Collapsed lung: symptoms, treatment and recovery (pneumothorax)

Collapsed lung symptoms and treatment. A collapsed lung is caused by an accumulation of air in the pleural cavity, which is the space between the two lung leaflets (pleurae). If the negative pressure in this space disappears, the elastic lung collapses, making it no longer able to absorb oxygen. The lung can collapse completely or partially. A collapsed lung occurs suddenly, causing sudden pain on one side of the chest. Shortness of breath may also occur if the collapsed lung is complete.

  • What is a collapsed lung?
  • Lungs
  • Lung is partially or completely collapsed
  • Causes of a collapsed lung
  • Spontaneous and non-spontaneous collapsed lung
  • Possible causes
  • Risk factors
  • Symptoms of a collapsed lung
  • Complications
  • Examination and diagnosis
  • Treatment of a collapsed lung
  • Wait and see policy
  • Tube in the chest cavity and slices of the lung
  • Prognosis
  • Prevention

 

What is a collapsed lung?

Lungs

The medical name for collapsed lung is pneumothorax . This literally means: air in the chest cavity. With a collapsed lung, there is air between the lung and the chest wall.
Both lungs are surrounded by a double membrane:

  • the pleura (the outer leaf); and
  • the pleura (the inner leaf).

 

Lung is partially or completely collapsed

The space between the two membranes is called the pleural cavity. This space is sealed airtight (vacuum), but does contain a thin layer of moisture, the pleural fluid. The pressure in the pleural space is negative due to the airtight seal, allowing the lungs to fully expand and follow all movements of the chest and diaphragm. When air gets between the lung membrane and the pleura, it is called a collapsed lung. This may be caused by a hole in the pleura and/or pleura. This allows air to enter the pleural space and removes the vacuum. Part of the lung or the entire lung then collapses. This leads to chest pain and shortness of breath.

Lungs / Source: Mikael Häggström, Wikimedia Commons (Public domain)

Causes of a collapsed lung

Spontaneous and non-spontaneous collapsed lung

Often there is no clear cause for the development of a collapsed lung. This is called a spontaneous collapsed lung. A spontaneous collapsed lung is often caused by a tear in a weak spot in the alveoli. Such a weak spot is, for example, due to an inflammation, an abnormality or a lung disease. In a spontaneous collapsed lung, only the pulmonary membrane is destroyed. The non-spontaneous collapsed lung has an external cause and the pleura, but often also the pleura, will be damaged.
The non-spontaneous collapsed lung can again be subdivided into:

  • Traumatic pneumothorax: as a result of an accident, both the pleura and the pleura or both membranes may be punctured.
  • An iatrogenic pneumothorax: a pneumothorax caused by a medical procedure.

The spontaneous collapsed lung has the following subdivision:

  • Primary (or idiopathic) spontaneous pneumothorax: the cause is not yet entirely clear.
  • Secondary spontaneous pneumothorax: this is a consequence of a disease or an abnormality of the tissues, in other words there is underlying lung disease.

 

Possible causes

A collapsed lung can be caused by several factors. The following division is often made:

  • spontaneous collapsed lung:
    • primary spontaneous collapsed lung (no identifiable cause);
    • a secondary spontaneous collapsed lung (as a complication of a lung disease such as COPD or asthma).
  • non-spontaneous collapsed lung:
    • traumatic collapsed lung (for example due to a stab, gunshot wound or broken ribs in an accident, causing the broken rib to puncture a hole in the lung);
    • iatrogenic collapsed lung (caused by surgical procedures on the chest).

 

Risk factors

Risk factors for a spontaneous collapsed lung are:

  • Gender: In general, men are more likely to develop a collapsed lung than women.
  • Smoking: the risk of spontaneous lung collapse is greater in smokers than in non-smokers.
  • Young men with a tall, lean physique have an increased risk of spontaneous lung collapse.
  • People with an underlying lung disease are more likely to develop spontaneous lung collapse.
  • Having already had a spontaneous collapsed lung increases the risk of recurrence.
  • People who experience significant pressure increases (for example divers) are more at risk of developing a spontaneous collapsed lung.

 

Symptoms of a collapsed lung

The symptoms of a collapsed lung are:

  • Chest pain: Sudden, stabbing, sharp chest pain on the side of the affected lung. This pain does not occur at the level of the sternum and the pain does not worsen when breathing in and out.
  • Shortness of breath: mild or severe, depending on the extent to which the lung has collapsed and whether lung disease is underlying the collapsed lung.

A dry cough can also occur, but coughing up blood is rare. Sometimes a bubbling sensation is observed in the chest. The patient may also suffer from pain in the neck, shoulder or abdomen. Because the body adjusts to breathing in the healthy lung, the complaints often improve after some time. It may even happen that a patient does not even realize that he has suffered a collapsed lung.

Complications

Possible complications vary depending on the size and severity of the collapsed lung, as well as the underlying cause and treatment. Sometimes air can continue to leak if the opening in the lung does not close or if the collapsed lung returns.

Doctor examines patient with stethoscope / Source: Monkey Business Images/Shutterstock

Examination and diagnosis

The doctor will often make the diagnosis based on the patient’s story and physical examination. The doctor then listens with a stethoscope: on the affected side he observes a weakened or completely absent breath sound. When tapping on the chest it sounds hollower than on the healthy side. A lung photo confirms the diagnosis.

Treatment of a collapsed lung

Wait and see policy

The treatment depends on the severity of the collapsed lung. In the case of a partial collapsed lung, patients usually wait and see, as spontaneous recovery occurs in many cases. Spontaneous healing often takes place within a few days: once the leak has healed, the air will be gradually absorbed by the body, causing the lung to expand again.

Tube in the chest cavity and slices of the lung

If there is no spontaneous recovery or if the lung collapse is complete, the air is extracted from the chest cavity by placing a tube in the chest cavity to which a pump is connected. If the hole in the lung has healed spontaneously, the tube can be removed. If this does not produce the desired result, plastering of the lung (pleurodesis) is often chosen. This involves injecting a substance into the chest that causes a sterile inflammatory reaction, as a result of which the pleura adheres to the chest wall and the lung can never collapse again.

Prognosis

The prognosis of a traumatic collapsed lung is excellent if no other life-threatening injuries are present. In the case of a spontaneous collapsed lung, the prognosis depends on the underlying cause and treatment method. The prognosis for iatrogenic collapsed lung is considered good.[1]
Up to 50 percent of patients with a collapsed lung will develop a collapsed lung again at some point in their lives.

Quit smoking / Source: Dmytro Zinkevych/Shutterstock.com

Prevention

Please observe the following preventive measures:

  • Stop smoking
  • Avoid or limit activities with drastic changes in air pressure, such as diving and flying.
  • Follow the instructions of your GP or treating physician and take your medication faithfully in case of lung disease.

Notes:

  1. Maritato KC, Colon JA, Kergosien DH. Pneumothorax. Compend Contin Educ Vet. 2009 May;31(5):232-42; quiz 242. PMID: 19517417.

 

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