Pneumothorax

Overview

Pneumothorax is the collapse of a lung that occurs when air leaks into the space between the lung and the chest wall. This condition increases pressure on the lung, making it difficult to breathe. The air leaking into the chest cavity may cause the lung to collapse partially or completely.

Your lungs are located in a vacuum-like environment within the rib cage. This vacuum structure allows the lungs to inflate easily when you breathe in. However, when a hole opens in the chest wall or a small tear occurs on the surface of the lung, this vacuum might be disrupted. The entering air pushes the lung from the outside inward, which may lead to the lung shrinking like a deflated balloon.

Some cases might emerge suddenly for no apparent reason, while others develop as a result of chest trauma (injury) or an existing lung disease. While small collapses might heal on their own, large collapses usually require the air to be drained using a tube. The treatment plan is determined based on the amount of collapse and the patient's complaints.

Symptoms of pneumothorax

Symptoms of pneumothorax typically begin suddenly and may intensify depending on the size of the collapse. Because the collapse of the lung disrupts the pressure balance within the chest, the body gives an immediate alarm. Symptoms can sometimes be confused with a heart attack or a panic attack.

• Sudden chest pain: You usually feel a sharp, stabbing pain on one side of the chest. This pain may become more severe when breathing in or coughing.
• Shortness of breath: You might notice that you cannot catch your breath because the lung cannot inflate to full capacity. As the amount of collapse increases, even speaking could become difficult.
• Back and shoulder pain: The pain in the chest can sometimes radiate toward the shoulder or shoulder blade on the same side.
• Cough: A tickling sensation in the throat and a dry cough might be observed. Coughing fits may be triggered as breathing becomes more difficult.
• Skin discoloration (cyanosis): When blood oxygen levels drop, a bluish tint might be noticed on the lips and fingertips.
• Rapid heart rate: The heart may begin to beat faster than normal to compensate for the oxygen deficit in the body.

When to see a doctor

If you have mild chest pain and a persistent cough, you should consult a pulmonologist. The risk of pneumothorax is higher particularly in tall, thin young men who smoke. An early chest X-ray can make the diagnosis easier.

When to seek emergency help

If you experience severe shortness of breath, sudden sharp chest pain, and a feeling of faintness, call 911 or emergency services immediately. If low blood pressure and extreme weakness are added to this, it could be a "tension pneumothorax." This is a highly life-threatening condition that requires immediate intervention.

Causes of pneumothorax

The causes of lung collapse can originate from weaknesses in the lung's own structure or from external physical impacts. Sometimes, it can develop even in people with no health problems due to the rupture of small air blisters on the lung surface.

• Chest trauma: Traffic accidents, falls from heights, or penetrating injuries can cause air to enter by piercing the chest wall. Rib fractures may also trigger collapse by tearing the lung tissue.
• Rupture of air blisters (blebs): Some people have small air blisters on the upper part of their lungs. When these blisters rupture, air from the lung leaks into the chest cavity.
• Lung diseases: Diseases such as COPD, asthma, or cystic fibrosis weaken the lung tissue. The risk of developing a lung collapse may increase as a result of damaged tissue tearing.
• Mechanical ventilation: In patients connected to a breathing machine in intensive care, the pressure applied by the device may lead to small tears in the lung.
• Smoking: Smoking disrupts the elasticity of lung tissue and might increase the likelihood of air blisters forming. The risk of pneumothorax is much higher in smokers than in non-smokers.

Diagnosis of pneumothorax

The diagnostic process begins with the doctor listening to your complaints and your lung sounds. When a lung collapses, respiratory sounds on that side decrease or disappear entirely. Imaging tests are used to confirm the diagnosis.

• Chest X-ray: This is the fastest and most common diagnostic method. The extent of the lung collapse and the amount of air in the chest cavity can be clearly seen in this film.
• Computed tomography (CT): This is used to detect small collapses or air blisters (blebs) in the lung. It provides more detailed information for patients planned for surgery.
• Oxygen measurement (pulse oximetry): Your blood oxygen level is measured with a small device attached to your finger. It indicates the severity of the lung's loss of function.

Treatment of pneumothorax

Treatment for lung collapse is determined by the amount of collapse and the underlying cause. The main goal of treatment is to evacuate the air in the chest cavity and ensure the lung reinflates. While observation might be sufficient for small collapses, interventional procedures are required for large cases.

• Observation and oxygen therapy: If the collapse is very small and the patient has no complaints, the patient is put on bed rest. Oxygen support may be given, expecting the air to be absorbed spontaneously by the body.
• Needle aspiration: A needle is inserted through the chest wall, and the accumulated air is drawn out with a syringe. This method is generally used to relieve the patient in emergencies.
• Chest tube insertion: A plastic tube is placed between the ribs. This tube is connected to a system that continuously drains the air inside. The tube remains in place until the lung is fully inflated.
• Surgical intervention (VATS): If the lung collapse recurs or the leak does not stop, the leaking area is repaired using a minimally invasive surgery method. The procedure of sticking the lung to the chest wall (pleurodesis) can also be performed during this time.
• Removal of air blisters: Other air blisters ready to rupture are also cleared during surgery to prevent the disease from recurring.

Risks of pneumothorax

Pneumothorax can lead to serious complications when not treated or when intervention is delayed. The pressure building up in the chest cavity affects not only the lung but the entire circulatory system.

• Tension pneumothorax: This is the most dangerous condition. The amount of air in the chest cavity increases so much that it pushes the heart and the other lung aside. This can lead to a sudden drop in blood pressure and cardiac arrest.
• Recurrent collapses: People who have experienced a lung collapse once have a high risk of the condition recurring, especially if they continue to smoke.
• Infection (empyema): Fluid or air accumulating in the chest cavity can become infected over time and may cause pus to gather around the lung.
• Respiratory failure: The body becomes unable to get enough oxygen due to the loss of lung function. This situation may require intensive care support.

Things to consider after pneumothorax

People who have had a lung collapse need to make some lifestyle changes during and after the recovery process. It takes time for the lung tissue to heal completely, and activities that tire the heart and lungs should be avoided during this process.

• Stop smoking immediately: Smoking increases the risk of the disease recurring by more than 50%. This is the most important thing you can do for your lung health.
• Take a break from air travel: Flying before the lung has completely healed may cause the lung to collapse again due to pressure differences. Get approval from your doctor before traveling.
• Avoid scuba diving: Pressure changes underwater carry a vital risk for those with a history of pneumothorax. Most experts may suggest you never do this sport again.
• Do not lift heavy weights: During the recovery process, stay away from movements that require heavy lifting or intense straining, as these can increase intra-thoracic pressure.
• Perform breathing exercises: Breathing exercises recommended by your doctor can help your lung open to its full capacity.