Pneumothorax – Diagnosis and Treatment
Pneumothorax is a condition where air enters the space between the lungs and the chest wall, causing part or all of a lung to collapse.
This area, called the pleural space, normally helps the lungs expand and contract smoothly during breathing. When air gets into this space, it can make breathing difficult and lead to chest pain.
Many cases of pneumothorax relate to other lung diseases, but it can also happen after an injury or for no clear reason. Understanding how pneumothorax affects the body helps people recognize its symptoms and the need for quick medical care.
Diagnosis
Doctors usually look for a pneumothorax with a chest X-ray or a CT scan to get clear images of the lungs and chest cavity. In some cases, an ultrasound may also be used, especially in emergency settings, to quickly detect air in the chest.
Common signs that prompt testing include sudden shortness of breath, sharp chest pain, decreased breath sounds on one side, and a rapid heart rate.
In severe cases, doctors may check for signs of low oxygen levels, low blood pressure, or a shift in chest structures (mediastinal shift), which could indicate a tension pneumothorax, a life-threatening complication.
A physical exam might reveal reduced or absent breath sounds on the affected side, hyperresonance when tapping the chest, or reduced chest movement.
Imaging tests confirm the diagnosis and help determine the size and severity of the pneumothorax, guiding the next steps in treatment.
Treatment
Careful Monitoring
If the lung collapse is small and the patient has stable vital signs, health care providers may choose to watch the condition instead of acting right away.
Regular chest X-rays track the amount of air in the chest and how well the lung is healing. Most people also receive extra oxygen through a mask, which helps their lung re-expand faster.
Providers may recommend this approach for healthy people who are not having trouble breathing. The patient may need to limit strenuous activities during recovery.
Recovery may take several weeks, and follow-up appointments ensure the lung is fully expanded.
Air Removal With Needle or Tube
When a larger part of the lung collapses, doctors often need to remove the trapped air quickly. There are two main ways to do this:
Needle Removal
A doctor inserts a thin needle with a small, flexible tube (catheter) between the ribs into the air space. The doctor uses a syringe attached to the catheter to slowly withdraw air.
Sometimes, the catheter stays in place to keep removing air for a few hours until the lung is stable.
Placing a Chest Tube
If more air needs to be removed, the doctor may insert a tube through the chest wall and into the chest cavity. The tube connects to a special device that lets air out but does not let it return.
This setup gently relieves pressure and allows the lung to re-expand. The tube usually stays in place for several days. Sometimes, a small vacuum pump speeds up air removal.
A table can help clarify differences between these two methods:
| Method | When Used | Procedure | Typical Duration |
|---|---|---|---|
| Needle removal | Moderate collapse | Catheter, syringe | Hours |
| Chest tube | Larger collapse, persistent | Tube, valve/suction | Several days |
Minimally Invasive Options to Seal Leaks
If the lung does not heal after air removal, medical teams may try approaches that do not require open surgery:
Chemical Irritation (Pleurodesis): A substance goes into the chest (often through the tube) to create irritation that makes the lung surface stick to the chest wall. This seals leaks and lowers the risk of more pneumothorax episodes.
Autologous Blood Patch: The doctor removes a small amount of the patientโs blood and puts it into the chest tube. The blood forms a sticky layer that helps close off any leaks in the lung tissue.
Bronchoscopy With Valve Placement: A doctor may do a bronchoscopy by passing a thin tube down the throat and into the airways to look for leaks. They may place a one-way valve in the airways so trapped air can escape but not return, which lets the tissue heal. This is especially useful if the leak continues and the patient cannot have surgery.
These steps often stop the leak and help people avoid more invasive treatments.
Surgery to Stop Air Leaks
If less invasive measures do not work, or if a person has repeated pneumothorax episodes, surgery may be necessary.
Video-Assisted Thoracoscopic Surgery (VATS) is a common method. Doctors make a few small incisions in the chest wall. Using a camera and special tools, they find and fix the area where the air is escaping.
Sometimes, they may remove a small part of the lung (called a bleb) that is prone to leaking.
Pleurodesis Surgery can also happen during VATS. The surgeon irritates the chest lining to make it adhere to the lung, sealing off any future leaks.
In rare cases, the surgeon must make a larger cut between the ribs (open surgery) to fix big or multiple leaks. This approach gives the best view for repairing damaged tissue but usually means a longer recovery.
Doctors may provide breathing support after surgery. Some patients go on a breathing machine (ventilator) during and after procedures.
After-Treatment and Preventing Problems
Even after a pneumothorax heals, follow-up medical care remains important. Doctors advise against certain activities that increase pressure in the chest, such as flying in an airplane, scuba diving, or playing wind instruments, for a while.
Key parts of ongoing care include:
- Regular visits for chest X-rays to check healing
- Following recommendations for activity and work
- Reporting any new chest pain, shortness of breath, or cough right away
- Avoiding smoking to reduce the risk of another pneumothorax
Some people may need extra oxygen therapy during recovery. Those with repeated lung collapses or ongoing lung disease could require further evaluation or future procedures.
Staying in contact with a healthcare provider and following instructions helps with recovery and lowers the risk of new problems.
