Pneumothorax

A pneumothorax can be caused by:

• Chest injury. Any blunt or penetrating injury to your chest can cause lung collapse. Some injuries may happen during physical assaults or car crashes, while others may inadvertently occur during medical procedures that involve the insertion of a needle into the chest.
• Lung disease. Damaged lung tissue is more likely to collapse. Lung damage can be caused by many types of underlying diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer or pneumonia. Cystic lung diseases, such as lymphangioleiomyomatosis and Birt-Hogg-Dube syndrome, cause round, thin-walled air sacs in the lung tissue that can rupture, resulting in pneumothorax.
• Ruptured air blisters. Small air blisters (blebs) can develop on the top of the lungs. These air blisters sometimes burst — allowing air to leak into the space that surrounds the lungs.
• Mechanical ventilation. A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely.

Underlying lung disease or mechanical ventilation can be a cause or a risk factor for a pneumothorax. Other risk factors include:

• Smoking. The risk increases with the length of time and the number of cigarettes smoked, even without emphysema.
• Genetics. Certain types of pneumothorax appear to run in families.
• Previous pneumothorax. Anyone who has had one pneumothorax is at increased risk of another.

Potential complications vary, depending on the size and severity of the pneumothorax as well as the cause and treatment. Sometimes air may continue to leak if the opening in the lung won't close or pneumothorax may recur.

A pneumothorax is generally diagnosed using a chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax.

• Observation: If only a small portion of your lung is collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the excess air is completely absorbed and your lung has re-expanded. This may take several weeks.
• Needle aspiration or chest tube insertion
• Nonsurgical repair: If a chest tube doesn't re-expand your lung, nonsurgical options to close the air leak may include:
  • Using a substance to irritate the tissues around the lung so that they'll stick together and seal any leaks. This can be done through the chest tube, but it may be done during surgery.
  • Drawing blood from your arm and placing it into the chest tube. The blood creates a fibrinous patch on the lung (autologous blood patch), sealing the air leak.
  • Passing a thin tube (bronchoscope) down your throat and into your lungs to look at your lungs and air passages and placing a one-way valve. The valve allows the lung to re-expand and the air leak to heal.
• Surgery: Sometimes surgery may be necessary to close the air leak.