Pneumothorax (Collapsed Lung)

What is a pneumothorax?

A pneumothorax (collapsed lung) happens when there’s air in the space between your chest wall and your lung (pleural space). Air in the pleural space can build up and press against your lung, causing it to partially or fully collapse. Pneumothorax is also called a punctured lung.

A pneumothorax can be a medical emergency. Go to the nearest emergency department right away if you think you could have collapsed lung.

What are the different types of collapsed lung?

The two main types of pneumothorax are spontaneous and traumatic.

Spontaneous pneumothorax

A spontaneous pneumothorax is a collapsed lung that happens without an injury. Types include:

• Primary spontaneous pneumothorax: When no underlying health condition or disease causes the collapsed lung. This can happen if abnormal air pockets in your lung (blebs) break apart and release air.
• Secondary spontaneous pneumothorax: Certain lung diseases can lead to a collapsed lung. This can happen when your lung is blocked, causing bulging areas (bullae) that can burst.

Traumatic pneumothorax

Injuries and medical procedures can cause a traumatic pneumothorax. Types include:

• Injury-related pneumothorax: When injury to your chest, like a fractured rib or knife wound, punctures your lung.
• Iatrogenic pneumothorax: When your lung is punctured during a medical procedure, like a lung biopsy or a central venous line insertion.

Other types of pneumothorax

Other types of pneumothorax include:

• Tension pneumothorax: When air can get into your lungs but can’t get out. The one-way valve effect causes pressure to build up inside of your chest. This is a serious form of pneumothorax that’s a medical emergency.
• Catamenial pneumothorax: A rare condition that can affect people with endometriosis. Endometrial tissue growing outside of your uterus can form cysts that can bleed into the pleural space, causing your lung to collapse.

How serious is a punctured lung?

The seriousness of a punctured lung depends on the cause and how much of your lung is collapsed. Some cases aren’t serious, and some are medical emergencies. A healthcare provider can tell you how much of your lung is collapsed and what your treatment options are.

What are the symptoms of a pneumothorax (collapsed lung)?

Signs and symptoms of a pneumothorax include:

• Chest pain on one side, especially when taking breaths.
• Cough.
• Fast breathing.
• Fast heart rate.
• Fatigue.
• Shortness of breath (dyspnea).
• Bluish skin, lips or nails (cyanosis).

If you have symptoms of a collapsed lung, go to the nearest emergency room. You may need immediate care.

What causes a pneumothorax?

Pneumothorax has three main causes: medical conditions, injuries and lifestyle factors.

Medical conditions

• Asthma.
• Pneumonia.
• Chronic obstructive pulmonary disease (COPD).
• Collagen vascular disease.
• Cystic fibrosis.
• Emphysema.
• Idiopathic pulmonary fibrosis.
• Lung cancer.
• Lymphangioleiomyomatosis.
• Tuberculosis.
• Acute respiratory distress syndrome (ARDS).

Injuries

• Blunt force trauma.
• Gunshot wound.
• Stab wound.
• Medical procedures, like a nerve block, lung biopsy, central venous line placement or mechanical ventilation.

Lifestyle factors

• Drug use, especially inhaled drugs.
• Smoking.
• Flying that involves drastic changes in air pressure.
• Scuba or deep-sea diving.

What are the risk factors for this condition?

You might be more at risk for a collapsed lung if you:

• Have a family history of pneumothorax.
• Are pregnant.
• Have a tall, thin body type, especially if you were assigned male at birth (AMAB).
• Have Marfan syndrome.
• Have endometriosis.

What are the complications of a punctured lung?

Although most collapsed lungs heal without issues, some people have serious complications. These can include:

• Re-expansion pulmonary edema.
• Damage or infection caused by the treatment.
• Respiratory failure.
• Heart failure.

How is pneumothorax diagnosed?

Providers usually diagnose a collapsed lung by listening to your lungs and by using imaging. This includes chest X-rays, CT scans (computed tomography scans) or a lung ultrasound. They may also use an arterial blood gas test to measure the levels of oxygen and carbon dioxide in your blood.

Your healthcare provider will ask about your history of lung disease and perform a physical exam. Some types of pneumothorax, like a tension pneumothorax, are diagnosed based on symptoms.

How is pneumothorax treated?

Your treatment depends on the cause, size and severity of your pneumothorax. Treatment may include:

• Observation: If your pneumothorax is minor, your provider may watch you for signs of heart or breathing problems. You’ll see your provider for a follow-up visit.
• Oxygen therapy.
• Thoracentesis: Placing a temporary needle between your ribs on the side of the pneumothorax to evacuate the air in your chest.
• Chest tube drainage: If you have a larger pneumothorax, your provider may put a tube in your chest to reduce the air in your pleural space. As the air pressure decreases, your lung re-expands and heals. You may have this tube in place for a couple of days or longer.
• Chemical pleurodesis: To prevent your lung from collapsing again, a provider may perform pleurodesis. Your provider makes a cut (incision) and inserts a tube. Then they use chemicals (such as doxycycline or talcum powder) to attach your lung to your chest cavity, eliminating extra space.

Some people need surgery to repair damage so a punctured lung can heal. You may need surgery if you don’t respond to other treatments or have:

• Persistent air leakage from the chest tube.
• A lung that doesn’t expand despite chest tube insertion.
• A recurrent collapsed lung.
• Pneumothorax in both lungs.
• Traumatic lung injuries.

Can pneumothorax be prevented?

To reduce your chances of a collapsed lung:

• Don’t smoke.
• Avoid or limit activities with drastic changes in air pressure (like scuba diving and flying). Follow precautions recommended by your provider if you do these activities.
• See your provider regularly to monitor any lung conditions.

If you have certain medical conditions or a family history of pneumothorax, you might not be able to prevent a collapsed lung.

What can I expect if I have a pneumothorax?

If you have a collapsed lung, you may be in the hospital for a couple of days or longer for treatment and monitoring. This allows your provider to check your progress and give you oxygen, if necessary.

How long does it take a punctured lung to heal?

Most of the time, a punctured lung can heal in a few days to two weeks. Your body reabsorbs the extra air around your lung, and your lung can reinflate.

Can you fully recover from a punctured lung?

Most people who have a punctured lung heal without major treatment. But you do have a chance that it’ll happen again (recurrence). Talk to your provider about your chances of recurrence and what to do if your symptoms come back.

Is pneumothorax life-threatening?

Some cases of pneumothorax are life-threating. A collapsed lung should always be monitored by a healthcare provider.

How do I take care of myself?

After going home from the hospital, it’s important to follow your provider’s recommendations for taking care of yourself. They may recommend you rest and limit or avoid certain activities, including:

• Smoking.
• Air travel.
• Scuba or deep-sea diving.

Keep all your follow-up appointments with your provider after you go home.

When should I see my healthcare provider?

Contact your provider if your symptoms return or get worse. If you’ve had a pneumothorax before, you might be at risk for it happening again.

When should I go to the ER?

Go to the emergency room if you have symptoms of a collapsed lung. You may need immediate treatment.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• What caused my collapsed lung?
• Is there anything I can do to prevent another collapsed lung?
• What are my treatment options?
• If I need to have a chest tube, how long will I have it?
• Will I need extra oxygen?
• Will I need to stay in the hospital?
• What kind of care will I need after treatment?
• What kind of care will I need after I leave the hospital or clinic?
• What should I avoid doing after my treatment?