What Is Pneumothorax (Collapsed Lung)?

Pneumothorax is a partially or completely collapsed lung. Lung collapse occurs when air forces its way into the pleural cavity, a membranous layer between the lungs and the chest wall. The pleural cavity is inflated beyond its natural limits, putting pressure on the lung and other parts of the chest, including the heart. Causes are varied, but include traumatic injury and chronic lung disease. Pneumothorax is more common in men than women and is potentially fatal.

There are several types of pneumothorax, with differing degrees of severity. If you or a loved one is showing signs of pneumothorax or another form of lung trouble, the respiratory specialists at Baptist Health are available to help.

What Are Pneumothorax Symptoms?

Pneumothorax is marked by the following symptoms:

• Sudden chest pain, followed by a steady achiness
• Labored breathing
• Chest tightness
• Accelerated heart rate
• A cold sweat
• Turning blue in appearance (cyanosis).

These symptoms are common to all types of pneumothorax. Several are known to medical research:

• Primary spontaneous pneumothorax: This type of lung collapse occurs, often without warning, for no apparent reason. Some of the lung’s alveoli burst, releasing air into the pleural cavity. Individuals with this condition are usually otherwise healthy.
• Secondary spontaneous pneumothorax: Secondary lung collapse typically results from an underlying medical condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD).
• Catamenial pneumothorax: This unusual form of lung collapse occurs only in menstruating women. Endometrial tissue attaches to the chest cavity, where it forms cysts. These cysts release blood into the pleural cavity, increasing pressure on the lungs.
• Traumatic or injury-related pneumothorax: Traumatic injury can lead to lung collapse. Gunshots, knife wounds, or blunt-force traumas that compromise respiratory pathways permit air to enter the pleural cavity. 
• Tension pneumothorax: Tension pneumothorax is a potentially fatal form of lung collapse that is an unwanted side effect of mechanical ventilation. If air is prevented from escaping the pleural cavity by the ventilator, pressure on the lungs and heart can build to critical levels.

Pneumothorax is often recurrent. Persons that have experienced lung collapse may undergo a second episode within one to two years of the first.

What Causes Pneumothorax?

Lung collapse has multiple causes. Some primary contributors include:

• Chest injuries: Broken ribs, bullet or stab wounds, blunt-force trauma, and similar injuries can facilitate lung collapse.
• Lung diseases: Lung disorders are the source of secondary spontaneous pneumothorax. These include COPD, cystic fibrosis, asthma, tuberculosis, emphysema, lung cancer, and certain forms of pneumonia.
• Activities involving dramatic changes in air pressure: Flying, scuba diving, and mountain climbing are all activities which subject participants to significant changes in air pressure. These changes can lead to pneumothorax.
• Medical procedures: Procedures which risk lung punctures, such as biopsies or catheter insertions, have resulted in some cases of lung collapse.

Pneumothorax has a number of associated risk factors. These include family history, tobacco use, and body type. Tall, thin persons are most vulnerable to primary spontaneous pneumothorax.

How Is Pneumothorax Diagnosed?

To diagnose pneumothorax, your physician will document symptoms and conduct a physical exam. He or she will also arrange for:

• A chest X-ray: A chest X-ray will allow your physician to see the outline of your lungs. A collapsed lung will be evident from its shrunken or misshapen appearance in the X-ray.
• A CT scan: A CT scan is an X-ray series that provides a cross-sectional view of the lungs. This image will provide greater detail than that of a single X-ray. 
• An electrocardiogram or EKG: EKGs measure your heart’s electrical activity. Certain irregularities are indicative of medical issues involving the heart, including pressure from air buildup in the pleural cavity.
• An arterial-blood gas (ABG) or pulse oximetry test: An ABG test measures the amount of oxygen and carbon dioxide in the blood. Pulse oximetry is a similar metric. Low oxygen and high carbon dioxide levels are evidence of respiratory dysfunction in the lungs.

How Is Pneumothorax Treated?

Pneumothorax treatment will depend on the cause, severity, and extent of lung collapse. Treatment methods include:

• Observation: If damage is minimal, collapsed lungs sometimes re-inflate themselves. Your physician may take a wait-and-see approach, keeping you under observation in case there is a sudden worsening of symptoms.
• Oxygen: Supplemental oxygen is sometimes prescribed for patients with a partial lung collapse.
• Needle aspiration: A hollow needle is inserted in the pleural cavity, to remove air by suction.
• Chest-tube drainage: Chest-tube drainage is similar to needle aspiration. A small plastic tube is inserted in the chest to remove air. The collapsed lung re-inflates, when freed of pressure.
• Autologous blood patch: Some procedures are designed to close air leaks into the pleural cavity. One of these is the autologous blood patch, which deploys a blood sample from the arm to form a sealant on the leak, stopping the flow of air out of the lungs.
• Surgery: Surgical procedures include open-chest thoracotomy and video-assisted thoracoscopic surgery (VATS). The former utilizes a catheter to suction out air from the pleural cavity; the latter is a minimally invasive procedure using tiny cameras and surgical tools to repair air leaks into the pleural cavity.
• Pleurodesis: Pleurodesis is a major invasive technique for persons with recurrent cases of lung collapse. It involves the purposeful irritation of the pleural cavity, joining it to the chest wall, and eliminating the possibility that air can enter the membranous structures surrounding the lungs.

Recovery from pneumothorax can take time. While recuperating, remember to:

• Observe your symptoms
• Refrain from lifting sizable objects
• Resume your exercise and other physical routines gradually
• Avoid activities like flying that expose you to sudden changes in air pressure.

The outlook for persons with pneumothorax is generally favorable, if the condition is properly diagnosed and treated in a timely fashion. More serious forms of lung collapse, resulting from traumatic injury, present a greater challenge.

Can Pneumothorax be Prevented?

Pneumothorax isn’t preventable, especially from an unknown or spontaneous cause. It is, however, possible to reduce the risk of a recurrent condition. You should:

• Stop smoking and the use of any tobacco products
• Avoid activities that involve sudden changes in air pressure (e.g., diving or mountain climbing).
• Avoid air travel, unless cleared to fly by your physician
• Keep regular appointments with your healthcare providers, especially if you have a chronic respiratory disorder.

Learn More About Pneumothorax from Baptist Health

If you’re dealing with a respiratory ailment or condition, see your Baptist Health physician. He or she will be able to assess your condition and determine which medical treatments, if any, are most appropriate for you.