Pneumothorax

Pneumothorax

Definition:

A collection of air or gas in the pleural space, which surrounds the lungs. See also spontaneous pneumothorax, traumatic pneumothorax, and tension pneumothorax.

Alternative Names:

Air around the lung; Air outside the lung; Primary pneumothorax; Secondary pneumothorax; Tension pneumothorax

Causes, incidence, and risk factors:

There are several types of pneumothorax, which are classified by cause.

Spontaneous pneumothorax is the occurrence of pneumothorax without a clear cause. Primary spontaneous pneumothorax occurs when there is no known underlying lung disease. It is thought to be caused by the rupture of a small, air-filled sac in the lung called a bleb or a bulla. The disease affects tall, thin men between 20 and 40 years old most frequently. Cigarette smoking and family history are contributing factors.

Secondary spontaneous pneumothorax is a complication of underlying pulmonary (lung) disease (COPD, asthma, cystic fibrosis, tuberculosis, whooping cough).

Traumatic pneumothorax results from a traumatic injury to the chest. The trauma may be penetrating (stab wound, gunshot) or blunt (blow from a motor vehicle accident). Pneumothorax may complicate certain medical procedures.

Tension pneumothorax is caused when excessive pressure builds up around the lung, forcing it to collapse. The excessive pressure can also prevent the heart from pumping blood effectively, leading to shock.

Symptoms:

sudden sharp chest pain, especially made worse by a deep breath or a cough
shortness of breath
chest tightness
easy fatigue
rapid heart rate
bluish color of the skin caused by lack of oxygen

Note: Symptoms may begin during rest or sleep.

Additional symptoms that may be associated with this disease:

Signs and tests:

Stethoscope examination of the chest reveals decreased breath sounds on the affected side.

Tests include:

chest X-ray to determine presence of air outside the lung
arterial blood gases

Treatment:

The objective of treatment is to remove the air from the pleural space, allowing the lung to re-expand. Small pneumothoraces may resolve on their own.

The placement of a chest tube (chest tube insertion) between the ribs into the pleural space allows the evacuation of air from the pleural space. With the chest tube left in place, the lung may take several days to reexpand. Hospitalization is required for proper care of the chest tube.

Surgery may be needed to prevent recurrent episodes.

Expectations (prognosis):

Up to 50% of patients with pneumothorax experience recurrence, but there are no long-term complications following successful therapy.

Complications:

recurrent pneumothorax
tension pneumothorax with shock

Calling your health care provider:

Call your health care provider if symptoms of pneumothorax develop; especially if you have previously experienced this condition.

Prevention:

There is no known prevention, other than to decrease risk by stopping smoking.

Review Date: 12/6/2001
Reviewed By: David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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