pneumothorax:
    • No treatment may be needed.
    • Extra oxygen is sometimes used to make it go away more quickly.
  • For a large pneumothorax or a pneumothorax that is causing symptoms, a procedure is done to drain the air from your lungs. To do this, a health care provider may use:
    • A needle with a syringe. This is used to suck air from a pleural space where no additional leakage is taking place.
    • A chest tube. This is used to suck air where there is ongoing leakage into the pleural space. The chest tube may need to remain in place for several days until the air leak has healed.
  • In more severe cases, surgery may be needed to repair the damage that is causing the leak.
  • If you have multiple pneumothorax episodes or have an air leak that will not heal, a procedure called a pleurodesis may be done. A medicine is placed in the pleural space to irritate the tissues around the lung so that the lung will stick to the chest wall, seal any leaks, and stop any buildup of air in that space.

If you have an underlying lung problem, severe symptoms, or a large pneumothorax you will usually need to stay in the hospital.

Follow these instructions at home:

Lifestyle

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These are major risk factors in pneumothorax. If you need help quitting, ask your health care provider.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
  • Avoid activities that take a lot of effort (strenuous) for as long as told by your health care provider.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do not fly in an airplane or scuba dive until your health care provider says it is okay.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If a cough or pain makes it difficult for you to sleep at night, try sleeping in a semi-upright position in a recliner or by using 2 or 3 pillows.
  • If you had a chest tube and it was removed, ask your health care provider when you can remove the bandage (dressing). While the dressing is in place, do not allow it to get wet.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You cough up thick mucus (sputum) that is yellow or green in color.
  • You were treated with a chest tube, and you have redness, increasing pain, or discharge at the site where it was placed.

Get help right away if:

  • You have increasing chest pain or shortness of breath.
  • You have a cough that will not go away.
  • You begin coughing up blood.
  • You have pain that is getting worse or is not controlled with medicines.
  • The site where your chest tube was located opens up.
  • You feel air coming out of the site where the chest tube was placed.
  • You have a fever or persistent symptoms for more than 2–3 days.
  • You have a fever and your symptoms suddenly get worse.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • A pneumothorax, commonly called a collapsed lung, is a condition in which air leaks from a lung and gets trapped between the lung and the chest wall (pleural space).
  • The buildup of air may be small or large. A small pneumothorax may go away on its own. A large pneumothorax will require treatment and hospitalization.
  • Treatment for this condition depends on how severe the pneumothorax is. The goal of treatment is to remove the extra air and allow the lung to expand back to its normal size.