Pneumothorax (Collapsed

Lung)
 Types

 Symptoms
 Risk factors

 Diagnosis

 Treatments

 Outlook

What is a pneumothorax?
“Pneumothorax” is the medical term for a collapsed lung. Pneumothorax
occurs when air enters the space around your lungs (the pleural space). Air
can find its way into the pleural space when there’s an open injury in your
chest wall or a tear or rupture in your lung tissue, disrupting the pressure that
keeps your lungs inflated.

Causes of ruptured or injured chest or lung walls can include lung disease,
injury from a sport or accident, assisted breathing with a ventilator, or even
changes in air pressure that you experience when scuba diving or mountain
climbing. Sometimes the cause of a pneumothorax is unknown.

The change in pressure caused by an opening in your chest or lung wall can
cause the lung to collapse and put pressure on the heart.
The condition ranges in severity. If there’s only a small amount of air trapped
in the pleural space, as can be the case in a spontaneous pneumothorax, it
can often heal on its own if there have been no further complications.

More serious cases that involve larger volumes of air can become fatal if left
untreated.

Types and causes of

pneumothorax
The two basic types of pneumothorax are traumatic pneumothorax and
nontraumatic pneumothorax. Either type can lead to a tension pneumothorax
if the air surrounding the lung increases in pressure. A tension pneumothorax
is common in cases of trauma and requires emergency medical treatment.

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.

Examples of injuries that can cause a traumatic pneumothorax include:

 trauma to the chest from a motor vehicle accident

 broken ribs
 a hard hit to the chest from a contact sport, such as from a football
tackle
 a stab wound or bullet wound to the chest
  medical procedures that can damage the lung, such as a central line
placement, ventilator use, lung biopsies, or CPR

Changes in air pressure from scuba diving or mountain climbing can also
cause a traumatic pneumothorax. The change in altitude can result in air
blisters developing on your lungs and then rupturing, leading to the lung
collapsing.

Quick treatment of a pneumothorax due to significant chest trauma is critical.

The symptoms are often severe, and they could contribute to potentially fatal
complications such as cardiac arrest, respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax doesn’t occur after injury. Instead, it happens

spontaneously, which is why it’s also referred to as spontaneous
pneumothorax.

There are two major types of spontaneous pneumothorax: primary and

secondary. Primary spontaneous pneumothorax (PSP) occurs in people who
have no known lung disease, often affecting young males who are tall and
thin. Secondary spontaneous pneumothorax (SSP) tends to occur in older
people with known lung problems.

Some conditions that increase your risk of SSP include:

 chronic obstructive pulmonary disease (COPD), such

as emphysema or chronic bronchitis
 acute or chronic infection, such as tuberculosis or pneumonia
 lung cancer
 cystic fibrosis, a genetic lung disease that causes mucus to build up in
the lungs
  asthma, a chronic obstructive airway disease that causes inflammation

Spontaneous hemopneumothorax (SHP) is a rare subtype of spontaneous

pneumothorax. It occurs when both blood and air fill the pleural cavity without
any recent trauma or history of lung disease.

Symptoms of a pneumothorax
The symptoms of a traumatic pneumothorax often appear at the time of chest
trauma or injury, or shortly afterward. The onset of symptoms for a
spontaneous pneumothorax normally occurs at rest. A sudden attack of chest
pain is often the first symptom.

Other symptoms may include:

 a steady ache in the chest

 shortness of breath, or dyspnea
 breaking out in a cold sweat
 tightness in the chest
 turning blue, or cyanosis
 severe tachycardia, or a fast heart rate

Risk factors for a pneumothorax

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

Risk factors for a traumatic pneumothorax include:

 playing hard contact sports, such as football or hockey

  performing stunts that may cause damage to the chest
 having a history of violent fighting
 having a recent car accident or fall from a height
 recent medical procedure or ongoing assisted respiratory care

The people at highest risk for a PSP are those who are:

 young
 thin
 male
 between the ages of 10 and 30
 affected by congenital disorders like Marfan’s syndrome
 smokers
 exposed to environmental or occupational factors, such as silicosis
 exposed to changes in atmospheric pressure and severe weather
changes

The main risk factor for SSP is having previously been diagnosed with a lung
disease. It’s more common in people over 40.

Diagnosing pneumothorax
Diagnosis is based on the presence of air in the space around the lungs. A
stethoscope may pick up changes in lungs sounds, but detecting a small
pneumothorax can be difficult. Some imaging tests may be hard to interpret
due to the air’s position between the chest wall and lung.

Imaging tests commonly used to diagnose pneumothorax include:

  an upright posteroanterior chest radiograph
 a CT scan
 a thoracic ultrasound

Treating pneumothorax
Treatment will depend on the severity of your condition. It will also depend on
whether you’ve experienced pneumothorax before and what symptoms you
are experiencing. Both surgical and nonsurgical treatments are available.

Treatment options can include close observation combined with the insertion
of chest tubes, or more invasive surgical procedures to resolve and prevent
further collapse of the lung. Oxygen may be administered.

Observation

Observation or “watchful waiting” is typically recommended for those with a

small PSP and who aren’t short of breath. In this case, your doctor will monitor
your condition on a regular basis as the air absorbs from the pleural space.
Frequent X-rays will be taken to check if your lung has fully expanded again.
Your doctor will likely instruct you to avoid air travel until the pneumothorax as
completely resolved.

Routine physical activity hasn’t been shown to worsen or delay healing of a

pneumothorax. However, it’s often advised that intense physical activity or
high-contact sports be delayed until the lung is fully healed and the
pneumothorax is gone.
A pneumothorax can cause oxygen levels to drop in some people. This
condition is called hypoxemia. If this is the case, your doctor will order oxygen
supplementation along with activity limitations.

Draining excess air

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.

Needle aspiration may be less uncomfortable than placement of a chest tube,

but it’s also more likely to need to be repeated.

For a chest tube insertion, your doctor will insert a hollowed tube between
your ribs. This allows air to drain and the lung to reinflate. The chest tube may
remain in place for several days if a large pneumothorax exists.

Pleurodesis

Pleurodesis is a more invasive form of treatment for a pneumothorax. This

procedure is commonly recommended for individuals who’ve had repeated
episodes of pneumothorax.

During pleurodesis, your doctor irritates the pleural space so that air and fluid
can no longer accumulate. The term “pleura” refers to the membrane
surrounding each lung. Pleurodesis is performed to make your lungs’
membranes stick to the chest cavity. Once the pleura adheres to the chest
wall, the pleural space no longer expands, and this prevents formation of a
future pneumothorax.

Mechanical pleurodesis is performed manually. During surgery, your surgeon

brushes the pleura to cause inflammation. Chemical pleurodesis is another
form of treatment. Your doctor will deliver chemical irritants to the pleura
through a chest tube. The irritation and inflammation cause the lung pleura
and chest wall lining to stick together.

Surgery

Surgical treatment for pneumothorax is required in certain situations. You may

need surgery if you’ve had a repeated spontaneous pneumothorax. A large
amount of air trapped in your chest cavity or other lung conditions may also
warrant surgical repair.

There are several types of surgery for pneumothorax. One option is

a thoracotomy. During this surgery, your surgeon will create an incision in the
pleural space to help them see the problem. Once your surgeon has
performed a thoracotomy, they’ll decide what must be done to help you heal.

Another option is thoracoscopy, also known as video-assisted thoracoscopic

surgery (VATS). Your surgeon inserts a tiny camera through your chest wall to
help them see inside your chest. A thoracoscopy can help your surgeon
decide on the treatment for your pneumothorax. The possibilities include
sewing blisters closed, closing air leaks, or removing the collapsed portion of
your lung, which is called a lobectomy.

What is the long-term outlook?

Your long-term outlook depends on the size of the pneumothorax, as well as
the cause and treatment required. In general, a small pneumothorax that
doesn’t cause significant symptoms can resolve with observation or minimal
treatment. When a pneumothorax is large, results from trauma, affects both
lungs, or is due to an underlying lung disease, treatment and recovery may be
more complicated. A pneumothorax that continues to reoccur can be even
more challenging to treat.

Having one pneumothorax increases the odds for a second. Get medical
attention as soon as possible if your symptoms occur again. In many cases,
less than 5 percent of people who’ve had surgery in combination with
pleurodesis to repair a pneumothorax have pneumothorax develop again.

HEALTHLINE NEWSLETTER

Get our weekly COPD email

To help you meet the challenges of living with COPD, we’ll send you support,
inspiration, and advice for both patients and caregivers.
Enter your email
SIGN UP NOW
Your privacy is important to us

Last medically reviewed on March 30, 2018

 6 sourcescollapsed


FEEDBACK:

Medically reviewed by Judith Marcin, M.D. — Written by Lydia

Krause — Updated on March 30, 2018

6 Natural Remedies for Wheezing

Herbs and Supplements for COPD (Chronic Bronchitis and Emphysema)

Asthma and Your Diet: What to Eat and What to Avoid
What Is a Respiratory Therapist?
Breathing Exercises to Increase Lung Capacity

Was this article helpful?

YesNo

Punctured Lung
 Types

 Symptoms

 Treatment

 Recovery and aftercare

  Complications

 Outlook

Overview
A punctured lung occurs when air collects in the space between the two layers
of the tissue lining your lung. This causes pressure on the lungs and prevents
them from expanding. The medical term is known as pneumothorax. There
are several variations of this issue, all of which are referred to as a punctured
or collapsed lung.

Types and causes

A punctured lung can be categorized in different ways depending on its cause:

Traumatic pneumothorax: This happens when there has been a direct

trauma to the chest, such as a broken rib or an injury from a stab or gunshot.
Some medical procedures deliberately collapse the lung, which would also fall
under this category.

Primary spontaneous pneumothorax: This is when the punctured lung

occurs without any exact cause. It typically happens when there is a rupture of
a small air sac on the outside of the lung. This causes air to leak into the
cavity around the lung.

Secondary spontaneous pneumothorax: This happens when a punctured

lung is caused by pre-existing lung disease, such as lung cancer, asthma,
or chronic obstructive pulmonary disease (COPD).
Symptoms
It’s important to recognize a punctured lung as soon as possible so that you
can get early treatment and avoid a life-threatening situation. If you
experience any form of trauma to the chest, look for the following symptoms:

 chest pain that increases after coughing or taking a deep breath

 shortness of breath
 abnormal breathing
 tightness in the chest
 a rapid heart rate
 pale or blue skin due to lack of oxygen
 fatigue

If you have a punctured lung, you may feel soreness in your chest. Usually the
collapse occurs on only one side, and that’s where the pain would occur.
You’d also have difficulty breathing.

Treatment
Treatment for a punctured lung varies depending on the severity of the trauma
and the amount of damage to the lung.

It’s possible for a small pneumothorax to heal on its own. In this case, you
may only require oxygen and rest to make a full recovery. A doctor may also
release additional air around the lung by sucking it out through a needle,
which allows the lung to fully expand.
For a large pneumothorax, a chest tube is placed through the ribs into the
area surrounding the lungs to help drain the air. The chest tube can be left in
place both for air drainage and also to help inflate the lung. In severe cases,
the chest tube may need to be left in place for several days before the chest
begins to expand.

Surgery may be required for people who experience repeated pneumothorax.

A large puncture wound would also require surgery, as the lung tissue would
not be able to close immediately and repair itself. The surgeons will likely work
to repair the injury by going through tubes placed down the throat into the
bronchial airways. Surgeons can also make an incision in the skin.
Additionally, surgeons may place a tube to remove excess air, and they may
have to suction out any blood cells or other fluids in the pleural space. The
approach depends on the injury.

Recovery and aftercare

It will usually take 6 to 8 weeks to fully recover from a punctured lung.
However, recovery time will depend on the level on injury and what action was
required to treat it.

There are some aftercare guidelines you can follow to help you recover and
prevent complications:

 Take any medications as prescribed by your doctor.

 Stay active while taking enough rest.
 Sleep in an elevated position for the first few days.
 Avoid putting unnecessary pressure on the ribcage.
 Wear loose-fitting clothing.
 Avoid smoking.
  Avoid a sudden change in air pressure.
 Avoid driving until you’re fully recovered.
 Watch for signs of a recurrence.
 Try breathing exercises that your doctor gives you.
 Attend all of your follow-up appointments.

Complications
The most common complication of a punctured lung is experiencing another
one in the future. Other complications include shock. This can happen if there
are serious injuries or infection, severe inflammation, or developing fluid in the
lung. Tension pneumothorax, which can lead to cardiac arrest, is another
possible complication.

Outlook
A punctured lung usually won’t cause any future health complications if it’s
treated quickly. However, if the collapse was caused by trauma to your lung,
it’s possible for the condition to occur again. You’re also more likely to
experience another punctured lung if you smoke.

It’s important to call your doctor immediately if you think you’re having another
collapse of the lung. Delaying treatment can lead to complications or a longer
recovery period.