What is a pneumothorax?

A pneumothorax is a collection of air between the outside surface of the lung and the inside surface of the chest wall. These two surfaces are lined with a smooth membrane called pleura and normally are in contact with each other, but they can become separated when air, fluid or blood collects between them.

Occurrences

A pneumothorax can occur whenever the surface of the lung is ruptured, allowing air to exit from the lung into the pleural space. It can occur when some injury punctures the chest wall, allowing outside air to enter the pleural space. A spontaneous pneumothorax occurs without chest trauma, and is usually due to the rupture of a small cyst on the lung surface. Such cysts may occur without any associated lung disease, or they can develop due to a variety of underlying lung disorders, emphysema being the most common.

Symptoms

The major symptoms of a spontaneous pneumothorax are the sudden onset of chest pain and/or shortness of breath. A physician may suspect that a pneumothorax is present after examining the patient and learning his/ her symptoms, but the most accurate diagnostic test is a chest X-ray, which will show air collected around the outside surface of the lung.

Treatment

A pneumothorax usually does not require emergency treatment unless so much air collects in the chest that the heart and major blood vessels are compressed; this condition, called a tension pneumothorax, requires prompt removal of air from the pleural space. When the pneumothorax is not the tension variety, its treatment will depend on its size, the patient’s symptoms, whether it is a recurrent problem, and whether the hole in the lung or chest wall has sealed itself.

Treatment options include:

1. Simple observation, waiting for the air in the pleural space to be absorbed by the blood stream;
2. Removal of the air through a tube that is inserted through the chest wall into the pleural space (the tube may be removed immediately after the air has been aspirated, or it may be left in place attached to a drainage system for several days);
3. Surgical procedures. The surgical approach is generally reserved for recurrent pneumothorax.

Risks

Persons who have had one pneumothorax have an increased risk of a recurrence. Because of this increased risk and because a pneumothorax which occurs during SCUBA diving may enlarge to a dangerous size as the diver ascends, persons who have had a pneumothorax should avoid SCUBA diving.