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.

Pneumothorax (Collapsed Lung): Symptoms, Causes, and More

A collapsed lung is the medical term for when air escapes outside of the lungs into the chest. The pressure causes the lung to be unable to expand. This is also called pneumothorax.

Pneumothorax is the medical term for a collapsed lung. It occurs when air enters the space around your lungs (the pleural space). This can happen when an open injury in your lung tissue causes air to leak into the pleural space. The resulting increased pressure on the outside of your lung causes it to collapse.

Pneumothorax can be traumatic or nontraumatic.

Traumatic pneumothorax results from an injury, like a blow to the chest. Nontraumatic pneumothorax can happen if you have lung disease, like chronic obstructive pulmonary disease (COPD), but it can also happen for no apparent reason in people without lung disease.

The long-term impact of pneumothorax can vary. If only a small amount of air is trapped in the pleural space, there may be no further complications. If the volume of air is larger or it affects the heart, it can be life-threatening.

If pneumothorax results from trauma, the symptoms often appear at the time of the injury or shortly after. Symptoms of spontaneous pneumothorax might appear when a person is at rest. A sudden attack of chest pain is often the first symptom.

Symptoms may include:

• a sudden, sharp, stabbing pain in the chest
• rapid breathing or shortness of breath (dyspnea)
• turning blue, known as cyanosis
• a rapid heart rate
• low blood pressure
• lung expansion on one side
• a hollow sound if you tap on the chest
• an enlarged jugular vein
• anxiety
• fatigue

There are different ways of categorizing pneumothorax, according to their causes or their impact.

One way of differentiating them is as follows:

• traumatic pneumothorax
• nontraumatic pneumothorax
  • primary spontaneous
  • secondary spontaneous

Other subtypes with either traumatic or nontraumatic causes are:

• simple, when it does not affect the position of other structures
• tension, which affects the position of other structures, like the heart
• open, when air moves in and out of an open wound in the chest

Traumatic pneumothorax

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

Here are some types of injuries that can cause traumatic pneumothorax:

• trauma to the chest from a motor vehicle accident
• broken ribs
• a blow to the chest during a contact sport, like football tackle
• a stab or bullet wound to the chest
• accidental damage during a medical procedure like a central line placement, ventilator use, lung biopsies, or CPR
• diving, flying, or being at high altitude due to air pressure changes

Quick treatment of pneumothorax due to chest trauma is critical as it can lead to fatal complications like cardiac arrest, respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax is called spontaneous, as it does not result from trauma.

When primary spontaneous pneumothorax happens, there’s no clear reason why it occurs. It’s more likely to happen:

• in people who smoke
• during pregnancy
• in people with Marfan syndrome
• in those with a family history of pneumothorax
• in an otherwise healthy person with a tall, thin body

Secondary spontaneous pneumothorax can happen if a person has:

• a form of COPD, including emphysema and chronic bronchitis
• acute or chronic infection, like tuberculosis or pneumonia
• lung cancer
• cystic fibrosis
• asthma
• severe acute respiratory distress syndrome (ARDS)
• idiopathic pulmonary fibrosis
• collagen vascular disease

Inhaling drugs like cocaine or marijuana can also trigger it.

Tension pneumothorax

Tension pneumothorax is not a classification of pneumothorax but a term that reflects the severity of pneumothorax. You may experience it if you have:

• a blow to the chest
• a penetrating injury
• changes in pressure when diving, flying, or mountaineering
• a spontaneous pneumothorax progressing to a tension type
• some medical procedures

The risk factors are different for a traumatic and spontaneous pneumothorax.

Risk factors for a traumatic pneumothorax include:

• contact sports, like football or hockey
• employment where there’s a risk of falls or other types of injury
• having a medical procedure that involves the chest or lung area
• ongoing assisted respiratory care

The people at highest risk of a nontraumatic pneumothorax include those who:

• have a history of smoking
• have an existing lung condition, like asthma or COPD
• have a family history of pneumothorax, which may indicate genetic factors
• have tall, slim bodies, as this can affect pressure at the top of the lung
• have inflammation in the small airways

Pneumothorax can lead to a number of complications, some of which can be life-threatening.

They include:

• respiratory failure or inability to breathe
• pulmonary edema following treatment for pneumothorax
• pneumohemothorax, when blood enters the chest cavity
• pneumopericardium, when air enters the cavity around the heart
• pneumoperitoneum, when are enters the space around the abdomen
• bronchopulmonary fistula, when a passageway opens between the lungs and the space around them
• heart attack

Tension pneumothorax can quickly progress to:

• an inability to breathe
• cardiovascular collapse
• death

It’s essential to seek emergency medical help as soon as symptoms arise.

Treatment aims to relieve pressure on the lung and allow it to re-expand.

The options will depend on:

• how severe the condition is
• whether the chest cavity is continuing to expand
• the cause
• whether it’s happened before or has been going on for some time

If you have tension pneumothorax or pneumothorax due to an injury, this is a life-threatening emergency. You’ll need immediate medical care and possibly surgery.

Here are some of the treatment strategies:

Observation

If pneumothorax results from a small injury, it may heal without treatment within a few days. Check with a doctor before flying or diving after pneumothorax.

If you’re having trouble breathing, you may need oxygen. Using oxygen can also help speed up the rate at which the lungs reabsorb air from the cavity.

Draining excess air

If the damage is significant or symptoms are severe, a surgeon may need to remove the air or carry out surgery.

Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. These can be done at the bedside without requiring general anesthesia.

In needle aspiration, the doctor inserts a needle into the cavity and extracts the air using a syringe.

For a chest tube insertion, the doctor will insert a hollowed tube between your ribs. This allows air to drain and the lung to reinflate. The tube may remain in place for 2 to 5 days or longer.

Surgery

The doctor may need to carry out a more invasive procedure to see what’s happening in your lungs, like a thoracotomy or thoracoscopy.

During a thoracotomy, your surgeon will create an incision in the pleural space to help them see the problem. During a thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), the doctor inserts a tiny camera through the chest wall to examine the lung.

If you’ve had repeated episodes of pneumothorax, you may need a small operation to repair any weak areas in the lung where the air is getting through. The doctor may also carry out pleurodesis, in which they stick the lung to the inside of the chest wall.

Other surgical options include:

• sewing blisters closed
• closing air leaks
• or removing the collapsed portion of your lung, which is called a lobectomy

These interventions can reduce the risk of pneumothorax happening again.

In many cases, a person with pneumothorax will need emergency medical treatment, and emergency doctors will carry out the evaluation and diagnosis.

A doctor will look for signs of air in the space around the lungs.

They’ll ask about:

• symptoms
• personal and family medical history
• recent activities
• any previous cases of pneumothorax

They may also carry out imaging tests, like:

• an X-ray
• a CT scan
• a thoracic ultrasound

Your long-term outlook depends on the size of the pneumothorax, the cause, and any treatment you receive.

Most cases of primary spontaneous pneumothorax resolve with observation or minimal treatment. It’s rarely life-threatening. But there’s a 30 percent chance that this type will recur within 5 years, and the risk of recurrence increases each time it happens.

It may take longer to recover if:

• you have a large pneumothorax
• you have a secondary spontaneous pneumothorax
• you have an underlying lung condition
• pneumothorax results from an injury
• it’s not your first experience of pneumothorax

In around 10% of cases, secondary spontaneous pneumothorax is fatal. The risk is higher if you have HIV or COPD. The risk of this type recurring within 5 years is around 43 percent, and the risk increases each time it happens.

Knowing your risk of developing pneumothorax and seeking help as soon as symptoms occur can help prevent severe complications.

Pneumothorax is a condition where air collects between the lungs and the chest cavity. In some cases, it’ll go away without treatment. In others, it can be life-threatening. This will depend on the size and cause of the problem.

There are different types of pneumothorax. Traumatic pneumothorax can happen if someone has an injury to the chest wall or lungs. Nontraumatic pneumothorax can affect people with COPD and other lung diseases, but it can also affect people without lung disease.

Treatment aims to remove the air and re-expand the lungs. In some cases, a surgeon may need to repair the lungs. Pneumothorax can be a life-threatening emergency. Anyone who experiences symptoms, like a sharp, stabbing pain in the chest, should seek immediate medical help.

Pneumothorax in newborns. What is pneumothorax in newborns?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Pneumothorax in newborns is an accumulation of air in the pleural cavity, which occurs due to damage to the alveolar wall. Pathology occurs with inadequate ventilation of the lungs, perinatal respiratory diseases, and the influence of iatrogenic factors. Pneumothorax is manifested by increased breathing, chest asymmetry, cyanosis of the skin and other signs of hypoxia. Diagnosis of the condition in newborns is performed by transillumination, chest X-ray, pulse oximetry. The treatment is carried out conservatively with oxygen therapy or with the help of invasive interventions (pleural puncture, drainage).

ICD-10

P.25.1 Perinatal pneumothorax

• Causes
• Pathogenesis
• Symptoms of pneumothorax in newborns
• Complications
• Diagnostics
• Treatment of pneumothorax in newborns
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Prices for treatment

General information

Pneumothorax in neonatology refers to the manifestations of the air leakage syndrome, occurs in 0.07-1% of babies, according to Russian data, and up to 1-1.5%, according to foreign colleagues. Among infants in the intensive care unit, the prevalence of the problem is 1.86%. This condition is 6 times more likely to be detected in preterm infants, and there is an inverse relationship between gestational age and the likelihood of the disease. In 85% of cases, unilateral pneumothorax develops, about 2/3 of the pathologies occur in the right lung.

Pneumothorax in newborns

Causes

Pneumothorax sometimes has physiological prerequisites: at the first breaths of a newborn, a large negative intrathoracic pressure is formed, the lungs quickly stretch, as a result of which rupture of the alveoli is possible. However, the child’s condition rarely worsens, and the consequences of damage to the lung tissue disappear without a trace after the normalization of the function of external respiration. Among the pathological causes of neonatal pneumothorax are the following:

• Respiratory therapy. Mechanical ventilation remains the main etiological factor in the occurrence of the condition, since 34% of newborns develop ruptures of the lung tissue. When ventilating in CPAP mode, the risk is reduced to 16%. In infants who received oxygen therapy with a mask, it is no more than 4%.
• Diseases of the respiratory system. Pneumothorax is diagnosed in 5-20% of newborns with RDS (hyaline membrane disease), which is caused by a violation of the elastic properties of the lungs. With transient tachypnea, the condition develops in 10% of cases. With aspiration of meconium, the risk increases to 20-50%.
• Lung injuries. In newborns, pneumothorax sometimes becomes the result of inaccurate therapeutic and diagnostic manipulations – catheterization of the subclavian and jugular veins according to the Seldinger method, sanitation of the tracheobronchial tree.
• Caesarean section. Elective surgery significantly increases the risk of pneumothorax compared with natural childbirth or emergency surgery, which was performed after a certain period of contractions. This pattern is explained by the more frequent development of the “wet lung” syndrome after a planned caesarean section.

Pathogenesis

The disease occurs when the alveoli are overstretched and ruptured, as a result of which air leaves the lung into the pleural cavity and accumulates there. The main producing factor is a physiological or pathological increase in intrapulmonary pressure. Pneumothorax often develops with uneven ventilation, for example, during mechanical ventilation, when air enters the subpleural alveoli with a large flow.

The frequent manifestation of pathology in premature newborns is due to underdevelopment of the lungs, their insufficient elasticity and lack of surfactant. As a consequence, there is a high predisposition to emphysema and the formation of “air traps”, against which the air leak syndrome appears. Sometimes pathology is formed when fluid is retained in the lung tissues, which provokes excessive extensibility of the alveoli.

Symptoms of pneumothorax in newborns

In 90% of cases, the disease is asymptomatic, since there is a small air leak, which does not give negative health effects. In the rest of the newborns, the main manifestation of pneumothorax is an increase in breathing more than 60 times per minute. During breathing, the child makes loud grunting or groaning sounds. Babies who are breastfed often drop their breasts because they don’t get enough oxygen.

Inadequate ventilation leads to respiratory failure. The skin of the newborn acquires a bluish tint in the area of ​​the nasolabial triangle and fingertips, with an increase in hypoxia, total cyanosis is formed. With massive pneumothorax, the affected side of the chest bulges, there is a noticeable asymmetry. There are cardiovascular disorders: tachycardia, arterial hypotension.

Complications

The most dangerous consequences of pneumothorax for premature babies with signs of RDS. Mortality in this case ranges from 14% to 31%, the rest of the newborns require long-term treatment in the intensive care unit. In 15% of infants, against the background of air leakage into the pleural cavity, persistent pulmonary hypertension is formed, which is associated with a pathological change in pressure in the vessels of the bronchopulmonary system.

With pneumothorax, air often accumulates in other cavities and tissues, which is manifested by pneumomediastinum, pneumopericardium, pneumoperitoneum. Serious consequences have interstitial emphysema, which, in combination with the presence of air in the pleural cavity, causes severe respiratory distress. Due to the increase in pressure in the venous system, blood flow to the heart decreases, cardiac output decreases and HF is formed.

Diagnostics

To suspect pneumothorax, a neonatologist needs only an external examination of the newborn and an assessment of physical data. The doctor pays attention to the asymmetry and size of the chest, counts the respiratory rate, during auscultation notes the weakening or absence of respiratory noises on the affected side. In order to diagnose the pathology and its negative consequences with 100% certainty, the following are used:

• Transillumination. When transilluminating the chest with a fiber-optic lamp in a darkened room, the doctor sees free air around the lungs. Such manipulation is informative only for prematurity of newborns.
• X-ray of OGK. On the x-ray, the neonatologist detects enlightenment in the peripheral parts of the chest and collapse (collapse) of the lung. In this case, the mediastinum, as a rule, is shifted to the healthy side. X-ray examination is also used to diagnose pneumopericardium.
• Pulse oximetry. Saturation assessment is necessary to determine the presence and degree of respiratory failure, making a decision on oxygen support. The lower the blood oxygen saturation, the more often adverse effects develop, and the higher the risk of death in the newborn.

Treatment of neonatal pneumothorax

Conservative therapy

Treatment is not indicated for asymptomatic incidental pneumothorax. In such a situation, the condition resolves on its own, does not cause long-term consequences, and does not disrupt the life of the newborn. In the presence of symptoms of respiratory failure, respiratory support is recommended in the form of an oxygen tent or nasal-mouth mask, which do not create high pressure in the bronchopulmonary system.

To prevent adverse consequences, it is necessary to find out the cause of the pathology in time and correct it. For example, with respiratory distress syndrome, a surfactant is inhaled into a newborn to normalize the functioning of the lungs. To prevent infectious complications, antibiotics are prescribed if necessary.

Surgical treatment

With severe pneumothorax or its rapid increase (valvular form), a newborn child requires invasive manipulations. The easiest way is to aspirate air with a syringe through the catheter. The method is suitable for the single removal of a small volume of gas. Also used is constant drainage of the pleural cavity with narrow tubes, which provide a gradual expansion of the lung and the elimination of the defect.

Prognosis and prevention

The probability of complete recovery depends on the degree of damage to the lungs, the presence of congenital or acquired bronchopulmonary diseases. Term newborns without RDS and the need for mechanical ventilation have a favorable prognosis; preterm infants often have negative consequences. Prevention involves a rational choice of tactics of mechanical ventilation and CPAP ventilation, accurate performance of invasive procedures.

You can share your medical history, what helped you in the treatment of pneumothorax in newborns.

Sources

1. Neonatology. T.1 / N.P. Shabalov. — 2020.
2. Analysis of cases of development of spontaneous pneumothorax in newborns / Yu.V. Peregudova, O.I. Petrusenko, A.V. Shaklein. – 2016.
3. Pneumothorax in newborns / V.EG. Vakulchik, A.V. Khudovtsova, Yu.V. Popova // Topical issues of surgery: materials of the XV Congress of Surgeons of the Republic of Belarus. – 2014.
4. Neonatology / ed. N.N. Volodin. — 2008.
5. This article was prepared based on the website: https://www.krasotaimedicina.ru/

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Pneumothorax: causes, symptoms and recommendations for the treatment of the disease. Dr. Peter

The lungs are covered on the outside with a smooth organ membrane – the visceral pleura. Another thin layer of tissue, the parietal pleura, lines the inside of the chest wall. Both layers of the pleura are separated from each other by a narrow, fluid-filled space – the pleural cavity. A certain negative pressure arises in the pleural cavity, which allows the so-called adhesive forces to literally attract the visceral and parietal parts of the pleura to each other. With this mechanism, the lungs follow the movements of the chest with each breath. If air enters the pleural cavity, the forces of physical cohesion are eliminated. The lung fails to expand in the affected area when inhaled and instead collapses (collapsed lung). In some cases, however, so little air enters the pleural cavity that the patient hardly notices anything.

Depending on the origin of the trapped air, doctors distinguish between internal and external pneumothorax:

• Open pneumothorax : air enters the pleural cavity from the outside, accumulating between the chest wall and the lungs – for example, in the event of an accident, when something pierces chest.

• Closed pneumothorax : when air enters the pleural cavity through the respiratory tract, for which there can be several reasons. Internal pneumothorax is more common than external pneumothorax.

Pneumothorax can also be classified according to the degree of air intake: if there is very little air in the pleural cavity, doctors speak of mantle pneumothorax. The lungs are still severely stretched, so it is possible that the victim has little to no symptoms.

But in the case of pneumothorax with collapsed lung, most of the organ collapses (partially), causing severe symptoms.

A serious complication of pneumothorax is the so-called tension (valvular) pneumothorax. It occurs in about 3% of cases of pneumothorax. With tension pneumothorax, more air is forced into the pleural cavity with each breath, but it cannot exit. As a result, the air in the chest takes up more and more space – it gradually compresses previously unaffected areas of the lungs, as well as large veins leading to the heart.

Causes

Depending on the cause, doctors distinguish different forms of pneumothorax:

• Primary spontaneous pneumothorax : usually occurs unexpectedly in healthy people, especially in young, slender men. The cause is spontaneous rupture of the lung tissue, for example, when emphysema bubbles suddenly burst in the lung tissue near the lung membrane. These bubbles form from the air sacs (alveoli) in the lungs when the walls between the individual sacs collapse (mostly from smoking!). However, if the exact cause remains unclear, it is called idiopathic spontaneous pneumothorax.

• Secondary spontaneous pneumothorax : develops in the presence of an existing lung disease. In most cases, this is COPD (chronic obstructive pulmonary disease), less often other diseases, such as pneumonia.

• Traumatic pneumothorax : caused by trauma to the chest. For example, the intense pressure from a car accident can break ribs and damage the lungs. Then air can penetrate from the outside into the pleural cavity. Stab wounds to the chest can also cause traumatic pneumothorax.

• Iatrogenic pneumothorax : this is when the pathology is the result of a medical intervention. For example, chest compressions used to resuscitate a cardiac arrest can break ribs and damage the lungs – followed by pneumothorax. When tissue is removed from the lungs (lung biopsy), bronchoscopy, or when a central venous catheter is placed, air can inadvertently enter the pleural space.

• Tension pneumothorax (also: valvular pneumothorax) may develop as a possible complication of pneumothorax. The valve mechanism is created at the point where air enters the pleural cavity – with each breath, new air enters without escaping. The resulting excess pressure in the pleural cavity shifts the heart to the healthy side, and also causes narrowing of the intact lung and large vessels. In the worst case, the pumping ability of the heart is so impaired that circulatory failure occurs – there is a risk of death!

An important risk factor for primary spontaneous pneumothorax is smoking — About 90% of all patients with pneumothorax smoke.

Women generally have a lower risk of spontaneous pneumothorax than men. However, in certain situations they are more susceptible to it. In childbearing age, the so-called menstrual pneumothorax can occur within 72 hours before or after menstruation. It usually happens on the right side. The cause of this special form of pneumothorax has not yet been elucidated. Endometriosis (when the lining of the uterus settles in the chest area) can be a trigger, or air can enter the abdomen through the uterus and from there into the chest. Catamenial pneumothorax is very rare, but has a high risk of recurrence. Another particular case is pneumothorax during pregnancy.

Symptoms of pneumothorax

Pneumothorax presents with a variety of symptoms depending on the cause and severity. If there is very little air in the pleural cavity (mantle pneumothorax), the victim may not have any symptoms at all.

But pneumothorax with collapse of the lung and large air intake is a dangerous condition, which is usually accompanied by clear symptoms:

• Severe cough.

• Stitching, breathing-dependent pain in the affected side of the chest.

• Possible formation of air bubbles under the skin (skin emphysema).

• Asymmetric movement of the chest during breathing (“lag” of the affected side).

In the so-called menstrual pneumothorax that occurs in young women during the premenstrual period, chest pain and shortness of breath are usually accompanied by expectoration of bloody discharge (hemoptysis).

With tension pneumothorax, shortness of breath continues to increase. If the lungs can no longer absorb enough oxygen to supply the body, the skin and mucous membranes turn blue (cyanosis). The heartbeat is even and strongly accelerated. In case of tension pneumothorax, it is necessary to consult a doctor as soon as possible!

Possible Complications and Risks

The course of a pneumothorax depends on its cause and the type and extent of any causative injury. The prognosis for the most common form, spontaneous pneumothorax, is usually good. The body can often gradually absorb a small amount of air from the pleural cavity (mantle pneumothorax), so that the pathology resolves itself.

If the lung has collapsed, treatment with pleural drainage or surgery is necessary. After the procedure, people usually recover quickly. However, in a third of patients with spontaneous pneumothorax, air again enters the pleural cavity (relapse). The best prevention is surgery (pleurodesis).

In addition, victims should avoid diving due to pressure fluctuations and should preferably stop smoking, both of which reduce the risk of recurrence. Patients with large foci of emphysema should also exercise caution when flying and consult with a physician beforehand if necessary.

In the case of traumatic pneumothorax, the prognosis depends on damage to the lung and/or pleura. Severe injuries after an accident can be life threatening.

Tension pneumothorax must always be treated immediately or death is likely.

Diagnosis

First of all, the doctor will ask about the medical history (medical history): he will ask about the type and severity of symptoms, the time of their onset and any previous incidents, as well as existing lung diseases. You should also tell your doctor about any medical interventions or injuries in the chest area.

After the conversation, a physical examination is performed: the doctor listens to the heart and lungs with a stethoscope – with pneumothorax, the breath noise in the affected lung is usually much weaker. He also taps on his chest and listens to see if the sound of tapping has changed in certain places.

If a pneumothorax is suspected, a chest x-ray is taken as soon as possible. In most cases, some characteristic signs can be revealed on the x-ray: in addition to the accumulation of air in the pleural cavity, sometimes a lung collapse can also be seen on the x-ray.

If x-rays are inconclusive, additional tests may be needed, such as ultrasound, computed tomography, or a puncture of the suspicious area (pleural puncture).

How to treat pneumothorax

Treatment of pneumothorax initially depends on its exact characteristics. If there is little air in the pleural space (mantle pneumothorax) and no severe symptoms, the pneumothorax can often resolve completely without treatment. In this case, the person initially remains under medical supervision to monitor the further course of the disease. Regular clinical examinations and x-ray checks help.

Pleural drainage and pleurodesis

If the lung has collapsed, pleural drainage becomes the treatment of choice: the doctor inserts a drainage tube from the outside through the chest into the pleural cavity.