A collapsed lung, or pneumothorax, occurs when air leaks into the space between the lung and the chest wall. This air leakage causes the lung to deflate partially or completely, preventing it from expanding properly and hindering its function. Prompt medical attention is often necessary to restore normal lung function.
Understanding a Collapsed Lung
The lungs are surrounded by two layers of tissue, forming the pleural cavity. Normally, this pleural space maintains negative pressure, allowing the lungs to expand and contract smoothly. A pneumothorax develops when air enters this space, disrupting the pressure balance and causing the lung to collapse. A collapsed lung can manifest as spontaneous or traumatic. Spontaneous pneumothorax occurs without apparent external injury, while traumatic pneumothorax results from a physical injury to the chest.
Causes and Risk Factors
A collapsed lung can arise from various underlying conditions or external events. Primary spontaneous pneumothorax (PSP) often affects individuals without pre-existing lung conditions, frequently observed in tall, thin males and smokers. This type typically results from the rupture of small air-filled sacs, called blebs, on the lung surface. Heavy smoking significantly elevates the risk, making it 102 times higher than for non-smokers.
Secondary spontaneous pneumothorax (SSP) occurs in people with underlying lung diseases, where damaged lung tissue is prone to tearing. Conditions such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and certain infections like tuberculosis, can contribute to this type. These pre-existing conditions weaken the lung structure, increasing vulnerability to air leaks.
Traumatic pneumothorax results from chest injuries like fractured ribs, stab wounds, or gunshot wounds. Blunt force trauma from incidents like car accidents can also cause a lung to collapse by damaging the chest wall or lung tissue. Additionally, a collapsed lung can be iatrogenic, a complication of medical procedures. This includes lung biopsies, central venous line insertions, or mechanical ventilation, where instruments or pressure changes cause a puncture or tear.
Recognizing the Signs
Symptoms of a collapsed lung can appear suddenly, often beginning with sharp chest pain. This pain is typically felt on one side and may worsen with deep breaths or coughing. Shortness of breath is another common symptom, varying in intensity depending on the extent of the collapse.
Other indicators can include a rapid heart rate and fatigue. In severe cases, skin, lips, or nails might take on a bluish tint, a sign of insufficient oxygen in the blood (cyanosis). A dry, hacking cough may also accompany these symptoms.
Diagnosis and Treatment Approaches
Diagnosing a collapsed lung typically begins with a physical examination, where a healthcare provider listens to the patient’s breathing and may tap the chest. The primary diagnostic tool is a chest X-ray, which shows air in the pleural space and the extent of lung collapse. A computed tomography (CT) scan or ultrasound may provide more detailed images or assess severity, especially in trauma cases.
Treatment varies based on size, cause, and the patient’s overall health. For a small pneumothorax, observation may be an option, as the lung can sometimes re-expand on its own. Supplemental oxygen therapy can help speed up air reabsorption and promote lung expansion.
Larger collapses often require intervention to remove trapped air. Needle aspiration involves inserting a hollow needle into the pleural space to withdraw excess air. If insufficient, a chest tube (thoracostomy) may be inserted to continuously drain air, allowing the lung to re-expand. For recurrent cases or those not responding to other treatments, surgical interventions, such as video-assisted thoracoscopic surgery (VATS), may be necessary. During VATS, pleurodesis might be performed, making the lung adhere to the chest wall to prevent future collapses.
Recovery and Outlook
Recovery following a collapsed lung varies, typically from a few days to several weeks, depending on severity and treatment. Follow-up appointments are important to monitor lung re-expansion and overall recovery, especially for observation cases. Patients are advised to avoid activities involving significant air pressure changes, such as flying or diving, for a period after recovery.
Individuals who have experienced a spontaneous pneumothorax face a risk of recurrence, as high as 30% to 50% within five years. The likelihood of recurrence may increase with each subsequent episode. Avoiding smoking helps reduce the chance of another collapsed lung. Despite potential recurrence, the outlook for individuals with a collapsed lung is generally favorable with timely diagnosis and treatment.