Pneumothorax

Definition
Pneumothorax is a collection of air or gas in the chest or pleural space that causes part or all of a
lung to collapse.

Description
Normally, the pressure in the lungs is greater than the pressure in the pleural space surrounding the
lungs. However, if air enters the pleural space, the pressure in the pleura then becomes greater
than the pressure in the lungs, causing the lung to collapse partially or completely. Pneumothorax
can be either spontaneous or due to trauma.
If a pneumothorax occurs suddenly or for no known reason, it is called a spontaneous
pneumothorax. This condition most often strikes tall, thin men between the ages of 20 to 40. In
addition, people with lung disorders, such as emphysema, cystic fibrosis, and tuberculosis, are at
higher risk for spontaneous pneumothorax. Traumatic pneumothorax is the result of accident or
injury due to medical procedures performed to the chest cavity, such as thoracentesis or
mechanical ventilation. Tension pneumothorax is a serious and potentially life-threatening condition
that may be caused by traumatic injury, chronic lung disease, or as a complication of a medical
procedure. In this type of pneumothorax, air enters the chest cavity, but cannot escape. This greatly
increased pressure in the pleural space causes the lung to collapse completely, compresses the
heart, and pushes the heart and associated blood vessels toward the unaffected side.

Causes and symptoms

The symptoms of pneumothrax depend on how much air enters the chest, how much the lung
collapses, and the extent of lung disease. Symptoms include the following, according to the cause
of the pneumothorax:

• Spontaneous pneumothorax. Simple spontaneous pneumothorax is caused by a rupture

of a small air sac or fluid-filled sac in the lung. It may be related to activity in otherwise
healthy people or may occur during scuba diving or flying at high altitudes. Complicated
spontaneous pneumothorax, also generally caused by rupture of a small sac in the lung,
occurs in people with lung diseases. The symptoms of complicated spontaneous
pneumothorax tend to be worse than those of simple pneumothorax, due to the
underlying lung disease. Spontaneous pneumothorax is characterized by dull, sharp, or
stabbing chest pain that begins suddenly and becomes worse with deep breathing or
coughing. Other symptoms are shortness of breath, rapid breathing, abnormal breathing
movement (that is, little chest wall movement when breathing), and cough.
• Tension pneumothorax. Following trauma, air may enter the chest cavity. A penetrating
chest wound allows outside air to enter the chest, causing the lung to collapse. Certain
medical procedures performed in the chest cavity, such as thoracentesis, also may
cause a lung to collapse. Tension pneumothorax may be the immediate result of an
injury; the delayed complication of a hidden injury, such as a fractured rib, that punctures
the lung; or the result of lung damage from asthma, chronic bronchitis, or emphysema.
Symptoms of tension pneumothorax tend to be severe with sudden onset. There is
marked anxiety, distended neck veins, weak pulse, decreased breath sounds on the
affected side, and a shift of the mediastinum to the opposite side.

Diagnosis
To diagnose pneumothorax, it is necessary for the health care provider to listen to the chest
(auscultation) during a physical examination. By using a stethoscope, the physician may note that
one part of the chest does not transmit the normal sounds of breathing. A chest x ray will show the
air pocket and the collapsed lung. An electrocardiogram (ECG) will be performed to record the

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electrical impulses that control the heart's activity. Blood samples may be taken to check for the
level of arterial blood gases.

Treatment
A small pneumothorax may resolve on its own, but most require medical treatment. The object of
treatment is to remove air from the chest and allow the lung to re-expand. This is done by inserting
a needle and syringe (if the pneumothorax is small) or chest tube through the chest wall. This
allows the air to escape without allowing any air back in. The lung will then re-expand itself within a
few days. Surgery may be needed for repeat occurrences.

Prognosis
Most people recover fully from spontaneous pneumothorax. Up to half of patients with spontaneous
pneumothorax experience recurrence. Recovery from a collapsed lung generally takes one to two
weeks. Tension pneumothorax can cause death rapidly due to inadequate heart output or
insufficient blood oxygen (hypoxemia), and must be treated as a medical emergency.

Prevention
Preventive measures for a non-injury related pneumothorax include stopping smoking and seeking
medical attention for respiratory problems. If the pneumothorax occurs in both lungs or more than
once in the same lung, surgery may be needed to prevent it from occurring again.

Key terms
Electrocardiagram — A test that provides a typical record of normal heart action.
Mediastinum — The space between the right and left lung.
Pleural — Pleural refers to the pleura or membrane that enfolds the lungs.
Thoracentesis — Also called a pleural fluid tap, this procedure involves aspiration of fluid from the
pleural space using a long, thin needle inserted between the ribs.

Resources

Organizations
American Association for Respiratory Care. 11030 Ables Lane, Dallas, Texas 75229. (972) 243-
2272. http://www.aarc.org.
American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872.
http://www.lungusa.org.

pneumothorax /pneu·mo·tho·rax/ (-thor´aks) air or gas in the pleural space, usually as a result
of trauma (traumatic or open p.) or some pathological process.
tension p. pneumothorax in which the pressure within the pleural space is greater than
atmospheric pressure; as a result, the mediastinum is displaced to one side, which interferes with
breathing.

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Tension pneumothorax.

http://medical-dictionary.thefreedictionary.com/Punctured+lung