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JAMA Patient Page
September 12, 2017

Pneumothorax

JAMA. 2017;318(10):974. doi:10.1001/jama.2017.10476

A pneumothorax (collapsed lung, dropped lung) is the entry of air into the pleural space (the space between the lungs and chest wall).

When air enters this area, the lung loses contact with the inside of the chest and “drops” down. As this happens, the lung is not able to expand as it usually does. A pneumothorax can be small and require no treatment or be a life-threatening emergency, based on the size of the air sac that is in the pleural space and how much pressure it places on the lung. If the air sac is large or places increased pressure on the lung, it makes it difficult to pull air in and out of the lungs when breathing.

How Does a Pneumothorax Occur?

In most cases, a pneumothorax is caused by a traumatic injury, such as a rib fracture or penetrating injury (stab or gunshot wound) that causes damage to the lung or chest. A life-threatening form called a tension pneumothorax results in increased pressure in the pleural space, collapsing major blood vessels that return blood to the heart. A pneumothorax can also be a complication of certain procedures such as lung biopsy, the placing of a central venous catheter (a thin plastic tube inserted into a large vein), and surgery that requires entry into the chest cavity, or it can occur spontaneously.

Symptoms

Symptoms of a pneumothorax can include chest pain, shortness of breath, cough, and increases in heart rate or breathing.

Diagnosis

A doctor can use an x-ray scan to confirm the diagnosis of pneumothorax in most cases. Sometimes, a very small pneumothorax cannot be seen on a chest x-ray and is diagnosed with a chest computed tomography or ultrasound scan.

Treatment

If a life-threatening tension pneumothorax develops, the pressure in the chest cavity needs to be released immediately, and an emergency procedure called a needle thoracostomy can be performed.

A nonthreatening pneumothorax is treated differently. If it is very small and causes minimal or no discomfort, major treatment is not needed. A doctor will typically monitor a patient in a hospital and obtain x-rays of the chest to make sure that the air in the lungs is not increasing in size.

For a larger pneumothorax, the air needs to be removed to allow the lung to reexpand by placing a chest tube into the pleural space to drain the air or fluid inside. The procedure is minor and can be performed using local anesthetic, but it requires that the patient be admitted to a hospital.

After treatment, when a chest x-ray shows no evidence of the pneumothorax and the doctor is satisfied that the lung injury is healing, the chest tube is removed and a bandage is placed over the small incision on the chest.

What to Expect After Treatment

In most cases, additional treatment is not required once the chest tube is removed and the chest x-ray shows no remaining pneumothorax. However, some patients may experience a recurrence of their pneumothorax, and a new chest tube may need to be placed. Depending on the cause and severity of the pneumothorax, a variety of surgical and nonsurgical procedures can be performed to help prevent further recurrences. Your doctor can provide you with specific information about your options.

After treatment for a traumatic pneumothorax, a minimum period of 2 to 4 weeks is recommended before flying.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Cheatham ML, Safcsak K. Air travel following traumatic pneumothorax: when is it safe? Am Surg. 1999;65(12):1160-1164.

Topic: Respiratory Health

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