Good Samaritan Medical Center

Pneumothorax

Pneumothoraxis a condition in which air in the lungs leaks into the chest cavity. This is a common complication of blunt trauma to the chest, often sustained from a fractured rib. Sometimes people can have a collapsed lung without rib fractures, when the force of the impact on the chest forces air out of the lung.

Learn about what caused collapsed lungs, what the symptoms are and your surgical options for treatment.

What is a pneumothorax?

Pneumothorax is the medical term for a collapsed lung. This happens when air from the lung escapes out of the lung and builds up in the space between the lung and the chest wall (called the Pleural space); this puts pressure on the lung and causes it to collapse.

Pneumothorax can also occur without injury due to damage of the lung tissue from diseases such as COPD (chronic obstructive pulmonary disease), asthma, cystic fibrosis, and pneumonia. Pneumothorax can also occur spontaneously in certain people.

INSERT IMAGE

The lungs sit in the chest, inside the ribcage. They are covered with a thin membrane called the “pleura.” The windpipe (or trachea) branches into smaller airways. In this drawing, 1 lung is normal, and 1 has collapsed because air has leaked out of it. The air that has leaked out of the lung (shown in blue) has filled the space outside of the lung.

Reproduced with permission from: Patient Information: Pneumothorax (collapsed lung) (The Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.

Tension pneumothorax

Tension pneumothorax is a severe form of a pneumothorax that is a life-threatening emergency and requires immediate medical attention. The lung is collapsed, and there is air outside of the lung. The air outside of the lung continues to increase (without any place for the air to escape) causing an increased pressure inside the chest which puts pressure on the heart and vital organs, causing them to shut down and stop working.

Immediate medical attention is required as this can be fatal. The chest needs to be decompressed (pressure released) immediately and then a chest tube will be placed.

Causes of a pneumothorax:

  • Chest injury, either blunt impact (such as from a fall or a car accident) or a penetrating (stab wound or gunshot wound)
  • Certain lung diseases: COPD, cystic fibrosis, asthma, pneumonia
  • Spontaneous pneumothorax can occur in certain people who have no known lung condition or injury,and can happen in young men or teenagers who have a tall/ slender build.
  • Smoking cigarettes and marijuana can increase a person's risk of pneumothorax

Symptoms of Pneumothorax:

*You should seek medical attention immediately if you have any of these symptoms.

  • Shortness of breath, or difficulty taking a full breath; may be mild to severe depending on the degree of lung that is collapsed
  • Sudden, sharp, sometimes stabbing chest pain or chest tightness

People with a small pneumothorax might not have any symptoms. They might find out that they have it when they have a chest X-ray for another reason.

Testing for a pneumothorax:

Your doctor or nurse will ask about your symptoms, do an exam, and do a chest X-ray.

He or she might also do a CT scan. A CT scan is an imaging test that can create pictures of the inside of the body to better evaluate the lungs and surrounding organs.

Treatment of pneumothorax:

Your treatment will depend on your symptoms and how small or big your pneumothorax is.

  • Small Pneumothorax - If your pneumothorax is small, your doctor might treat you by giving you oxygen and following your condition. That’s because a small pneumothorax sometimes will get better on its own. To follow your condition, your doctor might do a few chest X-rays over time. You will most likely be observed in the hospital in order to provide quick treatment if the pneumothorax gets larger.
  • Larger pneumothorax -If your pneumothorax is large or causing symptoms, your doctor will need to remove the air that has collected outside of your lung. He or she can do this in different ways. It usually involves having your doctor make a small hole in between your ribs, and he or she will put a tube (this is called a Chest Tube) through the hole and into the collection of air. The chest tube will stay in your chest for a few days, or more, until air is no longer leaking out of the lung. It will be followed by Chest X-rays and examination. You will need to stay in the hospital while this tube is in your chest.

Surgery for Pneumothorax:

If the chest tube doesn’t work, your doctor might need to do lung surgery to close off the air leak. This surgery is called“thoracoscopy or VATS (Video-assisted Thoracic Surgery).”During thoracoscopy, the doctor will give you medicine to make you sleep. Then he or she will make 2 or 3 small cuts between the ribs in your chest. He or she will put long, thin tools in these openings and into the space where the air collected. One of the tools has a camera on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to do the surgery.

If you need thoracoscopy to treat your pneumothorax, your doctor might do another surgical procedure during thoracoscopy to help prevent a future pneumothorax; this could be aPleurodesisorBlebresection.

  • Pleurodesis– This is a procedure that creates inflammation in the inside lining of the chest wall, which causes the lung to stick and adhere to the chest wall to prevent the lung from collapsing again. He or she might also do this procedure if your air leak stopped quickly, but you have had more than 1 pneumothorax, because you are at higher risk of having it happen again in the future.
  • Bleb Resection– This means removal of an area of the lung called a Bleb. A Bleb is an abnormal part of the lung that can rupture and cause a pneumothorax. Your lung tissue is made up of tiny air sacs; in certain diseases of the lung and connective tissue in the body, these tiny air sacs can join together and form a larger bubble (a bleb). If these are found during surgery they will be removed to prevent it from rupturing again.

Recovery after a Pneumothorax:

You will have a chest tube in place after surgery, this will stay in for several days and will be followed with X-rays and examination. You will need to stay in the hospital while the chest tube is in place. Once the chest tube is removed, the doctors will confirm that the lung has not re-collapsed (with another X-ray) before you will be sent home. You will be given instructions on breathing exercises (called Incentive Spirometry) to help expand your lungs and to help prevent pneumonia.

If you smoke, you should stop smoking. This can help lower your chance of getting another pneumothorax and will help with your overall recovery and your wound healing.

**You should also ask your doctor when you can fly in an airplane again. You will generally need to wait at least 2 weeks, and up to 12 weeks, before flying in an airplane or traveling to areas of elevation higher than 8000ft, as these altitude and pressure changes can cause the lung to re-collapse if the lung is not yet healed.

Learn more about pneumothorax.

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