A pneumothorax is an abnormal collection of air in the pleural space and occurs when air leaks into the space between your lungs and chest wall.

This air pushes on the outside of your lung and makes it collapse. In most cases, only a portion of the lung collapses. This causes chest pain and difficulty breathing or shortness of breath.

A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures involving your lungs or damage from underlying lung disease such as emphysema. Sometimes, pneumothorax occurs spontaneously in young, tall, healthy people and is often related to small pockets of abnormal lung tissue at the apex of the lung.

A small, uncomplicated pneumothorax may quickly heal on it’s own. When the pneumothorax is larger, a doctor usually inserts a tube or needle between your ribs to remove the excess air.

What causes a pneumothorax?

The lungs normally inflate by increasing the size of the chest cavity, resulting in a negative (vacuum) pressure in the pleural space (the area within the chest cavity but outside the lungs). If air enters the pleural space either by a hole in the lung or the chest wall, the pressure in the pleural space equals the pressure outside the body. Thus, the vacuum is lost and the lung collapses.

Spontaneous pneumothorax is caused by a rupture of a cyst or a small sac (bleb) on the surface of the lung. Pneumothorax may also occur following an injury to the chest wall such as a fractured rib, any penetrating injury (gunshot or stabbing) or surgical procedures on the chest. A pneumothorax can also develop as a result of underlying lung diseases, including cystic fibrosis, chronic obstructive pulmonary disease (COPD), lung cancer, asthma, and infections of the lungs.

What are the signs and symptoms of pneumothorax?

Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is sharp and may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue are other symptoms of pneumothorax. The skin may develop a bluish colour (cyanosis) due to decreased blood oxygen levels.

How is pneumothorax diagnosed?

Examination of the chest with a stethoscope reveals decreased or absent breath sounds over the affected lung. The diagnosis is confirmed by chest X-ray.

What is the treatment for pneumothorax?

A small pneumothorax without underlying lung disease may resolve on its own in one to two weeks. A larger pneumothorax or a pneumothorax associated with underlying lung disease often requires drainage of the free air and/or placement of a chest tube to evacuate the air. Possible complications of chest tube insertion include pain, infection of the space between the lung and chest wall, bleeding, fluid accumulation in the lung, and low blood pressure. In some cases, the air leak from the lung does not heal on its own and may require chest surgery to repair the hole in the lung. When a pneumothorax has occurs more than once or there is underlying lung disease a procedure called pleurodesis is recommended to prevent the pneumothorax from recurring. During this procedure it is often possible to staple and thereby seal the abnormal area of the lung from where the air is leaking. A pleurodesis is an operation performed under general anaesthetic where an irritating substance (sterile talc) is injected through a small hole between the ribs into the pleural space. The talc inflames the pleura (lining of the lung and chest wall) causing the lung and inner chest wall to bind tightly to each other as they heal. This can prevent the pneumothorax from recurring. Risks of a pleurodesis include infection, pain and collection of fluid around the lung or in the lung. One or two drainage tubes will be left in the chest for a few days afterward to reduce the risk of any of these problems and to remove any fluid or air in the chest cavity. Once the drainage tubes are removed you can usually go home. If your symptoms recur again after discharge you should seek medical advice with your GP, the emergency department or contact Dr Orr’s rooms.

What is the outcome (prognosis) of pneumothorax?

The outcome of pneumothorax depends upon the extent and type of pneumothorax. A small spontaneous pneumothorax will generally resolve on its own without treatment. A pneumothorax associated with underlying disease (secondary pneumothorax), even when small, is more serious and usually requires immediate treatment. Having one pneumothorax increases the risk of developing the condition again. The recurrence rate for both primary and secondary pneumothorax is about 30-40%; most recurrences occur within 1.5 to two years.

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