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:

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:

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.