Collapsed Lung | Atelectasis | Pneumothorax

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A collapsed lung happens when air enters the pleural space, the area between the lung and the chest wall. If it is a total collapse, it is called pneumothorax. If only part of the lung is affected, it is called atelectasis.

Causes of a collapsed lung include:

• Lung diseases such as pneumonia or lung cancer
• Being on a breathing machine
• Surgery on the chest or abdomen
• A blocked airway

If only a small area of the lung is affected, you may not have symptoms. If a large area is affected, you may feel short of breath and have a rapid heart rate.

A chest x-ray can tell if you have it. Treatment depends on the underlying cause.

NIH: National Heart, Lung, and Blood Institute

• Atelectasis

  (Mayo Foundation for Medical Education and Research)

• Pneumothorax

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Bronchoscopy and Bronchoalveolar Lavage (BAL)

  (National Library of Medicine)

  Also in Spanish

• Shortness of Breath

  (American Academy of Family Physicians)

  Also in Spanish

• Tests for Lung Disease

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• What Is LAM (Lymphangioleiomyomatosis)?

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• ClinicalTrials. gov: Pneumothorax

  (National Institutes of Health)

• ClinicalTrials.gov: Pulmonary Atelectasis

  (National Institutes of Health)

• Article: Deep learning for pneumothorax diagnosis: a systematic review and meta-analysis.

• Article: Comparison of three-dimensional reconstruction and CT-guided Hook-wire segmental resection for pulmonary…

• Article: Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung. ..

• Collapsed Lung — see more articles

• How the Lungs Work

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• American Lung Association

• Lung HelpLine and Tobacco QuitLine

  (American Lung Association)

• National Heart, Lung, and Blood Institute

Collapsed lung (pneumothorax) Information | Mount Sinai

Air around the lung; Air outside the lung; Pneumothorax dropped lung; Spontaneous pneumothorax

A collapsed lung occurs when air escapes from the lung. The air then fills the space outside of the lung between the lung and chest wall. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath.

The medical name of this condition is pneumothorax.

The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.

Pneumothorax occurs when air leaks from inside of the lung to the space between the lung and the chest wall. The lung then collapses. The dark side of the chest (right side of the picture) is filled with air that is outside of the lung tissue.

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

The pleural cavity is the space between the layers of the membrane lining the lung (pleura) and the chest cavity.

The lungs are paired organs that lie in the thoracic cavity. The lungs extract oxygen from inhaled air and transport the oxygen to the blood. Surrounding the lungs is a very thin space called the pleural space. The pleural space is usually extremely thin, and filled with a small amount of fluid.

Causes

Collapsed lung can be caused by an injury to the lung. Injuries can include a gunshot or knife wound to the chest, rib fracture, or certain medical procedures.

In some cases, a collapsed lung is caused by air blisters of the lung (blebs) that break open, sending air into the space around the lung. This can result from air pressure changes such as when scuba diving or traveling to a high altitude.

Tall, thin people and smokers are more at risk for a collapsed lung.

Lung diseases can also increase the chance of getting a collapsed lung. These include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• Tuberculosis
• Whooping cough

In some cases, a collapsed lung occurs without any cause. This is called a spontaneous collapsed lung or spontaneous pneumothorax.

Symptoms

Common symptoms of a collapsed lung include:

• Sharp chest or shoulder pain, made worse by a deep breath or a cough
• Shortness of breath
• Nasal flaring (from shortness of breath)

A larger pneumothorax causes more severe symptoms, including:

• Bluish color of the skin due to lack of oxygen
• Chest tightness
• Lightheadedness and near fainting
• Easy fatigue
• Abnormal breathing patterns or increased effort of breathing
• Rapid heart rate
• Shock and collapse

Exams and Tests

The health care provider will listen to your breathing with a stethoscope. If you have a collapsed lung, there are decreased breath sounds or no breath sounds on the affected side. You may also have low blood pressure.

Tests that may be ordered include:

• Chest x-ray
• Arterial blood gases and other blood tests
• CT scan if other injuries or conditions are suspected
• Electrocardiogram (ECG)

Treatment

A small pneumothorax may go away on its own over time. You may only need oxygen treatment and rest.

The provider may use a needle to allow the air to escape from around the lung so it can expand more fully. You may be allowed to go home if you live near the hospital.

If you have a large pneumothorax, a chest tube will be placed between the ribs into the space around the lungs to help drain the air and allow the lung to re-expand. The chest tube may be left in place for several days and you may need to stay in the hospital. If a small chest tube or flutter valve is used, you may be able to go home. You will need to return to the hospital to have the tube or valve removed.

Some people with a collapsed lung need extra oxygen.

Lung surgery may be needed to treat collapsed lung or to prevent future episodes. The area where the leak occurred may be repaired. Sometimes, a special chemical is placed into the area of the collapsed lung. This chemical causes a scar to form. This procedure is called pleurodesis.

Outlook (Prognosis)

If you have a spontaneous collapsed lung, you are more likely to have another one in the future if you:

• Are tall and thin
• Continue to smoke
• Have had two collapsed lung episodes in the past

How well you do after having a collapsed lung depends on what caused it.

Possible Complications

Complications may include any of the following:

• Another collapsed lung in the future
• Shock, if there are serious injuries or infection, severe inflammation, or fluid in the lung develops

When to Contact a Medical Professional

Contact your provider if you have symptoms of a collapsed lung, especially if you have had one before.

Prevention

There is no known way to prevent a collapsed lung. Following standard procedure can reduce the risk of a pneumothorax when scuba diving. You can decrease your risk by not smoking.

Hallifax R, Rahman NM. Pneumothorax. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 110.

Peak DA. Scuba diving and dysbarism. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 131.

Raja AS. Thoracic trauma. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 37.

Last reviewed on: 1/2/2023

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Closed pneumothorax – causes, symptoms, diagnosis and treatment

Closed pneumothorax – partial or complete collapse of the lung due to air entering the pleural cavity; while the pleural cavity does not communicate with the external environment, and the amount of gas during breathing does not increase. Manifested by pain in the chest on the side of the lesion, a feeling of lack of air, pallor and cyanosis of the skin, the patient’s desire to take a forced position, the presence of subcutaneous emphysema. The diagnosis of closed pneumothorax is confirmed by auscultation and x-ray. Medical care includes pain relief, oxygen therapy, pleural puncture or drainage.

General information

Closed pneumothorax is characterized by the presence of free gas in the pleural cavity in the absence of its communication with atmospheric air. It can be spontaneous or traumatic in origin; idiopathic (primary – arising for no apparent reason) or symptomatic (secondary – developing against the background of another pulmonary pathology).

According to the degree of lung collapse in pulmonology, small or limited (collapse of the lung by 1/3 of the volume), medium (decline by 1/2 of the volume) and total pneumothorax (collapse of the lung by more than half) are distinguished. Compared with other forms (open, valvular), closed pneumothorax has a more favorable course. At the same time, bilateral total or tension pneumothorax, if timely assistance is not provided, can lead to critical respiratory failure and death.

Closed pneumothorax

Causes of closed pneumothorax

1. Bullous lung disease . In most cases, rupture of subpleurally located air cysts in bullous emphysema leads to the occurrence of a closed pneumothorax.
2. Chronic broncho-pulmonary diseases : COPD, bronchiectasis, bronchial asthma, tuberculosis, staphylococcal destruction of the lung, pneumosclerosis, cystic fibrosis, malformations of the lungs, etc. In these cases, pleural adhesions or single alveoli are torn. Tearing bulls or adhesions can be triggered by physical exertion, straining, coughing, or simply forced breathing, but often occurs at rest.

Traumatic pneumothorax, as a rule, is a consequence of a closed injury of the chest, accompanied by a fracture of the ribs, rupture of the lung. This group sometimes includes iatrogenic closed pneumothorax, which develops in violation of the technique of pleural puncture, transthoracic fine-needle biopsy of the pleura, transbronchial lung biopsy, and placement of a subclavian catheter; barotrauma during mechanical ventilation, cardiopulmonary resuscitation. The imposition of an artificial closed pneumothorax (operative collapse therapy) is used as a method of treating cavernous pulmonary tuberculosis.

Predispose to the development of pathology: prematurity (underdevelopment of the pleura, mediastinal tissue, connective tissue, broncho-alveolar tract), addiction to smoking, connective tissue dysplasia, aggravated heredity.

In closed pneumothorax, air enters the pleural cavity at the time of injury or damage to the lung. In the absence of a valve mechanism, the defect in the lung tissue quickly closes, the amount of air in the pleural cavity does not increase, the pressure in it does not exceed atmospheric pressure, and there is no mediastinal flotation.

Tension pneumothorax, which is a complication of valvular pneumothorax, can be considered as closed by its mechanism. First, there is a progressive injection of air into the pleural cavity through the wound channel in the chest wall (external valvular pneumothorax) or damaged large bronchi (internal valvular pneumothorax). As the amount of air and pressure in the pleural cavity increase, the wound defect subsides, which marks the development of a tension pneumothorax. In this case, there is a dislocation of the structures of the mediastinum, compression of the SVC, life-threatening respiratory and circulatory disorders.

Symptoms of closed pneumothorax

The clinical picture of closed pneumothorax is determined by pain, respiratory failure and circulatory disorders, the severity of which depends on the volume of air in the pleural cavity. The disease most often manifests suddenly, unexpectedly for the patient, however, in 20% of cases, an atypical, erased onset is noted. In the presence of a small amount of air, clinical symptoms do not develop, and a limited pneumothorax is detected during a planned fluorography.

In the case of a medium or total closed pneumothorax, there are sharp stabbing pains in the chest, radiating to the neck and arm. There is shortness of breath, dry cough, feeling of lack of air, tachycardia, cyanosis of the lips, arterial hypotension. The patient sits, leaning his hands on the bed, his face is covered with cold sweat. Subcutaneous emphysema spreads along the soft tissues of the face, neck, torso, due to the ingress of air into the subcutaneous tissue.

With tension pneumothorax, the patient’s condition is severe or extremely severe. The patient is restless, feels a sense of fear due to a feeling of suffocation, greedily catches air with his mouth. The heart rate increases, the skin becomes bluish in color, a collaptoid state may develop. The described symptomatology is associated with a complete collapse of the lung and a shift of the mediastinum to the healthy side. In the absence of emergency care, tension pneumothorax can lead to asphyxia and acute cardiovascular failure.

Diagnosis of closed pneumothorax

Closed pneumothorax can be suspected by a pulmonologist on the basis of the clinical picture and auscultatory findings, and finally confirmed by the results of X-ray diagnostics. On examination, smoothing of the intercostal spaces is determined, the backlog of half of the chest on the side of the lesion during breathing; with ascultation – weakening or absence of respiratory sounds; with percussion – tympanitis; on palpation of soft tissues with symptoms of subcutaneous emphysema – a characteristic crunch.

With the help of X-ray of the lungs, it is possible to detect the accumulation of free gas between the collapsed part of the lung and the parietal pleura (with total pneumothorax – complete collapse of the lung with simultaneous displacement of the mediastinum to the healthy side). The final confirmation of the diagnosis is the receipt of air during thoracocentesis. The immediate causes of a closed pneumothorax are clarified after obtaining chest CT data or during diagnostic thoracoscopy.

CT scan of the chest. Pneumothorax due to rupture of a large bulla on the right. The integrity of the pleura/chest wall is intact

Differential diagnosis

Closed pneumothorax should be differentiated from:

• relaxation of the dome of the diaphragm
• uncomplicated lung cysts
• lung atelectasis
• lobar emphysema
• esophageal hernia
• hemothorax
• chylothorax
• myocardial infarction, etc.

This may require clarifying diagnostics (bronchography, angiopulmonography, CT of the lungs, radiography of the stomach, etc.).

Treatment of closed pneumothorax

A small amount of air in the pleural cavity, which does not give symptoms, can resolve itself. However, to exclude the progression of closed pneumothorax, X-ray control is necessary. In clinically significant cases, hospitalization of the patient in the department of thoracic surgery or traumatology and immediate provision of qualified assistance is required. When transporting to the clinic, it is necessary to anesthetize the patient, give him a semi-sitting position, provide inhalation of humidified oxygen, and in case of arterial hypotension, introduce vasotonic agents.

The subsequent treatment of a closed pneumothorax can be performed by a conditionally conservative or operative method. The first method involves a pleural puncture with simultaneous air evacuation or drainage of the pleural cavity with the imposition of drainage according to Bulau or an electrovacuum apparatus for active aspiration. A typical place for the installation of drainage is the II intercostal space in the midclavicular line.

In case of failure of the puncture-drainage method or repeated relapses of closed pneumothorax, thoraxoscopic or open intervention is performed to eliminate the root cause of the pathology. To prevent recurrence of the disease, pleurodesis is performed, leading to the formation of adhesions between the pleura and obliteration of the pleural fissure.

Prognosis of closed pneumothorax

Prognosis of closed pneumothorax is closely related to its underlying cause. It is noted that idiopathic pneumothorax proceeds more favorably than symptomatic. The most dangerous are tension and bilateral pneumothorax, leading to respiratory and cardiovascular failure.

Conditions that complicate closed pneumothorax include disease recurrence, pleurisy, pleural empyema, intrapleural bleeding, and the formation of a so-called rigid lung. With an unexplained or known, but unresolved cause of closed pneumothorax, relapses over 3 years are observed in half of the cases, after the elimination of the cause – only in 5%.

Drainage of the pleural cavity in St. Petersburg

What is pneumothorax?

Pneumothorax is an accumulation of air in the pleural cavity, resulting in a complete or partial collapse (collapse) of the lung with a violation of its function. This leads to hypoxia and respiratory failure. Open pneumothorax occurs, as a rule, with injuries of the chest, closed – with various diseases, such as bullous lung disease, tuberculosis, tumors.

The Euromed clinic treats spontaneous recurrent pneumothorax in bullous lung disease.

Article checked by Euromed Clinic thoracic surgeon Nechiporuk Vasily Mikhailovich.

Why Euromed?

• Euromed thoracic surgeons have extensive experience in the treatment of chest diseases, they are proficient in modern methods of performing operations, which contributes to the high effectiveness of the intervention and comfortable quick rehabilitation.
• Euromed is a full cycle clinic. Before the operation, we will arrange for you, if necessary, consultations with a therapist, cardiologist and any other specialist, here you can quickly take tests in our laboratory and immediately get the result. The process is organized clearly and takes much less time than in other clinics.

Treatment of pneumothorax

Pleural puncture
Used in patients younger than 50 years of age for the first episode of spontaneous pneumothorax if less than 30% of the lung is affected. The puncture is performed with a needle or a thin stylet catheter under x-ray control at the point of greatest accumulation of air.

Sometimes the lung expands after the puncture. The method is low-traumatic, but it is characterized by low efficiency, and therefore it is practically not used at present.

Pleural cavity drainage
It is used in case of ineffective pleural puncture, as well as in patients older than 50 years and with extensive spontaneous pneumothorax. The operation is performed under local anesthesia.

The drain is placed based on chest X-ray findings and is removed only after the lung has fully expanded. The next day after removal of the drainage, X-ray control is performed.

If the lung does not expand within three days and air continues to flow through the drainage, the patient is indicated urgent surgical treatment .

Postoperative period

In the postoperative period after any atypical lung resection, a cough is possible, which is associated not with the operation itself, but with anesthesia. Some blood may come out during coughing – this is a common postoperative phenomenon and is not a complication. In case of heavy bleeding, you should immediately contact your doctor.

The drains are removed after 3-5 days, after their removal the patient can leave the hospital. A month later, it is necessary to perform a control computed tomography of the chest.
The recurrence rate after surgery for spontaneous pneumothorax does not exceed 1%.

Operation cost: Drainage of the pleural cavity* — from 24,000 rubles.

*Basic cost of operation does not include : preoperative examination, anesthesia allowance, histological examination of the surgical material and hospital stay.

Nechiporuk
Vasily Mikhailovich

surgeon

Thoracic surgeon

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