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by Dameron A

Definition

A pneumothorax is air in the space between the lungs and the chest wall. This air bubble puts can push down on the lungs. A small amount of air may not cause symptoms. 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. Types of pneumothorax are based on causes:

  • Primary spontaneous pneumothorax—Cause is not clear. Genes may play a role.
  • Secondary spontaneous pneumothorax—May be caused by lung disease, injury, or use of machine to help you breathe.
  • Tension pneumothorax—Caused by trauma to the lungs, ribs and chest muscles.
  • Catamenial pneumothorax (women only)—Caused by small holes in the muscle under the lungs. It is linked to the menstrual cycle. Often linked to endometriosis .
Rib Fractures With Pneumothorax
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Risk Factors

Primary spontaneous pneumothorax is more common in tall, thin, young men.

The risk of primary spontaneous pneumothorax is higher with:

  • Smoking
  • Scuba diving and high-altitude flying
  • Poor nutrition resulting from anorexia nervosa

The risk of secondary spontaneous pneumothorax is higher with:

The risk of tension pneumothorax is higher with:

  • Trauma to the chest
  • Having a medical or surgical procedure
  • Mechanical ventilation—machine to help you breathe

Symptoms

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

  • Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
  • Acute 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

Those with lung disease should be aware of these symptoms. Get help as soon as symptoms arise.

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. The doctor will listen to breath sounds. A diagnosis may be made based on sounds and symptoms.

Images of the chest will be done. It will show how large the air leak is. Image tests may include:

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 let the lung open again.

Immediate Care

Air may be pulled out of the chest with a needle. It will be placed through the chest wall. The needle can be removed once the air is out.

A chest tube may be needed for large lung collapse. The tube is placed through the chest wall. It will stay in place until the lung has fully opened. The tube 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

Follow-up is an important part of the treatment plan. More than half of people with a pneumothorax will have another one.

Follow-up is an important part of the treatment plan. More than half of people with a pneumothorax will have another one.

Prevention

Prevention will depend on the cause. Steps to help reduce your risk of some pneumothorax include:

  • Wear a seatbelt when in a motor vehicle. This may prevent trauma to your chest.
  • Stop smoking.

RESOURCES

American College of Chest Physicians  http://www.chestnet.org 

American Thoracic Society  http://thoracic.org 

CANADIAN RESOURCES

The Canadian Lung Association  http://www.lung.ca 

Health Canada  http://www.hc-sc.gc.ca 

References

Pneumothorax. Merck Manual website, Professional Version. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax. Updated October 2017. Accessed August 20, 2018.

Spontaneous pneumothorax in adults. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114714/Spontaneous-pneumothorax-in-adults  . Updated August 13, 2018. Accessed August 20, 2018.

Tension pneumothorax. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115634/Tension-pneumothorax . Updated January 15, 2017. Accessed August 20, 2018.

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