What is collapsed lung?
A collapsed lung, also known as a pneumothorax, is a condition that occurs when air enters the space between the chest wall and the lung (pleural space). As air builds up, pressure inside the pleural space increases and causes the lung to collapse. The pressure also prevents the lung from expanding when you try to inhale, causing chest pain and shortness of breath.
What are the types of collapsed lung?
- Primary spontaneous pneumothorax: This type of collapsed lung may occur for no apparent reason, because it takes place without any underlying lung disease. Small, abnormal air sacs in the lung may rupture, releasing air. This condition can occur in otherwise healthy adults. Certain predisposing factors may increase the risk of primary spontaneous pneumothorax.
- Secondary spontaneous pneumothorax: A collapsed lung may occur because of underlying lung diseases, such as chronic obstructive pulmonary disease, cystic fibrosis and other conditions.
- Injury-related pneumothorax: A puncture wound to the chest, such as a gunshot or knife wound, can result in a collapsed lung. Blunt force trauma, such as a blow to the chest, or an accident that results in fractured ribs can also cause a pneumothorax.
- Tension pneumothorax: This is a life-threatening condition that is more likely to occur with traumatic pneumothorax (after a bullet or knife wound to the chest) or in patients on mechanical ventilation (a breathing machine) than with other kinds of pneumothorax. A one-way valve mechanism prevents air from escaping the pleural cavity. When the person inhales, more air enters the pleural space, increasing pressure on the lung and heart. This can lead to respiratory compromise and to a drop in blood pressure. If the patient is not treated immediately, death can result.
- Catamenial pneumothorax: This is an extremely rare condition that occurs only in menstruating women. The onset of the pneumothorax is usually within 72 hours before or after the menstrual cycle begins. Endometrial tissue becomes attached to the thorax, where it forms cysts. The cysts can release blood similar to the way that the lining of the uterus is shed during menstrual periods. Blood and air that enter the pleural space can cause the lung to collapse.
Symptoms and Causes
What causes collapsed lung?
There are many causes of collapsed lung. They are associated with the type of collapsed lung.
Factors associated with primary spontaneous pneumothorax include:
- Cigarette smoking: Cigarette smoke can cause inflammation of the airways.
- Family history.
- Body type: People who are tall and thin are more likely to develop primary spontaneous pneumothorax.
Lung diseases associated with secondary spontaneous pneumothorax include:
- Chronic obstructive pulmonary disease.
- Cystic fibrosis.
- Lung cancer.
- Bacterial pneumonia: Certain forms of pneumonia caused by staphylococcus, streptococcus and other types of bacteria may cause a lung to collapse.
Other factors may also cause collapsed lung. These include:
- Injury or trauma to the chest area: Bullet or stab wounds, fractured ribs, or a blunt force injury can cause the lungs to collapse.
- Certain medical procedures: These include procedures in which the lung may inadvertently be punctured (needle aspiration to drain fluid from the lung, biopsy or the insertion of a large intravenous catheter into a neck vein).
- Activities in which there are sharp changes in air pressure: Flying in an airplane or deep-sea diving may result in collapsed lung.
What are the symptoms of collapsed lung?
- Chest pain (usually sudden onset and sharp in nature).
- Shortness of breath.
- Skin that is bluish in color.
- Rapid breathing.
- Rapid heartbeat.
Diagnosis and Tests
How is collapsed lung diagnosed?
Your doctor will perform a physical examination of your lungs and ask whether you have a history of lung disease. An arterial blood gas test may be performed to measure the amount of carbon dioxide and oxygen in the blood. Higher than normal levels of carbon dioxide and low levels of oxygen are indicators of a collapsed lung. A chest X-ray will usually be obtained to confirm whether a pneumothorax is present. If the chest X-ray is inconclusive, computed tomography scan of the chest may be required.
Management and Treatment
How is collapsed lung treated?
The treatment will depend on the underlying cause, the size of the pneumothorax and the severity of the condition.
- Observation: If the pneumothorax is very small and there are no symptoms, the lung may re-inflate on its own. The patient should be observed closely for signs of respiratory or cardiac problems and schedule follow-up visits with a healthcare provider.
- Supplemental oxygen: If the pneumothorax is very small, the patient may only require supplemental oxygen. Patients should be observed to see whether their condition remains stable. Additional chest X-rays might be taken during that period.
- Needle aspiration: A needle attached to a syringe is inserted into the chest cavity to remove air via suction.
- Percutaneous chest tube drainage: If the pneumothorax is large or if the patient has trouble breathing, a small plastic tube may be inserted into the pleural space to remove air. The collapsed lung will reinflate as the pressure on the lung decreases. Ultrasound or other imaging methods may be used to guide the placement of the chest tube.
- Open chest thoracotomy: An incision is made to allow insertion of a small-bore catheter or chest tube to remove air under suction pressure.
- Video-assisted thoracoscopic surgery (VATS): This is a minimally invasive procedure in which a tiny fiber-optic camera (thorascope) and surgical instruments are inserted through one or more small incisions. The camera displays video images on a monitor while the surgeon removes lung tissue.
- Chemical pleurodesis: This procedure involves introducing a chemical irritant into the pleural space in order to attach the outside of the lung to the chest cavity. It is performed to prevent the lung from collapsing again.
- Mechanical pleurodesis: This procedure is similar to chemical pleurodesis, except it is performed by a surgeon who uses a piece of dry gauze to roughen the pleural membrane.
If these methods are not effective or if collapsed lung recurs, surgical treatment may be needed. Patients with traumatic lung injuries or secondary spontaneous pneumothorax may be candidates for surgery. Indications that surgery may be required include
- Persistent air leakage for more than 1 week.
- Pneumothorax in both lungs.
- Recurrent pneumothorax.
How can collapsed lung be prevented?
There is no way to prevent a collapsed lung, although the risk of its recurrence may be reduced. If you have experienced a spontaneous pneumothorax, another one is likely to occur within 2 years.
Here are some tips to prevent a recurrence.
- Stop smoking: Smoking increases the risk of a pneumothorax, so patients are encouraged to quit.
- Avoid air travel until 1 week after complete resolution has been confirmed by a chest X-ray.
- Diving should be discouraged permanently unless a very secure definitive prevention strategy has been performed such as surgery.
- Follow-up with your healthcare provider. If you have a respiratory disorder, schedule regular visits with your doctor.