Pneumothorax

What is pneumothorax?

Pneumothorax is a collection of air or gas in the cavity between the lung and the chest wall because there is a leak in the framework of the chest and lung (pleural space) or the lung itself. This will cause the lungs to shrink. What are the types and causes of Pneumothorax?

  • Primary or Spontaneous Pneumothorax occurs spontaneously or suddenly. It happens to those who have thin air bubbles (called sub-pleura blebs / bullae) in the lungs at birth. These bubbles can burst suddenly due to excessive pressure change between the atmosphere and the chest cavity.

  • Secondary or Complicated Pneumothorax occurs due to lung diseases such as pneumonia, lung cancer, asthma, chronic obstructive pulmonary disease (COPD) or injury such as gunshot or stab wound to the chest wall which causes  fractures / broken ribs or chest wall injury . It can also be caused by complications of respiratory support system (ventilation).

What is the main complication of Pneumothorax?

The main complication is the occurrence of Tension Pneumothorax that can lead to death and requires immediate care.  A unidirectional valve mechanism develops whereby air enters the chest cavity and lungs while inhaling (inspiration), but cannot escape when exhaled (expiration). As a result, there is increased pressure on the chest cavity and lungs which causes the lungs to shrink and thereby restricting blood flow.

What are the risk factors of Pneumothorax?

  • Most of the Pneumothorax cases are caused by sub-pleura blebs / bullae formed in the lungs.

  • Young men who are tall ,thin and possess Marfan’s Syndrome.

  • Smoking and especially heavy smoking for the male, the risk is increased 22-folds while for the female, the risk is increased by 8-folds.

  • The risk is also increased for those with infections or lung diseases such as tuberculosis (TB) of the lungs, sarcoidosis, cystic fibrosis, lung cancer and pneumocystis  carinii (in patients with AIDS).

What are the symptoms of Pneumothorax?

  • Spontaneous Pneumothorax usually occurs at rest.

  • A third of patients experience sudden chest pain and shortness of breath.

  • Cough

  • Heart pounding / fast heartbeat

  • The skin becomes blue due to lack of oxygen

How is Pneumothorax detected / diagnosed?

  • Examination of chest with a stethoscope shows less entry of air into the lung involved.

  • Chest  x-ray examination

How is Pneumothorax treated?

Mild Pneumothorax can disappear on its own within two weeks.

Severe Pneumothorax requires a chest tube to be inserted between the lung and the chest wall (pleural space) to remove trapped air and ensure the lungs do not continue to shrink.

What is the effect / prognosis of Pneumothorax?

The effect of Pneumothorax depends on the type and severity of the Pneumothorax.

Mild Pneumothorax can disappear on its own without treatment.

Secondary Pneumothorax associated with pulmonary disease although mild, is serious and can lead to death and therefore needs immediate treatment.

Patients who have had Pneumothorax are at higher risk of recurrence. The recurrence rate is approximately 40% and may occur within 1.5 to 2 years.

Last Reviewed : 8 October 2014
Writer : Dr. Wan Fadhilah bt. Wan Ismail
Translator : Mr. Varuges VM Abraham
Accreditor : Dr. Fauziah bte. Zainal Ehsan