What is a pneumothorax?
Pneumothorax is when air collects outside of the lung tissue and into the chest cavity causing the lung to deflate. It may be accompanied by shortness of breath and/or pain with deep breathing. When severe, it can cause a person to collapse and may even allow for air to be felt under the skin (i.e., crunchy like dry cereal). There are two main kinds of air leakage. First, the lung itself may tear open allowing air to leak from the lung into the chest cavity. This is called a bronchopleural fistula. The second kind is when a wound in the chest wall allows air to be sucked into the chest cavity from the atmosphere. This is commonly referred to as an open pneumothorax. If a significant amount of air is collected, pressure can build up in the chest causing it hard to breath and making it difficult for blood to flow to and from the heart. This is commonly referred to as a tension pneumothorax and can be fatal if not appropriately treated.
Why do people get a pneumothorax?
There are many reasons to have a pneumothorax, but the common denominator is damage to the lung or chest wall. This may be due to a lung disease, surgery, or chest trauma. The most common lung disease leading to pneumothorax is COPD or chronic obstructive pulmonary disease. More rare lung diseases that cause a pneumothorax include alpha-one antitrypsin disease, eosinophilic bronchitis, and lymphangioleiomyomatosis. Being on a mechanical ventilator with increased air pressure may also cause a pneumothorax.
How is a pneumothorax treated?
The air that leaks outside of the lung needs to either be drained or re-absorbed by the lung. The most common way to drain the air is by placing a tube in the chest wall and sucking the air back into a collection system, allowing the lung to re-expand. If the air leak is small, the lung may be able to reabsorb the air. Air, however, is made up of nitrogen, carbon dioxide and oxygen. While the lung can readily and frequently handle oxygen and carbon dioxide, it cannot absorb the nitrogen. Frequently supplemental oxygen (by mask or nasal cannula) is given to the patient to “flush out” the nitrogen and replace it with oxygen, so that the lung can absorb it.
If a pneumothorax recurs, sometimes the area of damaged lung must be removed by a surgeon and an adhesive (or pleurodesis) agent is placed in the chest cavity to hold the lung to the chest wall and prevent it from deflating in the future.
What are the usual tests that are done if a pneumothorax is suspected or found?
The first test is usually a chest x-ray. This is sometimes done with the person blowing a deep breath out to get a better view of the deflated lung. Other tests may include a CT scan of the chest to look for further lung damage, pulse oximetry or arterial oxygen measurement, and blood work.
Does having a pneumothorax limit your activity?
Yes. Patients with pneumothorax who have a chest tube will not be able to do heavy lifting, scuba diving, or air travel until they are well-healed. Once the pneumothorax is healed, your doctor will discuss with you if, and when, you are able to resume these activities.
What happens if a pneumothorax does not improve?
Sometimes the hole in the lung does not close and seal itself. This is called a bronchopleural fistula. Surgery may be required to help close the hole. Sometimes, if the lung and chest are not infected, the hole may be allowed to remain open chronically. Sometimes, this can be “glued shut” with fibrin glue and other lung closure devices.
Self-check for management of a pneumothorax
- I have been evaluated for the cause of my pneumothorax.
- I have quit smoking and will avoid smoking environments.
- I am aware of the dangers of changing altitudes or barometric pressure.
Managing Doctors
- Primary Care
- Pulmonary
- Thoracic Surgery