Traumatic pneumothorax occurs when a physical injury causes the lung to collapse. It can be the result of a blunt or penetrating chest injury (gunshot or knife wounds to the chest, automobile accidents), or can occur as a complication following certain medical procedures. High-risk medical procedures include transbronchial biopsy, pleural biopsy, thoracentesis, central venous catheter placement, intercostal needle anesthesia, and esophagoscopy.

Traumatic pneumothorax is often accompanied by hemothorax (a collection of blood between the lung and chest wall).

History of recent chest injury or high-risk procedure, plus:

• chest pain
• shortness of breath
• breathing, rapid
• chest tightness
• hypoxemia (low oxygen level in blood)

Listening to the chest with a stethoscope may reveal decreased breath sounds on one side of the chest. There may be a bluish coloration of the skin caused by lack of oxygen. The affected person may have a rapid heart rate.

Tests:

• chest X-ray
• pulse oximetry
• arterial blood gas

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

Aspiration of air through a catheter to a vacuum bottle may reexpand the lung.

The placement of a chest tube between the ribs into the pleural space (see accompanying illustrations) allows the evacuation of air from the pleural space when simple aspiration is not successful, or if the pneumothorax is large. Re-expansion of the lung may take several days with the chest tube left in place.

Hospitalization is required for chest tube management. Antibiotics may be given while the chest tube is in place.

Surgery may be needed to repair tears in the lungs or bronchi.

Immediate prognosis depends on the extent of the initial chest trauma and any other associated injuries. However, there are usually no long-term complications following successful therapy for an isolated pneumothorax.

• If untreated, tension pneumothorax can develop.
• There is a small risk of infection from placement of a chest tube.

Call your health care provider if symptoms recur after treatment of a traumatic pneumothorax.

Use safety measures (such as seat belts) to prevent physical injuries.