A punctured lung, or pneumothorax, occurs when air collects in the space between the lung and the chest wall. This air exerts pressure, causing the lung to partially or completely collapse. It is a medical emergency requiring immediate attention to prevent severe complications.
Recognizing the Signs
A sudden, sharp chest pain is often the first sign of a punctured lung. This pain worsens with deep breaths or coughing. Shortness of breath, ranging from mild to severe, also makes breathing difficult.
A rapid heart rate may occur as the body compensates for reduced oxygen. Rapid breathing and a feeling of chest tightness are also common. In severe cases, fatigue may develop, and the skin, lips, or nails can appear bluish, indicating low blood oxygen.
Understanding the Condition
Pneumothorax involves air or gas within the pleural cavity, the space between the two thin membranes surrounding the lungs. Normally, this space maintains a slight negative pressure, keeping the lung expanded. When air leaks in, it disrupts this balance, causing the lung to pull inward and collapse.
Causes of a punctured lung fall into two main categories:
Traumatic Pneumothorax
This type results from chest injuries, such as a broken rib, knife wound, or gunshot. Medical procedures like lung biopsies or central venous line insertions can also inadvertently cause iatrogenic pneumothorax.
Spontaneous Pneumothorax
Spontaneous pneumothorax occurs without external injury. Primary spontaneous pneumothorax often affects tall, thin individuals due to the rupture of small air-filled sacs called blebs on the lung surface. Secondary spontaneous pneumothorax happens in people with pre-existing lung diseases like COPD, asthma, cystic fibrosis, or emphysema, where damaged lung tissue is prone to collapse.
Immediate Medical Response and Complications
When a lung collapses, it impairs the body’s ability to take in oxygen and remove carbon dioxide. This reduced gas exchange lowers blood oxygen levels and can impact heart function. The condition requires immediate medical attention due to its potential for rapid progression and severe outcomes.
Tension pneumothorax is a life-threatening emergency. This occurs when air enters the pleural space but cannot escape, creating a one-way valve effect. As air builds up, pressure increases inside the chest, pushing the affected lung and mediastinum (the space containing the heart and major blood vessels) towards the opposite side.
This shift can compress the heart and large blood vessels, reducing blood flow back to the heart and decreasing its pumping ability, which can lead to circulatory collapse and cardiac arrest. Other complications include respiratory failure, where the lungs cannot adequately oxygenate the blood, recurrence, especially in individuals with underlying lung conditions, and infection in the pleural space (empyema).
Treatment and Recovery
Diagnosis of a punctured lung begins with a physical examination, where reduced or absent breath sounds may be noted. A chest X-ray is the most common and often sufficient imaging test to confirm the presence and size of air around the lung. A computed tomography (CT) scan may be used for more detailed imaging or when the diagnosis is less clear.
Treatment varies depending on the pneumothorax size and patient symptoms. For very small, stable cases, observation with supplemental oxygen may be sufficient, allowing air to reabsorb naturally. Larger or more symptomatic pneumothoraxes require intervention to remove trapped air. Needle aspiration involves inserting a thin needle with a syringe between the ribs to withdraw excess air. For significant air collections, a chest tube (thoracostomy) is inserted into the pleural space; this tube, connected to a one-way valve or suction, continuously drains air and allows the lung to re-expand.
For persistent air leaks, recurrent pneumothorax, or if the lung does not re-expand with a chest tube, surgical options may be considered. Procedures like video-assisted thoracoscopic surgery (VATS) or open thoracotomy address the air leak source, remove blebs, or perform pleurodesis, which helps the lung stick to the chest wall to prevent future collapses. Recovery typically takes 6 to 8 weeks, depending on severity and treatment. Activity restrictions, such as avoiding air travel or scuba diving due to pressure changes, are advised during recovery. Regular follow-up appointments monitor healing and address complications or recurrence.