A pneumothorax, commonly known as a collapsed lung, occurs when air leaks into the space between the lung and the chest wall, known as the pleural space. This trapped air disrupts the normal negative pressure within this space, which keeps the lung fully inflated against the chest wall. As pressure builds, the lung partially or completely collapses, impairing the body’s ability to exchange oxygen and carbon dioxide. The specific approach to treatment is guided by the severity of the collapse, the underlying cause, and the patient’s physical stability. Addressing a pneumothorax requires a careful progression from immediate recognition and definitive diagnosis to a tailored intervention strategy.
Initial Recognition and Diagnosis
The onset of a pneumothorax is often marked by sudden, sharp, one-sided chest pain that typically worsens with deep breathing or coughing. This pain is frequently accompanied by breathlessness, which may range from mild discomfort to severe respiratory distress. A rapid heart rate and quick, shallow breathing are common physiological responses to the body’s decreased oxygen supply.
A medical professional begins the process by taking a detailed patient history, especially noting any underlying lung conditions like chronic obstructive pulmonary disease, or any recent trauma to the chest. During the physical examination, a doctor may detect decreased or absent breath sounds over the affected side. Percussion over the same area might also produce a hollow, hyperresonant sound due to the presence of air.
Definitive confirmation relies on medical imaging, with a chest X-ray being the standard initial diagnostic tool. The X-ray clearly shows the outline of the collapsed lung and the presence of air in the pleural space. In more complex or subtle cases, particularly in traumatic injuries, a computed tomography (CT) scan is used to provide a more detailed cross-sectional view of the chest cavity.
Non-Invasive Management
For patients who are clinically stable and have a relatively small pneumothorax, the least aggressive management approach is observation. This “watchful waiting” recognizes that the body can naturally reabsorb the trapped air over time, allowing the lung to re-expand without mechanical intervention.
To accelerate this natural healing process, supplemental oxygen is often administered, a technique referred to as “nitrogen washout.” The air in the pleural space is primarily nitrogen, and breathing a high concentration of oxygen significantly lowers the nitrogen level in the blood. This creates a larger pressure gradient, causing the trapped air to move more quickly into the bloodstream for eventual removal.
This non-invasive method can significantly reduce the hospital stay and prevent the need for more invasive procedures for minor collapses. Conservative management is suitable only when the patient shows no signs of respiratory or cardiovascular compromise.
Minimally Invasive Procedures
When the pneumothorax is larger, causing more significant symptoms, or if the patient has an underlying lung disease, active removal of the air becomes necessary. The initial step is often a simple needle aspiration, suitable for many first-time primary spontaneous pneumothoraces. This involves inserting a small-bore needle or catheter to withdraw the air directly using a syringe.
Needle aspiration is generally effective in 60 to 70 percent of cases and allows for potential immediate discharge after observation if the lung remains expanded. If aspiration fails to re-expand the lung, a more definitive treatment is required: tube thoracostomy, commonly known as chest tube insertion.
This procedure involves placing a flexible tube through the chest wall into the pleural space. The tube is connected to a closed drainage system that maintains a water seal to prevent outside air from entering the chest. Continuous suction may be applied to actively pull air out of the chest cavity, promoting lung re-expansion.
The chest tube remains in place until the lung is fully inflated and the air leak has completely sealed, a process that can take several days. Chest tube insertion is an effective method for managing moderate to large pneumothoraces, as well as complex cases like traumatic or secondary pneumothoraces.
Surgical Repair Techniques
Surgical intervention is typically reserved for cases where the air leak persists despite chest tube drainage, or for patients who have experienced a recurrence. The modern approach overwhelmingly favors Video-Assisted Thoracoscopic Surgery (VATS), a minimally invasive technique. VATS uses small incisions through which a camera and specialized instruments are inserted, offering the surgeon an excellent view of the chest cavity.
The primary goal of the VATS procedure is to locate and repair the source of the air leak, commonly a rupture of small, air-filled sacs on the lung surface called blebs or bullae. The surgeon uses surgical staples to resect or seal these abnormal tissues, effectively eliminating the primary cause of the collapse.
The second component of the surgery is pleurodesis, designed to prevent future collapses by permanently adhering the lung to the chest wall. This is achieved by intentionally irritating the pleural surfaces, causing them to scar and stick together. Mechanical pleurodesis involves physically abrading the lining of the chest wall. Alternatively, chemical pleurodesis uses a substance, such as sterile talc, to induce the necessary scarring.
While VATS is the standard, an open thoracotomy is sometimes necessary for complex cases involving significant scarring or failed previous surgeries.
Recovery and Preventing Recurrence
Following any intervention, the patient enters a recovery phase focused on pain management and careful monitoring of lung function. Post-procedure care includes regular chest X-rays to confirm the lung remains fully expanded and to check for any residual air or fluid collection.
Long-term health management is paramount for preventing a recurrence. The single most impactful action a patient can take is absolute and permanent smoking cessation, as smoking is strongly linked to the underlying lung abnormalities that cause pneumothorax.
Patients are also advised to temporarily avoid activities that involve significant pressure changes. This includes refraining from air travel and high-altitude exposure for several weeks to months, as lower atmospheric pressure can cause any remaining trapped air to expand. Scuba diving is typically restricted permanently due to the high risk of a recurrent collapse under increasing water pressure.