Definition & Overview

Pneumothorax is a condition characterized by the collapse of one or both lungs due to the accumulation of air or gas between the parietal pleura and viscera of the lung.

Cause of Condition

There are different types of pneumothorax, and each is a result of a variety of factors. These include:

  • Primary spontaneous pneumothorax occurs in healthy people and is not often associated with a known cause, such as an injury or disease. However, the majority of the cases are associated with the rupture of a bleb (air blisters that form on top of the lungs). Blebs are not considered a disease, but can cause air from the lungs to leak into the cavity if they rupture.

  • Secondary pneumothorax is caused by an underlying medical condition of the lungs, such as diseases of the airways, lung infections, interstitial lung disease, cancer, and connective tissue diseases. The most common causes are emphysema, tuberculosis, ankylosing spondylitis, lung cancer, acute severe asthma, and cystic fibrosis.

  • Tension pneumothorax is a medical emergency characterized by the increase of air pressure in the cavity, usually caused by a laceration in the lung that has formed in a one-way valve, which lets air out of the lung but not does permit air back in.

  • Traumatic pneumothorax is caused by an injury to the chest, which causes air to leak from the lungs to the thoracic cavity. Stab wounds, accidents, and bullet wounds can cause such injuries.

  • Iatrogenic pneumothorax is a direct result of a medical procedure, such as central venous catheter insertion, transthoracic lung biopsy, and thoracentesis. It can also be caused by medical equipment, such as mechanical ventilation and tracheostomy tube placement.

  • Catamenial pneumothorax is a rare form of spontaneous pneumothorax. The condition occurs in women during their menstrual cycle. The exact cause is unknown but it is believed that the condition is associated with endometriosis. This form of pneumothorax is recurring, but usually only during the menstrual period.

Key Symptoms

The primary symptom of pneumothorax is a sudden onset of chest pain and difficulty breathing. If the pain is severe, you should proceed to a hospital’s emergency department or call for emergency medical services.

Other symptoms are chest tightness, rapid heart rate, fatigue, and a bluish skin color due to the lack of oxygen. However, it is also important to note that not all patients will display symptoms of the condition. For instance, primary spontaneous pneumothorax is usually asymptomatic and only displays symptoms when a bleb ruptures.

Who to See & Types of Treatment Available

If you believe that the symptoms you’re experiencing are that of a pneumothorax, but the situation does not necessarily indicate an emergency, it’s best to consult your primary care physician. Your doctor will have you undergo several different tests to provide an accurate diagnosis of your condition. You will also be referred to a respiratory specialist for further diagnosis and treatment.

However, if the symptoms prevent you from functioning normally, you should be taken to a hospital’s emergency department. Some cases of pneumothorax, such as tension pneumothorax and traumatic pneumothorax are considered medical emergencies.

The most common tests used in the diagnosis of pneumothorax are x-rays and CT-scans. In some cases, these tests are combined to produce cross-sectional images.

Treatment will depend on the severity of your condition. However, if the condition is tension pneumothorax, a tube will be inserted into your chest to relieve the pressure and prevent the lung/s from collapsing. This method may also be used in different forms of pneumothorax, depending on the doctor’s assessment of the situation.

Regardless of the type, once the doctor suspects your condition may be a pneumothorax, you’ll be given supplemental oxygen to help you breathe better. Once this happens, you can expect that you’ll be admitted to the hospital. The length of time you’ll spend at the hospital will depend on the type of treatment and your ability to recover from the condition.

Some forms of pneumothorax may be treated using simple needle aspiration. In this procedure, a needle is inserted into the chest between the ribs. Air accumulated in the thoracic cavity will pass through the needle, relieving pressure on the lungs in the process. In some cases, the patient may not need to be admitted, but will need to return to the hospital immediately if he or she finds it difficult to breathe.

If a simple aspiration is not enough to treat the condition, the patient will likely need an intercostal tube drainage, which essentially involves inserting a chest drain tube. Severe or difficult cases may require surgery. If so, a thoracic surgeon will need to perform the procedure, such as an open thoracotomy.

If surgery is not preferred, but there is a high risk of recurrence, another option is a procedure called pleurodesis, which involves obliterating the space between the membranes to prevent any air from leaking out of the lungs. However, this procedure is only considered if the patient is unwilling to undergo surgery.

Spontaneous pneumothorax rarely results in death, but the rate of recurrence is high. If a person has been successfully treated for spontaneous pneumothorax, preventive measures, such as living a healthy life and quitting smoking, should be taken to prevent the condition from recurring.

References:

  • Light RW, Lee GY. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Mason RJ, Murray JF, Broaddus VC, et al., eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Elsevier Saunders; 2010:chap 74.
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