A pneumothorax, commonly called a collapsed lung, can be a painful and worrying experience.

In a healthy body, the lungs touch the chest walls. A pneumothorax occurs when air enters the space between the chest wall and the lung, called the pleural space. The pressure of this air causes the lung to collapse in on itself. The lung can completely collapse, but most often only a part of it collapses. This collapse can also put pressure on the heart, causing further symptoms.A few different things can cause a pneumothorax, and symptoms can vary widely. Doctors can help diagnose and treat pneumothorax.

Reasons

The causes of pneumothorax are categorized as either primary spontaneous, secondary spontaneous or traumatic.

Primary spontaneous pneumothorax

A primary spontaneous pneumothorax (PSP) occurs when the person has no known history of lung disease. The immediate cause of PSP is unknown.

Risk groups for primary spontaneous pneumothorax include:

• smokers of tobacco or cannabis
• tall men
• people aged 15-34
• people with a family history of pneumothorax

The most important risk factor associated with PSP is smoking. A review in the medical journal BMJ noted that men who smoke tobacco are 22 times more likely to develop PSP than nonsmokers. Women who smoke tobacco are nine times more likely than non-smokers to develop PSP.

If treated early, PSP is usually not fatal.

Secondary spontaneous pneumothorax

Secondary spontaneous pneumothorax (SSP) can be caused by a variety of lung diseases and disorders. SSP carries more severe symptoms than PSP and is more likely to cause death. Lung conditions that may increase the risk of pneumothorax include:

• chronic obstructive pulmonary disease (COPD)
• cystic fibrosis
• severe asthma
• lung infections, such as tuberculosis and some forms of pneumonia
• sarcoidosis
• thoracic endometriosis
• pulmonary fibrosis
• lung cancer and sarcomas involving the lungs

Certain connective tissue disorders can also cause SSP. These disorders include:

• rheumatoid arthritis
• polymyositis and dermatomyositis
• ankylosing spondylitis
• systemic sclerosis
• Ehlers-Danlos syndrome
• Marfan syndrome

Under certain circumstances, children are also at risk for SSP. Causes of SSP in children include: congenital malformations, foreign object inhalation, measles, echinococcosis. The risk may also be higher if a family member has previously experienced SSP.

Traumatic pneumothorax

A traumatic pneumothorax is the result of impact or injury. Possible causes include blunt trauma or injury that damages the chest wall and pleural space. One of the most common ways this happens is when someone breaks a rib. The sharp points of the broken bone can puncture the chest wall and damage the lung tissue. Other causes include sports injuries, car accidents, and puncture or stab wounds. A traumatic pneumothorax can occur even if there is no noticeable chest wound. This is common in people who have experienced blast trauma from an explosion. Scuba divers must take precautions when underwater to prevent pneumothorax. When divers breathe from a tank of compressed air, they experience different levels of pressure from the water and the air itself. The force of these different pressures can cause damage to the lungs, which can take the form of a pneumothorax. Certain medical procedures can also lead to a traumatic pneumothorax. Inserting a catheter into a vein in the chest or taking a sample of lung tissue can lead to a pneumothorax. Doctors often monitor people after these procedures to spot any early signs that may need treatment.

Tension pneumothorax

Any of these types of pneumothorax can turn into a tension pneumothorax. This is caused by a leak in the pleural space that looks like a one-way valve. As a person inhales, air leaks into the pleural space and becomes trapped. It cannot be released during exhalation. This process leads to increased air pressure in the pleural space which is life threatening and needs immediate treatment.

Symptoms

The symptoms of pneumothorax may not be noticeable at first and may be confused with other disorders. Symptoms of pneumothorax can range from mild to life-threatening and may include:

• difficulty breathing
• chest pain, which may be worse on one side of the chest
• sharp pain during inhalation
• chest pressure that gets worse over time
• blue discoloration of the skin or lips;
• increased heart rate
• rapid breathing
• confusion or dizziness
• loss of consciousness or coma

Some cases of pneumothorax have almost no symptoms. These can only be diagnosed with an X-ray or other type of scan. Others need urgent medical attention. Anyone experiencing the above symptoms should contact their doctor or seek immediate medical attention.

Diagnosis

Diagnosing pneumothorax can be complicated due to the variety of symptoms and causes. In non-emergency situations, doctors will first physically examine a person to look for signs of the disorder. They may tap on their chest to check for abnormal sounds or listen to their breathing through a stethoscope.

Doctors will also ask someone about their medical history and habits, such as smoking. They may also ask about any family history of lung disorders. Imaging is an important part of most diagnoses. Doctors use X-rays to take pictures of the chest and look for signs of a collapsed lung. A technician takes the X-ray while the person inhales fully and holds their breath.The size of the pneumothorax is usually measured as the space between the lung and the chest wall. The size of the pneumothorax often determines how it is treated.CT scans are used to get a better picture of the lung than an X-ray can provide. Doctors often use CT scans in trauma situations when they need an accurate image of a puncture wound or other injury for treatment. Ultrasound is used in some cases and can provide a quick way to see the size and severity of a pneumothorax. It may be more sensitive than x-rays for examining blunt trauma. In cases of severe tension pneumothorax, evidence of a damaged lung is often very obvious and requires immediate attention to prevent permanent damage or even death.

Treatment

Most forms of pneumothorax require medical attention. The extent of this medical care can vary as much as the disorder itself.Standard medical treatment usually involves inserting a small tube between the ribs or under the collarbone to release the gas that has built up. This will slowly decompress the lung.Doctors may prescribe various medications to numb pain, help remove toxins, or prevent infection in the body. Some people may need oxygen if their lung capacity is insufficient.

The surgical treatment may be necessary in some cases, especially in people who have repeated pneumothorax. People with SSP are more likely to need medical attention because of the severe nature of the lung disease associated with the condition. Those with SSP may experience more severe symptoms and face a greater risk of serious complications and death. Some very small pneumothoraces may heal without any treatment. Doctors can give their patients the option of allowing the pneumothorax to heal under supervision without taking any medical or surgical action. A person experiencing signs or symptoms should report them to a doctor. They can decide whether medical intervention is necessary to reduce the risk of serious events.

Pneumothorax can be difficult to diagnose and treat. A person should work closely with their doctor to make sure the treatment is successful. Pneumothorax should be taken seriously and can be life-threatening in some cases. Most cases can be treated with early medical intervention. Working with a qualified doctor as soon as symptoms are noticed is the best way to ensure that the pneumothorax heals properly.