Definition

A pneumothorax is air in the space between the lungs and the chest wall. This air bubble puts can push down on the lungs. A small amount of air may not cause symptoms. More air will make it hard to breathe and collapse part of the lung.

Causes

The air leak happens because of damage to the chest wall, lungs, or muscle under the lungs. Types of pneumothorax are based on causes:

• Primary spontaneous pneumothorax—Cause is not clear. Genes may play a role.
• Secondary spontaneous pneumothorax—May be caused by lung disease, injury, or use of machine to help you breathe.
• Tension pneumothorax—Caused by trauma to the lungs, ribs and chest muscles.
• Catamenial pneumothorax (women only)—Caused by small holes in the muscle under the lungs. It is linked to the menstrual cycle. Often linked to endometriosis.

Rib Fractures With Pneumothorax

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Risk Factors

Primary spontaneous pneumothorax is more common in tall, thin, young men.

The risk of primary spontaneous pneumothorax is higher with:

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

The risk of secondary spontaneous pneumothorax is higher with:

• Lung diseases such as:
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • Cystic fibrosis
  • Tuberculosis
  • Pertussis
  • Lung cancer
  • Interstitial lung disease
• Connective tissue diseases, such as rheumatoid arthritis, Marfan syndrome, or scleroderma

The risk of tension pneumothorax is higher with:

• Trauma to the chest
• Having a medical or surgical procedure
• Mechanical ventilation—machine to help you breathe

Symptoms

Pneumothorax may not cause symptoms if it is small. Larger pneumothorax can cause:

• 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 past health. A physical exam will be done. The doctor will listen to breath sounds. A diagnosis may be made based on sounds and symptoms.

Images of the chest will be done. It will show how large the air leak is. Image tests may include:

• Chest x-ray
• CT scan
• Ultrasound

Treatment

Treatment will depend on the size of the pneumothorax. A small injury may heal on its own. Tests may be done to make sure the area has healed.

Larger problems will need care. The goal of treatment is to take out the extra air and let the lung open again.

Follow-up is an important part of the 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 pneumothorax include:

• Wear a seatbelt when in a motor vehicle. This may prevent trauma to your chest.
• Stop smoking.