The oxygen-rich air you breathe circulates inside your lungs through a vast network called the bronchial tree. From here, oxygen enters the bloodstream and continues to the heart, as well as to various organs and tissues in the body.
A collapse of the lung, also called pneumothorax, occurs when air that normally circulates within the lung leaks into the space between the lung and the chest wall, pushing the lung down or causing it to collapse.
This causes the affected section of the lung to shut down. In most cases, only a portion of the lung collapses, leaving the rest of the lung intact.
A severe lung collapse can cause low blood oxygen levels, respiratory failure, cardiac arrest, and shock. This is a medical emergency and can be fatal if not treated immediately.
What Causes Lung Collapse?
A lung collapse can occur as the result of trauma to the chest, damaged lung tissue, or a malfunction within the lung itself.
Pneumothorax is usually caused by trauma to the chest. Traumatic events can include:
- a rib fracture
- a gun shot wound
- a knife wound
- a hard blow to the chest
- CPR (cardiopulmonary resuscitation)
- a lung biopsy (using a needle through the chest)
- endoscopy procedures
Damaged Lung Tissue
Damaged lung tissue can also cause lung collapse. Damaged tissue isn’t as strong as healthy tissue, so it collapses more easily. This damage can be a result of inflammatory or traumatic lung disease, but it can also be caused by: and
- lung cancer
- sarcoidosis (a chronic, nodular inflammatory disease)
- pulmonary fibrosis (the formation of excess connective tissue in the lungs)
- cystic fibrosis (hereditary condition with buildup of thick mucus in lungs and other organs)
Air blebs are small, air-filled blisters that form on the outer lining of your lungs. They are not a sign of any disease or other lung condition, and experts aren’t sure why they form in certain people.
Sometimes, these air blisters rupture spontaneously or due to changes in air pressure and cause pneumothorax.
What are the symptoms of a pneumothorax?
- The typical symptom is a sharp, stabbing pain on one side of the chest, which suddenly develops.
- The pain is usually made worse by breathing in (inspiration).
- You may become breathless. As a rule, the larger the pneumothorax, the more breathless you become.
- You may have other symptoms if an injury or a lung disease is the cause. For example, cough or high temperature (fever).
- A chest X-ray can confirm a pneumothorax. Other tests may be done if a lung disease is the suspected cause.
When to See a Doctor About Your Symptoms
When pneumothorax first occurs, you may feel a sharp pain in your chest that gets worse if you cough. You may also have difficulty breathing or shortness of breath.
These symptoms can cause mild discomfort in some patients and are often confused with the symptoms of a chest cold or bronchitis.
If the collapse affects a larger portion of your lung, you may experience other symptoms in conjunction with chest pain and shortness of breath. These symptoms include:
- tiring easily
- a rapid heart beat
- a tight feeling in the chest
- bluish skin tone
- low blood pressure
- flared nostrils when breathing
All symptoms of pneumothorax should be treated as a medical emergency. Even if the symptoms are mild, seek urgent care as soon as possible.
The doctor will listen to your lungs with a stethoscope while asking you to breathe deeply and exhale. If your lung has collapsed, the doctor will have trouble hearing breathing sounds from the affected lung. If the doctor has trouble hearing your breathing sounds, he or she may order imaging tests to get a better look at your lungs.
Doctors can easily identify a collapsed lung using a chest X-ray. Your doctor may also order an imaging test called a CT (computerized tomography) scan to view the affected lung in more detail.
Treating Lung Collapse
Treatments for a collapsed lung are designed to restore lung function by removing external pressure on the lung.
When Treatment is Unnecessary
If the lung collapse is mild or affects only a small portion of the lung, your doctor may choose to monitor it carefully rather than treat it.
Throughout the course of observation you may have several chest X-rays. You may also be ordered to rest more to speed up the healing process.
If your doctor feels it is necessary, he or she may give you supplemental oxygen to help your lungs recover.
Suctioning Off Excess Air
For collapses that affect a larger area of the lung, you will need treatment to remove the excess air from your chest cavity.
The air may be removed using a chest tube or needle. A needle with a syringe is inserted into your chest near the area of collapse and in the area of your rib cage. Your doctor then pulls up the syringe on the needle to suction out the air.
A chest tube is used in the same way, though it is usually connected to a water seal container or a machine that suctions the air continuously.
If the area of collapsed lung is large, the machine may need to suction the area for several days.
Some people have repeated episodes of spontaneous pneumothorax. If this occurs, a procedure may be advised with the aim of preventing further recurrences.
For example, an operation is an option if the part of the lung that tears and leaks air out is identified. It may be a small bleb on the lung surface, which can be removed.
Another procedure that may be advised is for an irritant powder (usually a kind of talc powder) to be put on the lung surface. This causes an inflammation which then helps the lung surface to stick to the chest wall better.
A lung specialist will be able to give the pros and cons of the different procedures. The procedure advised may depend on your general health, and whether you have an underlying lung disease.
If you are a smoker and have had a primary spontaneous pneumothorax, you can reduce your risk of a recurrence by stopping smoking.
If an air leak from the lung is the underlying cause of the collapse, surgery may be necessary to repair the leak.
Your doctors will make two small incisions in your chest and insert a fiber optic camera into one of them to view the lung. A surgical tool will be inserted into the other incision and used to close the leak.
If an air bleb is to blame, the surgeon will sew it closed. If no bleb is visible, he or she will instill a talc-like substance into the pleural space to cause irritation. The irritated will then seal itself together to close off the leak.
Outlook and Complications
If treated promptly, pneumothorax may cause no future health complications. However, if the collapse was caused by trauma, you may develop the condition again.
According to the Merck Manual, if an air leak in the lung is sealed using talc, it will recur in about 25 percent of cases. If the leak is closed using surgical sutures, it will recur in about 5 percent of cases.