What Is Pneumothorax?
Pneumothorax is the medical term for a collapsed lung. Pneumothorax occurs when air becomes trapped in the space around the lungs—the pleural space. This can cause the lung to collapse and put pressure on the heart.
The condition ranges in severity. Small pneumothoraxes without complication can heal on their own in many cases. More serious cases that involve large volumes of trapped air can become fatal if left untreated. 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.
One or both lungs can collapse after a chest injury or as a result of underlying lung disease. People who participate in sports such as mountain climbing or SCUBA diving can experience pneumothorax due to changes in altitude. The abrupt change of air pressure can cause air blisters to develop on your lungs and then rupture. The ruptured blisters, called blebs, causes your lung to collapse.
Sometimes the cause of pneumothorax is unknown.
Types of Pneumothorax
There are two basic types of pneumothorax: traumatic pneumothorax (TP) and non-traumatic pneumothorax (NTP).
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
- hard hit to the chest from contact sport (e.g. football tackle)
- stab wound to the chest
- medical procedures that damage the lung (e.g. insertion of chest tubes, ventilator use, lung biopsies, and the administration of CPR)
Swift treatment of TP is critical. Symptoms are often severe, and could contribute to potentially fatal complications such as cardiac arrest, respiratory failure, and shock.
NTP does not occur after injury. Instead, it happens spontaneously. There are two major types of NTP:
- primary spontaneous pneumothorax (PSP) occurs in individuals who have never been diagnosed with lung disease
- secondary spontaneous pneumothorax (SSP) occurs in individuals with known lung problems.
Some conditions that increase your risk of SSP include:
- chronic obstructive pulmonary disease (emphysema, chronic bronchitis)
- acute/chronic infection (tuberculosis , pneumonia)
- lung cancer
- cystic fibrosis (genetic lung disease that causes mucous build up in the lungs)
- asthma (chronic inflammatory obstructive airway disease)
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.
Risk factors for Pneumothorax
Risk factors differ between traumatic and non-traumatic types of pneumothorax.
Risk factors for TP include:
- playing hard contact sports (e.g. football)
- performing stunts that may cause damage to the chest
- history of violent fighting
People at highest risk for PSP are those who are:
- young and thin
- between the ages of 10 and 30
- affected by congenital disorders like Marfan’s syndrome
- exposed to environmental or occupational factors, such as silicosis
- changes in atmospheric pressure and severe weather changes(JThorac Dis)
The primary risk factor for SSP is having previously diagnosed lung disease. It is most common in individuals over 40.
Symptoms of Pneumothorax
Symptoms of TP may appear at the time of chest trauma or shortly after. The onset of NTP symptoms normally occurs when the person is at rest. A sudden attack of chest pain is typically the first symptom.
Other symptoms may include:
- steady ache in the chest
- shortness of breath (dyspnea)
- breaking out in a cold sweat
- tightness in the chest
- turning blue (cyanosis)
- severe tachycardia (fast heart rate)
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:
- upright posteroanterior chest radiograph
- computed tomography (CT)
- lung sonography
- thoracic ultrasound
Treatment for Pneumothorax
Treatment will depend on the severity of your condition. It will also depend on whether you have previously experienced pneumothorax.
Both surgical and nonsurgical treatments are available. Nonsurgical treatments include:
- bed rest
- oxygen supplementation
- needle aspiration
- chest tube insertion
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 re-expanded. You are instructed to rest to promote healing. Vigorous activity might hinder 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.
Needle aspiration and chest tube insertion are two non-surgical treatments designed to “drain” 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. If a large area of your lung has collapsed, the chest tube may remain installed for a few days.
Pleurodesis is a more invasive form of treatment for pneumothorax. This procedure is used to both treat and prevent recurrences of a collapsed lung. Pleurodesis essentially destroys the pleural space so that air and fluids can no longer accumulate. The term “pleura” refers to the membrane that contains 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 healthcare provider will deliver chemical irritants to the pleura through a chest tube. The irritation and inflammation causes the pleura to stick together (LAM Foundation).
Surgical treatment for pneumothorax is required in certain situations. You may need surgery if you have 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. They include:
- thoracotomy—an incision into the pleural space
- simple thoracoscopy—insertion of a small scope through the chest wall
- lobectomy—removal of part of the lung
Thoracotomy is the incision into the chest wall. Once your surgeon has performed a thoracotomy, they will decide what must be done to help you heal. Thoracoscopy is the use of a tiny camera to see inside your chest. Surgical treatment for pneumothorax can include sewing blisters closed, closing air leaks, or removing the collapsed portion of your lung. This is called a lobectomy.
Long-Term Outlook After Pneumothorax
Your long-term outlook depends on the speed at which 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. If your symptoms recur, seek medical attention as quickly as possible.