Appointment Center (303) 436-4949

 

Pneumothorax

Definition

Pneumothorax is a condition in which air collects in the space between the lungs and the chest wall. This air pocket puts pressure on the lung. The pressure can collapse a part of the lung.

Causes  ^

The chest cavity should be a sealed chamber. Air can leak into the chamber if there is damage to lung tissue, the chest wall or the diaphragm. The diaphragm is a large muscle that sits under the lungs. It separates the abdomen and chest cavity.

The air creates a pocket in the chest cavity. When it becomes large enough it will collapse a section of lung. Some may only affect a small area, others may be life-threatening.

Causes may vary based on the type of pneumothorax, for example:

  • Primary spontaneous pneumothorax—Cause is not clear. Your genes may play a role.
  • Secondary spontaneous pneumothorax—Air leaks in through damaged lung tissue. May be caused by lung disease, injury, or mechanical ventilation.
  • Tension pneumothorax—Caused by trauma to the lungs and/or ribs and chest muscles. This is the most serious type. The collapse happens quickly and involves a larger area of lung. It may make it hard for the heart to pump blood.
  • Catamenial pneumothorax (women only)—Caused by small holes in the diaphragm. Occurs within 72 hours of start or end of menstrual cycle. It is most often happens with endometriosis.

Rib Fractures With Pneumothorax
BN00065

Copyright © Nucleus Medical Media, Inc.

Risk Factors  ^

Primary spontaneous pneumothorax is more common in:

  • Tall, thin young men
  • Teenagers up to the age of 30

Factors that may increase your chance of primary spontaneous pneumothorax may include:

  • Smoking
  • Scuba diving and high-altitude flying
  • Poor nutrition resulting from anorexia nervosa

Conditions that increases your risk of secondary spontaneous pneumothorax include:

Factors that may increase your chance of tension pneumothorax include:

  • Penetrating or blunt force trauma to the chest
  • Having a medical or surgical procedure
  • Mechanical ventilation

Symptoms  ^

Pneumothorax may not cause symptoms if it is small. If they do occur, symptoms include:

  • Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
  • Acute shortness of breath
  • Cough
  • Tightness in the chest
  • Rapid heartbeat
  • Bluish color of the skin due to a lack of oxygen
  • Flaring of the nostrils
  • Feelings of anxiety, stress, and tension

Those with lung disease should be aware of these symptoms. Get help as soon as symptoms arise.

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may be able to hear reduced or absent breath sounds on the affected side. The level of oxygen in your blood may be monitored with pulse oximetry.

Images of your chest, heart, and lungs, will be needed. Your doctor may order one or more of the following:

Treatment  ^

Treatment will depend on how much of the lung is involved. The goals of treatment are to remove the excess air and let the lung fully expand again.

Oxygen may be given if you are having trouble breathing. It may also help speed up removal of air.

Treatment options include:

Observation

If only a small area of the lung is involved, it may resolve on its own. The progress will be monitored by the doctor. X-rays will show when the lung has fully expanded again.

Removing Air

The excess air may need to be removed. It may be needed for a large pneumothorax. This will be done urgently for a tension pneumothorax.

The excess air may be pulled out of the chest with a needle. Once the air is removed, the needle can be removed.

A chest tube may be needed for large collapse. It may also be needed for a pneumothorax that has problems before or after needle procedure. The tube will be placed through the chest wall. It will stay in place to let air drain until the lung has fully expanded. The tube may be needed for several days.

Sclerosing agent

This method may be needed if the area has not fully healed and surgery is not wanted. An agent is put into the space between the chest wall and the lung. It will help the sides stick together so that more air cannot enter.

Surgery

Surgery may be needed if air leaks continue. It may also be done to stop some types of pneumothorax from happening again. Surgery may include:

  • Removal of weak spots that are allowing air to leak out of the lungs
  • Closing the space between the lung and chest wall—called pleural abrasion or pleurodesis
  • Removing part or all of the lining that sticks to the chest wall—pleurectomy
  • Removing any lung lesions

Follow-up is an important part of any pneumothorax treatment plan. More than half of people with a pneumothorax will have another one.

Prevention  ^

Prevention will depend on the cause. Steps to help reduce your risk of some pneumothoraxes include:

  • Wear a seatbelt when in a motor vehicle. This may prevent trauma to your chest.
  • Stop smoking.
  • If you have a history of pneumothorax, it is often recommended that you avoid:
    • Scuba diving
    • Travel on planes (not always limited)
RESOURCES:

American College of Chest Physicians
http://www.chestnet.org

American Thoracic Society
http://thoracic.org

CANADIAN RESOURCES:

The Canadian Lung Association
http://www.lung.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Catamenial pnuemothorax. National Organization for Rare Disorders website. Available at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1227/printFullReport. Updated February 14 2012. Accessed August 24, 2017.

Pneumothorax. Merck Manual website, Professional Version. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax. Updated September 2014. Accessed August 24, 2017.

Pneumothorax - emergency management. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T913035/Pneumothorax-emergency-management. Accessed August 24, 2017.

Spontaneous pneumothorax in children. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T306335/Spontaneous-pneumothorax-in-children. Updated January 11, 2016. Accessed August 24, 2017.

Spontaneous pneumothorax in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114714/Spontaneous-pneumothorax-in-adults. Updated June 19, 2017. Accessed August 24, 2017.

Tension pneumothorax. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115634/Tension-pneumothorax. Updated January 151, 201t. Accessed August 24, 2017.

Last reviewed September 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 8/25/2017

Original text