A pneumothorax is air that is trapped between a lung and the chest wall. The air gets there either from the lungs or from outside the body.

Primary spontaneous pneumothorax

This means that the pneumothorax develops for no apparent reason in an otherwise healthy person. This is the common type of pneumothorax. It is thought to be due to a tiny tear of an outer part of the lung - usually near the top of the lung. However, the tear often occurs at the site of a tiny bleb or bullae on the edge of a lung. Air then escapes from the lung but gets trapped between the lung and the chest wall. Most occur in healthy young adults who do not have any lung disease. It is more common in tall thin people.

Secondary spontaneous pneumothorax

This means that the pneumothorax develops as a complication (a secondary event) of an existing lung disease. This is more likely to occur if the lung disease weakens the edge of the lung in some way. So, for example, a pneumothorax may develop as a complication of chronic obstructive airways disease (COPD) - especially where lung bullae have developed in this disease. Other lung diseases that may be complicated by a pneumothorax include: pneumonia, tuberculosis, sarcoidosis, cystic fibrosis, lung cancer, and idiopathic pulmonary fibrosis.An injury to the chest can cause a pneumothorax.

What are the symptoms of a pneumothorax?

A sharp, stabbing pain on one side of the chest, which suddenly develops. The pain is usually made worse by breathing in (inspiration). You may become breathless.

A chest X-ray can confirm a pneumothorax. Other tests may be done if a lung disease is the suspected cause.

What happens to the trapped air and small tear on the lung?

In most cases of spontaneous pneumothorax, the pressure of the air that leaks out of the lung and the air inside the lung equalises. The amount of air that leaks varies. Often it is quite small and the lung collapses a little. Sometimes it can be large and the whole lung collapses.

The small tear that caused the leak usually heals within a few days, especially in cases of primary spontaneous pneumothorax. Air then stops leaking in and out of the lung. The trapped air of the pneumothorax is gradually absorbed into the bloodstream. The lung then gradually expands back to its original size. Symptoms may last as short as 1-3 days in cases of primary spontaneous pneumothorax.

Tension pneumothorax

This is a rare complication. This causes shortness of breath that quickly becomes more and more severe. This occurs when the tear on the lung acts like a one-way valve. In effect, each breath in (inspiration) pumps more air out of the lung, but the valve action stops air coming back into the lung. The volume and pressure of the pneumothorax increases. This puts pressure on the lungs and heart. Emergency treatment is needed to release the trapped air.

What is the treatment for pneumothorax?

No treatment may be needed

You may not need any treatment if you have a small pneumothorax. A small pneumothorax is likely to clear over a few days.

Aspirating (removing) the trapped air is sometimes needed

This may be needed if there is a larger pneumothorax or if you have other lung or breathing problems. As a rule, a pneumothorax that makes you breathless is best removed. It is essential to remove the air quickly in a tension pneumothorax. The common method of removing the air is to insert a very thin tube through the chest wall with the aid of a needle. Sometimes a larger tube is inserted through the chest wall to remove a large pneumothorax. This is more commonly needed for cases of secondary spontaneous pneumothorax when there is underlying lung disease. Commonly, the tube is left place for a few days to allow the lung tissue that has torn to heal.

Treating recurrences

Some people have repeated episodes of spontaneous pneumothorax. If this occurs, a procedure may be advised with the aim of preventing further recurrences. It may be a small bleb on the lung surface, which can be removed. Another procedure that may be advised is for an irritant powder (usually a kind of talc powder) that can be put on the lung surface. This causes an inflammation which then helps the lung surface to stick to the chest wall better.

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