Pneumothorax, air in
the lungs, air in the chest or collapsed lung
- The lungs are covered by a saclike
membrane known as the pleura, which separates the
lungs from the bony (ribs) chest wall. The pleurae have two
layers: one covers the lungs (visceral), the other
is attached to the inside of the chest cavity
(parietal). Between the two layers there is a thin
film of fluid that lubricates the lungs, allowing them to
move smoothly during respiration (breathing). Under normal
conditions, there should be no air between the lungs and the
chest cavity. The introduction of air into this cavity will
cause the lung to collapse, and compromise breathing.
- The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax
- Depends on the size of p.
- Chest pain:
- Sharp or stabbing
- Chest tightness
- Made worse by breathing or
- Shortness of breath
- Cyanosis or bluish color to the
skin and lips due to hypoxia (low oxygen level)
- Rapid rate of breathing
- Patient may be in Shock or unconscious,
especially with trauma or tension
- Primary p. -- in healthy
individuals this occurs without any underlying diseases
- Secondary -- complication of
underlying lung disease
- Spontaneous p. -- often occurs
after the rupture of a bulla (aka bleb) or blister (not
found in normal lungs), which are small air-filled sacs in
the lungs of individuals with certain risk factors. Could be
primary or secondary.
- Procedures or surgeries
- Skin may show the site of trauma
- Low Blood Pressure
- Fever may be present
- Air can leak under the skin (subcutaneous Emphysema) and has
a spongy feel
- Pallor -- pale skin
- Rapid heart and respiration rate
- The chest movements are not
- The trachea (major airway --
located in the center of the neck) may be shifted in
- When the doctor listens to the
heart or the lungs, the normal sounds may be diminished or
- Chest X-Ray will show the abnormal air pocket, and Collapsed Lung or
structures that have been pushed to one side.
- CAT scan, using computer imaging,
shows detailed views of the chest and lungs.
- Blood tests may show low oxygen
levels (<80 mm Hg) and acidic blood (acidosis = pH
- Tall thin males in their 20-40s
(Marfan's and Ehlers-Danlos syndromes)
- Family history of p.
- History of p. -- 50% chance of
recurrence after one episode
- COPD (chronic obstructive pulmonary disease) or Emphysema
- Cystic Fibrosis
- Whooping Cough
- Rapid climbing to high altitudes
or while scuba diving
- Pneumonias such as
with klebsiella or staph. aureus
- Traumatic -- injury to the chest such as in knife or gunshot wounds, automobile accident, procedures like pleural biopsy, endoscopy, Thoracentesis,
chest tube placement
- Tension p. -- the air is trapped
and builds up with each breath. It can put pressure on and
shift other structures in the chest, such as the
esophagus, trachea, heart, and blood vessels.
- Tension p. risk factors -- lung
infections, trauma to the chest, mechanical ventilation (a
machine that breaths for the patient), and CPR.
- Outpatient treatment -- if there is
no hypoxia (reduction of oxygen supply to tissues) and the
collapse is less than 30%:
- Assurance that air will be
absorbed into the body without interference
- Oxygen therapy
- Monitor blood pressure, heart
rate and breathing
- In patient with severe symptoms and
- Objective is to remove the air.
- General physician may consult
with a surgeon or a pulmonologist (lung doctor).
- A needle may be used to remove
- Aspiration involves inserting a catheter (Teflon tube) into the chest cavity (between the ribs) and attaching to a simple bottle (vacuum inside with no air). This may be enough to expand the Collapsed Lung.
- A plastic chest tube is inserted through an incision in the chest (between the ribs) and then connected to suction. This method may take few days to drain the trapped air and expand the Collapsed Lung.
- Multiple episodes of Pneumothorax may
require surgery or injection of medicines (talc or
Doxycycline) into the pleural
Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk
to your doctor before high altitude climbing, flying, or
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