Pneumothorax

Definition

A pneumothorax is air in the space between the lungs and the chest wall. The air can push down on the lungs. A small amount of air may not cause symptoms, but more air will make it hard to breathe and collapse part of the lung.

Causes

The air leak happens because of damage to the chest wall, lungs, or muscle under the lungs. The cause of pneumothorax depends on the type:

• Primary spontaneous pneumothorax—Cause is not clear, but genes may play a role
• Secondary spontaneous pneumothorax—Caused by lung disease, injury, or the use of machine to help with breathing
• Tension pneumothorax—Caused by trauma to the lungs, ribs, and chest muscles
• Catamenial pneumothorax—Caused by small holes in the muscle under a woman's lungs. It is linked to the menstrual cycle and endometriosis.

Rib Fractures With Pneumothorax

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Risk Factors

Primary spontaneous pneumothorax is more common in tall, thin, young males. Things that may raise the risk are:

• Smoking
• Scuba diving and flying at a high altitude
• Poor nutrition from anorexia nervosa

The risk of secondary spontaneous pneumothorax is higher with:

• Lung diseases such as:
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • Cystic fibrosis
  • Tuberculosis
  • Pertussis
  • Lung cancer
  • Interstitial lung disease
• Connective tissue diseases, such as rheumatoid arthritis , Marfan syndrome , and scleroderma

The risk of tension pneumothorax is higher with:

• Trauma to the chest
• Having a medical or surgical procedure
• Mechanical ventilation—the use of a machine to help with breathing

Symptoms

Pneumothorax may not cause symptoms if it is small. A larger pneumothorax can cause:

• Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
• Shortness of breath
• Cough
• Tightness in the chest
• Rapid heartbeat
• Bluish color of the skin due to a lack of oxygen
• Flaring of the nostrils
• Feelings of anxiety , stress, and tension

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on lung sounds and breathing.

Blood tests may be done.

Images of the chest will be taken. This can be done with:

• Chest x-ray
• CT scan
• Ultrasound

Treatment

Treatment will depend on the size of the pneumothorax. A small injury may heal on its own. Tests may be done to make sure the area has healed.

Larger problems will need care. The goal of treatment is to take out the extra air and allow the lung to open again.

Emergency Care

Air may be removed using a needle placed through the chest wall.

A tube may be placed through the chest wall to treat a large lung collapse. It will stay in place until the lung has fully opened. It may be needed for several days.

Surgery

Surgery may be needed if air leaks continue. It may also be done if the pneumothorax keeps happening. Surgery may include:

• Removal of weak spots that are allowing air to leak out of the lungs
• Sealing the space between the lung and chest wall—called pleural abrasion or pleurodesis
• Removing part or all of the lining that sticks to the chest wall—pleurectomy
• Removing damaged lung tissue

Prevention

Prevention will depend on the cause. The risk of some types of pneumothorax may be lowered by:

• Not smoking
• Managing chronic health problems that affect the lungs
• Avoiding or limiting activities with changes in air pressure, such as scuba diving and flying

References

• Pneumothorax. Merck Manual website, Professional Version. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax.
• Spontaneous pneumothorax in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/spontaneous-pneumothorax-in-adults.
• Tension pneumothorax. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/tension-pneumothorax.