Pneumothorax

Pneumothorax, commonly called a collapsed lung, occurs when air collects in the pleural space around the lungs, preventing the lung from fully expanding.

A pneumothorax develops in the pleural space, the small area between the two thin layers of tissue (the pleura) that surround the lungs. Normally, this space contains only a small amount of fluid that allows the lungs to move smoothly during breathing. When air enters the pleural space, pressure can build around the lung and cause part or all of the lung to collapse.

A collapsed lung can happen suddenly and may occur for several reasons. Some pneumothoraces develop without an obvious cause, while others result from lung disease, chest injury, or medical procedures. Symptoms often include sudden chest pain, shortness of breath, rapid breathing, or a feeling of tightness in the chest. Pneumothorax can affect people of all ages, but certain groups—including people with underlying lung conditions, smokers, and tall, thin young adults—may have a higher risk.

What is a pneumothorax?

A pneumothorax is a condition in which air enters the pleural space, the small area between the lungs and the chest wall. Because the pleural space normally contains only a thin layer of fluid, the presence of air can create pressure around the lung and prevent it from expanding normally. As pressure builds, part or all of the lung may collapse, which is why a pneumothorax is often called a collapsed lung.

The amount of lung collapse can vary. Some pneumothoraces are small and cause only mild symptoms, while others are larger and can significantly affect breathing. Symptoms may develop suddenly and range from mild chest discomfort to more noticeable shortness of breath and chest pain.

There are several types of pneumothorax:

• Spontaneous pneumothorax: Occurs without an obvious injury and may happen in otherwise healthy people or in people with underlying lung disease
• Traumatic pneumothorax: Develops after an injury to the chest, such as trauma from an accident or a fractured rib
• Iatrogenic pneumothorax: Occurs as a complication of certain medical procedures involving the chest or lungs
• Tension pneumothorax: A more serious form in which pressure continues to build inside the chest and can become a critical medical emergency

Understanding the type and cause of a pneumothorax helps guide diagnosis and treatment decisions.

What are the symptoms of pneumothorax?

Symptoms of a pneumothorax, or collapsed lung, can vary depending on the size of the pneumothorax and how much of the lung is affected. Some people experience mild symptoms, while others develop more significant breathing problems.

Common symptoms of pneumothorax may include:

• Sudden chest pain
• Shortness of breath
• Rapid breathing
• Chest tightness
• Fast heart rate
• Fatigue or feeling lightheaded

Symptoms often develop suddenly and can worsen if more air collects in the pleural space.

What causes a pneumothorax?

A pneumothorax can develop for several reasons. Some occur without an obvious cause, while others are related to injury or underlying lung disease.

Risk factors may include:

• Smoking
• Chronic lung disease
• Chest injury or trauma
• Certain medical procedures
• Family history
• Tall, thin body type

How is a pneumothorax diagnosed?

Diagnosing a pneumothorax usually begins with a review of symptoms and a physical examination. Because a collapsed lung can cause symptoms such as sudden chest pain, shortness of breath, or rapid breathing, your doctor will ask about your medical history, recent injuries, and any underlying lung conditions.

Imaging tests are often used to confirm the diagnosis and determine the size and severity of the pneumothorax. These tests may include:

• Chest X-ray: Often the first test used to identify air in the pleural space and evaluate the degree of lung collapse
• CT scan: Provides more detailed images and may help identify smaller pneumothoraces or underlying lung conditions
• Ultrasound: In some settings, ultrasound may be used to quickly evaluate the lungs and pleural space

The results of these tests help guide treatment decisions and determine whether monitoring or intervention may be needed.

How is a pneumothorax treated?

Treatment for a pneumothorax, or collapsed lung, depends on several factors, including the size of the pneumothorax, the severity of symptoms, and whether an underlying lung condition is present.

Treatment options may include:

• Observation and monitoring: Small pneumothoraces sometimes improve on their own and may only require follow-up imaging and monitoring
• Oxygen therapy: Supplemental oxygen may help improve symptoms and support recovery
• Needle aspiration or drainage: Removing air from the pleural space can allow the lung to re-expand
• Chest tube placement: Larger pneumothoraces may require a chest tube to continuously remove air around the lung
• Surgery: For recurrent pneumothoraces or more complex cases, surgery may help prevent future episodes

The goal of treatment is to remove air from the pleural space, allow the lung to fully expand, relieve symptoms, and reduce the chance of recurrence. The treatment approach recommended for each patient depends on their individual condition and overall health.

What are the potential risks and complications of pneumothorax?

The risks and complications of a pneumothorax, or collapsed lung, can vary depending on the size of the pneumothorax, the cause, and a person’s overall health. Some pneumothoraces are small and resolve with minimal treatment, while others may require urgent medical attention.

Potential complications of pneumothorax may include:

• Worsening shortness of breath: As more air collects in the pleural space, breathing may become increasingly difficult
• Progressive lung collapse: Additional pressure around the lung can cause a larger portion of the lung to collapse
• Recurrence: Some people experience repeat pneumothoraces, especially if they have certain risk factors or underlying lung conditions. The risk of future recurrence increases substantially with every episode of pneumothorax
• Persistent air leak: In some cases, air may continue leaking into the pleural space and require additional treatment
• Reduced lung function: Larger or repeated pneumothoraces can affect normal breathing and lung performance
• Tension pneumothorax: A severe form of pneumothorax in which pressure continues to build in the chest, potentially affecting the lungs and heart; this is considered a medical emergency

Seek prompt medical attention if symptoms such as sudden chest pain, shortness of breath, or difficulty breathing develop or worsen.

Early evaluation and treatment can often help reduce complications, prevent future recurrence and improve recovery.