Collapsed Lung

What is a collapsed lung?

A collapsed lung, or a pneumothorax, occurs when air from your lung leaks into your chest cavity. The build up of air in the space between the lung and the chest wall puts pressure on your lung, causing it to collapse.

Pneumothorax can occur for many reasons.

• Blunt trauma to the chest causing a rib fracture
• Blunt injury to the chest, like a fall or car accident, pushing the air out of the lungs
• Damage of lung tissue from diseases such as COPD, asthma, cystic fibrosis or pneumonia
• Penetrating injury to the chest, like a stab wound or gunshot
• Smoking cigarettes and marijuana
• Spontaneously

What a collapsed lung looks like

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 condition. It is a life-threatening emergency and requires immediate medical attention. If your diagnosis is tension pneumothorax, the air outside your lung has no place to escape. Instead, it continues to increase and causes pressure on vital organs, such as your heart. This eventually will cause your vital organs to shut down and stop working.

Tension pneumothorax requires immediate medical attention as it can be fatal. The chest cavity needs decompression, or releasing of pressure, immediately. We then place a chest tube between your ribs to your lung to help you recover.

Symptoms of a collapsed lung

 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
• 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. It creates pictures of the inside of your body to better check your lungs and surrounding organs.

Treatment of pneumothorax

Your treatment will depend on your symptoms and how small or large the pocket of air outside your lungs are.

• Small Pneumothorax - If your pneumothorax is small, your doctor might treat you by giving you oxygen and observing you. 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. Often your doctor will admit you to the hospital for observation. This allows us to treat you quickly if your condition worsens.
• Larger pneumothorax - If your pneumothorax is large or causing symptoms, your doctor will need to intervene. He of she will remove the air that has collected outside of your lung. Although we can do this in a few different ways, a chest tube is the most common. Placing your chest tube involves your doctor making a small hole between your ribs where we insert the tube. The tube provides an escape valve for the air trapped in your chest cavity. The tube will stay in your chest for a few days, or more, until air is no longer leaking out of the lung. You will need to stay in the hospital while this tube is in your chest. Before discharge from the hospital, we will want to have a chest x-ray and a physical examination.

Surgery for pneumothorax

In cases where a chest tube doesn’t work, your doctor might need to do lung surgery to close off the air leak. We call this surgery “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 surgery to treat your condition, your doctor might do another procedure at the same time. These two procedures can help prevent a future pneumothorax.

• Pleurodesis – This is a procedure that creates inflammation in the inside lining of your chest wall. The lung becomes large enough to stick and adhere to the chest wall. This prevents your lung from collapsing again. Your doctor might recommend this procedure you have had more than 1 pneumothorax. Having more than ones puts you at higher risk of having it happen again in the future.
• Bleb Resection – A bleb is an abnormal part of the lung that can rupture and cause a pneumothorax. Tiny air sacs make up your lung tissue. In certain lung and connective tissue diseases, these tiny air sacs combine and form a larger bubble or a bleb. If we find blebs during surgery, we will remove them to prevent repeat rupturing.

Recovery after a Pneumothorax:

After surgery you will have a chest tube placed. It will stay in for several days to a week, depending on your healing process. To ensure we placed your tube in the most optimal location for your lung, we will give you x-rays and an examination. You will need to stay in the hospital while the chest tube is in place. After removal of you chest tube and before you go home, your doctor will confirm that your lung has not re-collapsed. We give you instructions on breathing exercises, called incentive spirometry. These help expand your lungs and dialate your air sacs. This will help prevent pneumonia.

If you smoke, you should stop smoking. Smoking can increase your chance of getting pneumothorax. Smoking cessation will help your body recovery more completely. It will also help with your wound healing treatment.

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 using this transportation. Flying in an airplane or traveling to areas where the elevation is higher than 8000ft are dangerous. The pressure change can cause your lung to re-collapse if it is not yet healed.