Pneumothorax (collapsed lung)

Your lungs are wrapped in a thin, two-layer lining called the pleura. Normally the two layers glide against each other with no air between them. A pneumothorax happens when air gets into that space, called the pleural space. The air pushes on the lung and makes part or all of it collapse, like a balloon that cannot fully inflate.

On a chest X-ray, the edge of the collapsed lung shows up as a thin white line. Beyond it, the space is black with no lung markings, because it is filled with air.

A small pneumothorax can cause only mild pain and go unnoticed for a day or two. People with lung disease often feel much worse, even with a small one, because they have less lung reserve.

Rarely, air keeps entering the chest and cannot escape. Pressure builds up and pushes on the heart and the other lung. This is called a tension pneumothorax, and it is life-threatening. It needs immediate treatment to let the air out.

A doctor listens to your chest; breath sounds may be quiet on the affected side. A chest X-ray usually confirms the diagnosis and shows how large the pneumothorax is. A CT scan gives more detail, finds small air pockets and can show blebs or lung disease. In emergency rooms, a quick ultrasound at the bedside can also detect it.

When I look at the chest X-ray, I measure how far the lung edge has pulled away from the chest wall and compare it with earlier images. Just as important is how you are breathing. A small pneumothorax in a comfortable young person may only need watching, while the same size in someone with emphysema may need a tube right away.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Interventional radiologists often place small-bore chest tubes, thin tubes about the width of a pencil lead to a drinking straw. They are guided by CT, ultrasound or X-ray and are more comfortable than the large tubes used in surgery. If the air leak lasts longer than about 4 to 5 days, or the lung collapses again, a chest surgeon may recommend video-assisted thoracoscopic surgery (VATS). The surgeon removes the blebs and makes the lining stick to the chest wall so it cannot collapse again. See also pleurodesis.

Chest tubes are placed at El Camino Hospital with moderate sedation and numbing medicine. Your heart rate, blood pressure and oxygen are watched throughout. The procedure usually takes 15 to 20 minutes.

1. 1
   Getting ready

   You lie on your back or side. Sedation through your IV helps you relax, and oxygen is given.

2. 2
   Numbing and planning

   We use imaging to choose a safe spot, usually high on the front of the chest or on the side. The skin and the space between the ribs are numbed.

3. 3
   Placing the tube

   A thin needle enters the pleural space, and a guidewire follows. A small, soft tube slides over the wire and curls inside the chest.

4. 4
   Connecting and securing

   The tube is stitched and taped to the skin, then connected to a one-way Heimlich valve or a drainage box with suction. Many people breathe easier right away.

With a Heimlich valve, a small one-way valve on the end of the tube, many people can go home and return in a day or two for an X-ray. If the tube is connected to suction, you stay in the hospital. Chest X-rays show when the lung has re-expanded and the leak has stopped. Removal takes a few seconds: the stitch is cut, the tube slides out and an airtight dressing goes on for 24 hours.

1. With the tube
   Some soreness at the site. Walk around, breathe deeply and use pain medicine as needed. Keep the dressing dry.
2. 1 to 3 days
   Most air leaks stop. The tube is removed once X-rays show the lung is fully expanded.
3. 2 to 4 weeks
   A follow-up X-ray is often done. Avoid heavy lifting, contact sports and strenuous exercise until you are cleared.
4. Flying
   Wait until an X-ray shows the lung is fully re-expanded, and then usually at least 1 more week. Ask us before you book.
5. Long term
   Stop smoking; it greatly raises the chance of another collapse. Scuba diving is generally unsafe for life unless you have had surgery to prevent recurrence.

After a first spontaneous pneumothorax, about 1 in 3 people have another within a few years, most often in the first year. A pneumothorax after a lung biopsy or other procedure usually does not come back.