In a healthy body, the lungs are touching the walls of the chest. A pneumothorax occurs when air gets into the space between the chest wall and the lung, called the pleural space.
The pressure of this air causes the lung to collapse on itself. The lung may fully collapse, but most often only a part of it collapses. This collapse can also put pressure on the heart, causing further symptoms.
A few different things can cause pneumothorax, and symptoms can vary widely. Doctors can help to diagnose and treat pneumothorax.
The causes of pneumothorax are categorized as either primary spontaneous, secondary spontaneous, or traumatic.
If air gets in between the lung and the chest wall, it can cause the lung to collapse in on itself.
A primary spontaneous pneumothorax (PSP) occurs when the person has no known history of lung disease. The direct cause of PSP is unknown.
At-risk groups for primary spontaneous pneumothorax include:
- tobacco or cannabis smokers
- tall men
- people ages 15-34
- people with a family history of pneumothoraces
The most important risk factor associated with PSP is smoking tobacco. A review in the medical journal BMJ noted that men who smoke tobacco are 22 times more likely to develop PSP than nonsmokers. Women who smoke tobacco are nine times more likely than nonsmokers to develop PSP.
If treated promptly, PSP is usually not fatal.
Secondary spontaneous pneumothorax (SSP) can be caused by a variety of lung diseases and disorders.
SSP carries more serious symptoms than PSP, and it is more likely to cause death.
Lung diseases that may increase the risk of developing pneumothorax include:
- chronic obstructive pulmonary disease (COPD)
- cystic fibrosis
- severe asthma
- lung infections, such as tuberculosis and certain forms of pneumonia
- thoracic endometriosis
- pulmonary fibrosis
- lung cancer and sarcomas involving the lungs
Certain connective tissue disorders may also cause SSP. These disorders include:
- rheumatoid arthritis
- polymyositis and dermatomyositis
- ankylosing spondylitis
- systemic sclerosis
- Ehlers-Danlos syndrome
- Marfan's syndrome
Under certain conditions, children are also at risk for SSP. Causes of SSP in children include:
- congenital malformations
- inhaling a foreign object
The risk may also be higher if a family member has previously experienced SSP.
A traumatic pneumothorax can occur without a noticeable wound, such as while scuba diving or after an explosion.
A traumatic pneumothorax is the result of an impact or injury. Potential causes include blunt trauma or an injury that damages the chest wall and pleural space.
One of the most common ways this occurs is when someone fractures a rib. The sharp points of the broken bone can puncture the chest wall and damage lung tissue. Other causes include sports injuries, car accidents, and puncture or stab wounds.
A traumatic pneumothorax can occur even if there is no noticeable wound on the chest. This is common in people who have experienced a blast trauma from an explosion.
Scuba divers have to take precautions when underwater to prevent pneumothorax. When divers breathe from a compressed air tank, they experience different levels of pressure from the water and the air itself. The force of these different pressures can cause damage to the lungs, which may take the form of a pneumothorax.
Certain medical procedures may also lead to traumatic pneumothorax. Inserting a catheter into a vein in the chest or taking a sample of lung tissue may lead to a pneumothorax. Doctors will often monitor people after these procedures to catch any early signs that may need treatment.
Any of these types of pneumothorax can turn into a tension pneumothorax. This is caused by a leak in the pleural space that resembles a one-way valve.
As a person inhales, the air leaks into the pleural space and becomes trapped. It cannot be released during an exhale. This process leads to increased air pressure in the pleural space that is life-threatening and needs immediate treatment.
Symptoms of pneumothorax may hardly be noticeable at first and can be confused with other disorders.
The symptoms of pneumothorax can vary from mild to life-threatening and may include:
- shortness of breath
- chest pain, which may be more severe on one side of the chest
- sharp pain when inhaling
- pressure in the chest that gets worse over time
- blue discoloration of the skin or lips
- increased heart rate
- rapid breathing
- confusion or dizziness
- loss of consciousness or coma
Some cases of pneumothoraces have almost no symptoms. These can only be diagnosed with an X-ray or another type of scan. Others require emergency medical attention. Anyone experiencing the symptoms above should contact their doctor or seek immediate medical help.
Diagnosing pneumothorax can be complicated due to the variety of symptoms and causes.
In non-emergency situations, doctors will first physically examine a person to look for signs of the disorder. They may tap on their chest to check for abnormal sounds or listen to their breathing through a stethoscope.
A doctor will usually use an X-ray to look for signs of a collapsed lung.
Doctors will also ask someone about their medical history and habits, such as smoking. They may also ask about any family history of lung disorders.
Imaging is an important part of most diagnoses. Doctors use X-rays to take images of the chest and look for signs of a collapsed lung. A technician takes the X-ray while the person inhales fully and holds their breath.
The size of the pneumothorax is usually measured as the space between the lung and chest wall. The size of the pneumothorax often determines how it is treated.
CT scans are used to get a better picture of the lung than an X-ray provides. Doctors often use CT scans in trauma situations when they need an accurate image of a puncture wound or other damage for treatment.
Ultrasound is used in some situations and can provide a quick way to view the size and severity of a pneumothorax. It may be more sensitive than X-rays for examining blunt trauma.
In cases of a severe tension pneumothorax, the evidence of the collapsed lung is often very obvious and requires immediate attention to prevent permanent damage or death.
Most forms of pneumothorax require medical attention. The extent of this medical attention can vary as much as the disorder itself.
The standard medical treatment usually involves inserting a small tube between the ribs or under the collarbone to release the gas that has built up. This will slowly decompress the lung.
Doctors may prescribe various drugs to numb pain, help remove toxins, or prevent infection in the body. Some people may need oxygen if their lung capacity is deficient.
Surgical treatment may be necessary in some cases, especially in individuals who have had repeated pneumothoraces.
People with SSP are more likely to need medical attention due to the serious nature of the lung diseases associated with the condition. Those with SSP may experience more severe symptoms and face a greater risk of serious complications and death.
Some very small pneumothoraces may heal without any treatment. Doctors may give their patients the option to allow the pneumothorax to heal under supervision without taking any medical or surgical action.
A person who experiences any signs or symptoms should report them to a doctor. They can decide whether medical intervention is necessary to reduce the risk of serious events.
Pneumothorax can be difficult to diagnose and to treat. A person needs to work closely with their doctor to make sure the treatment is successful.
Pneumothoraces should not be taken lightly and may be life-threatening in certain situations.
Most cases can be treated with prompt medical intervention. Working with a doctor, as soon as symptoms are noticed, is the best way to ensure the pneumothorax heals correctly.