Overview
A pneumothorax, commonly called a collapsed lung, happens when air escapes into the pleural space, the thin gap between the lung and the chest wall. The air presses on the lung, so it cannot expand fully.
A spontaneous pneumothorax comes on without an injury, sometimes alongside a condition such as COPD. A traumatic one follows a chest injury. A tension pneumothorax is a very large one that can strain the heart and lungs and make drop, so it is a life-threatening emergency.
Symptoms
Symptoms usually start suddenly:
- Sharp chest or shoulder pain, often on one side, that is worse on a deep breath or cough
- Shortness of breath
- Chest tightness
- A fast heartbeat
A small pneumothorax may cause few or no symptoms. A larger one may also cause blue or grey skin, light-headedness or fainting, and in the most serious cases collapse.
When to see a doctor
Even if the pain has settled, have sudden sharp chest pain checked the same day. Chest pain or breathlessness after any chest injury needs care at once, and so does pain or breathlessness that returns after treatment. Ask a doctor before flying, scuba diving or going to high altitude after a collapsed lung.
Causes
Air leaks out of the lung or enters through the chest wall. Common causes include:
- A chest injury, such as a broken rib or a stab wound
- A small air blister (bleb) on the lung that bursts, which scuba diving or high altitude can trigger
- A lung disease such as asthma, COPD, cystic fibrosis or tuberculosis
- A chest procedure, such as a , or being on a breathing machine
- No clear cause at all
Risk factors
- Smoking tobacco or cannabis
- Being tall and thin, and being male
- Age: it is most common in young adults and in people over 55
- A family history of spontaneous pneumothorax
- A lung disease such as asthma, COPD or tuberculosis
- A previous collapsed lung
Complications
Left untreated, a pneumothorax can lead to complete collapse of the lung and to shock, a dangerous fall in . A tension pneumothorax can cause the heart and lungs to fail.
A collapsed lung can also happen again, more so in people who are tall and thin, who keep smoking, or who have already had two or more.
Prevention
There is no sure way to prevent a collapsed lung. These steps lower the risk:
- Not smoking tobacco or cannabis
- Having lung conditions such as asthma and COPD treated
- Following standard scuba diving safety rules
Diagnosis
The doctor listens to the chest, where breath sounds may be quieter on the affected side, and checks the pulse, and oxygen level. Tests may include:
- A chest X-ray, the main test, which shows air outside the lung
- An scan of the chest
- A , if other injuries or a lung condition are suspected
- An and blood tests
Treatment
Treatment depends on the size of the pneumothorax, how breathless the person is, and the cause. A small one may heal by itself with rest, and oxygen if needed, while the doctor checks progress.
A larger one needs the air removed. A doctor can draw it out with a needle and syringe, or place a chest tube between the ribs so the air drains and the lung can expand. The tube may stay for several days, which can mean a stay in hospital, although some people go home with a small tube and a one-way valve.
If the air keeps leaking or the lung collapses again, surgery, or pleurodesis (a procedure that makes the lung stick to the chest wall), may be offered. A tension pneumothorax is treated at once, by releasing the trapped air.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Sudden sharp chest pain in a young, fit person is just gas or a muscle pull.”What is true?
Fact
A collapsed lung often affects young adults who are otherwise healthy, especially people who are tall and thin. Sudden chest pain on one side, with breathlessness, needs to be checked with a chest X-ray. Only a doctor can tell it apart from other causes.
Myth“A collapsed lung means the lung is destroyed and will never work again.”What is true?
Fact
The lung is squeezed by air outside it, not destroyed. A small pneumothorax may clear by itself, and a larger one is treated by draining the air, which lets the lung expand again.
Myth“It only happens after an accident or a blow to the chest.”What is true?
Fact
An injury can cause it, but a pneumothorax can also happen with no clear cause. Lung conditions such as asthma, COPD, cystic fibrosis and tuberculosis raise the risk, and so does a burst air blister on the lung.
Myth“Once treated, it will never come back.”What is true?
Fact
A collapsed lung can happen again. The risk is higher in tall, thin people, in those who keep smoking and in those who have had two or more already. If it keeps returning, surgery or pleurodesis can help to prevent another one.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can a collapsed lung heal on its own?
A small one sometimes does, with rest and oxygen if needed. That should only be decided after a doctor has examined you and looked at the X-ray. A larger one needs the air removed.
Will it happen again?
It can. The chance is higher in tall, thin people, in people who keep smoking and in those who have already had two or more. Stopping smoking helps, and if it keeps happening, surgery or pleurodesis can lower the chance.
Is it safe to fly or scuba dive afterwards?
Pressure changes from diving and high altitude can make an air blister on the lung burst, so ask your doctor before flying, diving or travelling to high altitude. The advice depends on the cause and on how well the lung has healed.
How is a collapsed lung different from a heart attack?
A collapsed lung is air around the lung, while a heart attack is a blocked artery of the heart. Both can cause sudden chest pain, and they are hard to tell apart without tests such as an X-ray and an ECG, so sudden chest pain always needs emergency care.