Pneumothorax

(Collapsed Lung)

What is a pneumothorax?
A pneumothorax is a collection of free air in the chest outside the lung that causes the lung to
collapse.

What are the types of pneumothorax?

A spontaneous pneumothorax, also referred to as a primary pneumothorax, occurs in the
absence of a traumatic injury to the chest or a known lung disease. A secondary (also termed
complicated) pneumothorax occurs as a result of an underlying condition.

What causes a pneumothorax?

Spontaneous pneumothorax is caused by a rupture of a cyst or a small sac (bleb) on the
surface of the lung. Pneumothorax may also occur following an injury to the chest wall such as a
fractured rib, any penetrating injury (gun shot or stabbing), surgical invasion of the chest, or may
 be deliberately induced in order to collapse the lung. A pneumothorax can also develop as a
result of underlying lung diseases, including cystic fibrosis,chronic obstructive pulmonary
disease (COPD), lung cancer, asthma, and infections of the lungs.

Who is at risk for pneumothorax?

Spontaneous pneumothorax affects about 9,000 persons each year in the U.S. who have no
history of lung disease. This type of pneumothorax is most common in men between the ages of
20 and 40, particularly in tall, thin men. Smoking has been shown to increase the risk for
spontaneous pneumothorax.

What is tension pneumothorax?

In some instances, the lung continues to leak air into the chest cavity and results in
compression of the chest structures, including vessels that return blood to the heart. This is
referred to as a tension pneumothorax and can be fatal if not treated immediately.

What are the signs and symptoms of pneumothorax?

Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is
sharp and may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate,
rapid breathing, cough, andfatigue are other symptoms of pneumothorax. The skin may develop
a bluish color (termed cyanosis) due to decreases in blood oxygen levels.

How is pneumothorax diagnosed?

Examination of the chest with a stethoscope reveals decreased or absent breath sounds over
the affected lung. The diagnosis is confirmed by chest x-ray.

How is a pneumothorax treated?

A small pneumothorax without underlying lung disease may resolve on its own in one to two
weeks. A larger pneumothorax and a pneumothorax associated with underlying lung disease
often require aspiration of the free air and/or placement of a chest tube to evacuate the air.
Possible complications of chest tube insertion include pain, infection of the space between the
lung and chest wall (the pleural space), hemorrhage (bleeding), fluid accumulation in the lung,
and low blood pressure (hypotension). In some cases, the leak does not close on its own. This
is called a bronchopleural fistula, and may require chest surgery to repair the hole in the lung.

What is the outcome (prognosis) of pneumothorax?

The outcome of pneumothorax depends upon the extent and type of pneumothorax. A small
spontaneous pneumothorax will generally resolve on its own without treatment. A secondary
pneumothorax associated with underlying disease, even when small, is much more serious and
carries a 15% mortality (death) rate. A secondary pneumothorax requires urgent and immediate
treatment. Having one pneumothorax increases the risk of developing the condition again.
Therecurrence rate for both primary and secondary pneumothorax is about 40%; most
recurrences occur within 1.5 to two years.

Pneumothorax At A Glance

 A pneumothorax is a collection of free air in the chest that causes the lung to collapse.
 Pneumothorax may occur on its own in the absence of underlying disease; this is termed
spontaneous pneumothorax.
  Pneumothorax may also occur as a consequence of an injury or underlying lung
disease.
 A small spontaneous pneumothorax may resolve without treatment; a pneumothorax
arising as a result of lung disease or injury requires immediate treatment.
 Treatment may include insertion of a chest tube or aspiration of the free air in the chest
cavity.
 A pneumothorax (a term for collapsed lung) occurs when air leaks into the
space between your lungs and chest wall, creating pressure against the lung.
Depending on the cause of the pneumothorax, your lung may only partially
collapse, or it may collapse completely.
 A pneumothorax can be caused by a chest injury, certain medical procedures
involving your lung, lung disease, or it may occur for no obvious reason.
 A small, uncomplicated pneumothorax may quickly heal on its own, but when
the pneumothorax is larger, the excess air is usually removed by inserting a
tube or needle between your ribs and slowly removing the air over a few
days.

Signs and symptoms of a pneumothorax usually include:

 Sudden, sharp chest pain on the same side as the affected lung — this pain
doesn't occur in the center of your chest under the breast bone

 Shortness of breath, which may be more or less severe, depending on how

much of your lung is collapsed

 A feeling of tightness in your chest

 A rapid heart rate

If only a small amount of air enters the space between your lungs and your chest
wall (pleural space), you may have few signs or symptoms. However, even a
slightly collapsed lung is likely to cause some chest pain and some shortness of
breath that slowly improves over a few hours to a day or so, even if there is no
reduction in the size of the collapse.

When to see a doctor 

See your doctor right away if you have sudden chest pain and trouble breathing of
any kind. Many conditions other than pneumothorax can cause these symptoms,
and most require an accurate diagnosis and prompt treatment. If your chest pain is
severe or breathing becomes increasingly difficult, get immediate emergency care.

Causes
By Mayo Clinic staff

Your lungs and chest wall are both elastic. As you inhale and exhale, your lungs
recoil inward while your chest wall expands outward. The two opposing forces
create a negative pressure in the space between your rib cage and lung. When air
 enters that space, either from inside or outside your lungs, the pressure it exerts
can cause all or part of the affected lung to collapse.

There are several types of pneumothorax, defined according to what causes them:

 Primary spontaneous pneumothorax. Primary spontaneous

pneumothorax is thought to develop when a small air blister (bleb) on the top of
the lung ruptures. Blebs are caused by a weakness in the lung tissue and can
rupture from changes in air pressure when you're scuba diving, flying, mountain
climbing or, according to some reports, listening to extremely loud music.
Additionally, a primary spontaneous pneumothorax may occur while smoking
marijuana, after a deep inhalation, followed by slow breathing out against partially
closed lips that forces the smoke deeper into the lungs. But most commonly, blebs
rupture for no obvious reason.

Genetic factors may play a role in primary spontaneous pneumothorax because this
condition may run in families. A primary spontaneous pneumothorax is usually mild
because pressure from the collapsed portion of the lung may in turn collapse the
bleb.

 Secondary spontaneous pneumothorax. This develops in people who

already have a lung disorder, especially emphysema, which progressively damages
your lungs. Other conditions that can lead to secondary spontaneous pneumothorax
include tuberculosis, pneumonia, cystic fibrosis and lung cancer. In these cases, the
pneumothorax occurs because the diseased lung tissue is next to the pleural space.

Secondary spontaneous pneumothorax can be more severe and even life-

threatening because diseased tissue may open a wider hole, allowing more air into
the pleural space than does a small, ruptured bleb. Additionally, people with lung
disease already have reduced lung reserves, making any reduction in lung function
more serious. A secondary spontaneous pneumothorax almost always requires
chest tube drainage for treatment.

 Traumatic pneumothorax. Any blunt or penetrating injury to your chest

can cause lung collapse. Knife and gunshot wounds, a blow to the chest, even a
deployed air bag can cause a pneumothorax. So can injuries that inadvertently
occur during certain medical procedures, such as the insertion of chest tubes,
cardiopulmonary resuscitation (CPR), and lung or liver biopsies.

 Tension pneumothorax. The most serious type of pneumothorax, this

occurs when the pressure in the pleural space is greater than the atmospheric
pressure, either because air becomes trapped in the pleural space or because the
entering air is from a positive-pressure mechanical ventilator. The force of the air
can cause the affected lung to collapse completely. It can also push the heart
toward the uncollapsed lung, compressing both it and the heart. Tension
 pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated
quickly.

Risk factors
By Mayo Clinic staff

Risk factors for pneumothorax include:

 Your sex. In general, men are far more likely to have a pneumothorax than
women are, though women can develop a rare form of pneumothorax (catamenial
pneumothorax) related to the menstrual cycle.

 Smoking. This is the leading risk factor for primary spontaneous

pneumothorax. The risk increases with the length of time and the number of
cigarettes smoked.

 Age. Primary spontaneous pneumothorax is most likely to occur in people

between 20 and 40 years old, especially if the person is very tall and underweight.

 Lung disease. Having another lung disease, especially emphysema, makes

a collapsed lung more likely.

 A history of pneumothorax. If you've had one pneumothorax, you're at

increased risk of another, usually within one to two years of the first episode. This
may occur in the same lung or the opposite lung.

Complications
By Mayo Clinic staff

Possible complications from a spontaneous or traumatic pneumothorax include:

 Recurrence. Close to half the people who have had one pneumothorax have
another, usually within three years of the first.

 Persistent air leak. In spite of a functioning chest tube inserted to suction

the air out, air may sometimes continue to leak if the opening in the lung won't
close. After several days to a week or so, it may be necessary to surgically close
the air leak.

Complications of a tension pneumothorax are more serious and include:

 Low blood oxygen levels (hypoxemia). Because a tension pneumothorax

causes near or total collapse of one lung and can compress the other, you take in
less air and less oxygen enters your bloodstream. As a result, you develop lower
 than normal blood oxygen levels. Lack of oxygen can disrupt your body's basic
functioning, and severely low levels can be life-threatening.

 Cardiac arrest. If air continues to build up, the increasing pressure can
push your heart and blood vessels toward the uncollapsed lung, compressing both
your healthy lung and heart. A tension pneumothorax can interfere with the return
of blood to the heart and lead to a sudden loss of heart function. Cardiac arrest is
fatal if not treated immediately.

 Respiratory failure. This occurs when blood levels of oxygen fall too low,
and the level of carbon dioxide becomes too high. Severely low blood oxygen can
lead to heart arrhythmias and unconsciousness, and high carbon dioxide levels to
sleepiness, confusion and coma. Eventually, respiratory failure may prove fatal.

 Shock. This critical condition occurs when blood pressure drops so low that
the body's vital organs are deprived of oxygen and nutrients. Shock is a major
medical emergency and requires immediate care.

Tests and diagnosis

By Mayo Clinic staff

A pneumothorax is generally diagnosed using a chest X-ray. Other tests are

sometimes performed, including:

 Computerized tomography (CT) scan. CT is an X-ray technique that

produces more-detailed images than conventional X-rays do. This may be done if
your doctor suspects a pneumothorax after an abdominal or chest procedure. A CT
scan can help determine whether an underlying disease may have caused your lung
to collapse — something that may not show up on a regular X-ray.

 Blood tests. These may be used to measure the level of oxygen in your

arterial blood.

Treatments and drugs

By Mayo Clinic staff

The goal in treating a pneumothorax is to relieve the pressure on your lung,

allowing it to re-expand, and to prevent recurrences. The best method for achieving
this depends on the severity of the lung collapse and sometimes on your overall
health:

 Observation. If your lung is less than 20 percent collapsed, your doctor may
simply monitor your condition with a series of chest X-rays until the air is
completely absorbed and your lung has re-expanded. Because it may take weeks
for a pneumothorax to heal on its own, however, a needle or chest tube may be
used to remove the air, even when the pneumothorax is small and nonthreatening.

 Needle or chest tube insertion. When your lung has collapsed more than
20 percent, your doctor is likely to remove the air by inserting a needle or hollow
 tube (chest tube) into the space between your lungs and your chest wall. Chest
tubes are often attached to a suction device that continuously removes air from the
chest cavity and may be left in place for several hours to several days.

 Other pneumothorax treatments. If you have had more than one

pneumothorax, you may have treatments to prevent further recurrences.

A common surgical procedure is called video-assisted thoracoscopy, which uses

small incisions and a tiny video camera to guide the surgery. In this procedure, two
or three tubes are placed between your ribs while you're under general anesthesia.
Through one of the tubes, the surgeon can observe with a fiberscope, while through
the other tube, the surgeon attempts to close the air leak with surgical instruments.
Rarely, when this doesn't work, a surgical procedure with an incision is necessary.

The chest tube remains in as long as necessary until the air in the pleural space is
gone and doesn't recur when the chest tube is clamped and checked with an X-ray.
Video-assisted thoracoscopy leads to less pain and a shorter recovery time than
other types of surgery do because the chest cavity can be accessed without
breaking any ribs.

Prevention
Although it's often not possible to prevent a pneumothorax, stopping smoking is an
important way to reduce your risk of a first pneumothorax and avoid a recurrence.