Spontaneous pneumothorax

Definition

Spontaneous pneumothorax is a collection of air or gas in the chest that causes the lung to collapse. Spontaneous means there is no traumatic injury to the chest or lung.

See also: Pneumothorax

Causes, incidence, and risk factors

There are two types of spontaneous pneumothorax:

• Primary spontaneous pneumothorax
• Secondary spontaneous pneumothorax

Primary spontaneous pneumothorax occurs in people without lung disease. It usually occurs in tall, thin men between the ages of 20 and 40. Usually, the rupture of a small air- or fluid-filled sac in the lung (called a bulla) causes a primary spontaneous pneumothorax.

Secondary spontaneous pneumothorax most often occurs with chronic obstructive pulmonary disease (COPD). Other lung diseases commonly associated with spontaneous pneumothorax include:

• Tuberculosis
• Pneumonia
• Asthma
• Cystic fibrosis
• Lung cancer
• Interstitial lung disease

Symptoms

• Sudden chest pain or chest tightness
  • Chest pain may be dull, sharp, or stabbing
  • Breathing or coughing makes pain worse
• Shortness of breath
• Rapid respiratory rate
• Abnormal breathing movement
  • Splinting --  bending over or holding the chest to protect against pain
  • Restricting chest wall motion when breathing (protection against pain)
• Cough

Signs and tests

The doctor will use a stethoscope to listen to the lungs and breath sounds.

The following tests may also be done:

• Chest x-ray
• Arterial blood gases

Treatment

The objective of treatment is to remove the air from around the lungs, allowing the lung to re-expand. Small lung collapses may get better on their own.

Aspiration (withdrawal) of air may re-expand the lung. The placement of a chest tube between the ribs into the pleural space allows the evacuation of air when simple aspiration is not successful or if the pneumothorax is large. Re-expansion of the lung may take several days with the chest tube left in place. Hospitalization is required for chest tube management.

Surgery may be needed for repeated lung collapses.

A procedured called pleurodesis can help prevent air and fluid buildup around the lungs and prevent collapses.

Patients should stop smoking and avoid high altitudes, scuba diving, or flying in unpressurized aircraft to prevent the recurrence of pneumothorax.

Expectations (prognosis)

Between 30-50% of patients with spontaneous pneumothorax have another lung collapse. However, there are no long-term complications following successful therapy.

Calling your health care provider

Call your health care provider if severe shortness of breath develops.

Call your health care provider if you have had a spontaneous pneumothorax and you are experiencing the same or similar symptoms.

Prevention

Stopping smoking will decrease the risk of developing severe lung disease that may lead to pneumothorax. Controlling lung diseases such as asthma may lower the risk of pneumothorax.

Illustrations

Pneumothorax - chest X-ray

Respiratory system

Chest tube insertion- series

Page Content:

Lung collapse - spontaneous