As your healthy lungs expand and contract, each of the two layers of the pleura, a membrane that surrounds each lung, slips smoothly over the other. A pneumothorax occurs when air gets into the pleural space between the two layers, and separates them. Part of the lung, sometimes the whole lung, collapses, and is there emptied of air. A pneumothorax may be caused by a chest injury, or, more commonly, by air escaping in to the pleura from the lung. A small pneumothorax will often simply disappear. But sometimes more air enters the pleural space, which can cause a larger and larger area of the lung to collapse. What are the symptoms?
The major symptoms of a pneumothorax are breathlessness and chest pain, generally on the affected side, but sometimes at the bottom of the neck. The pain is usually sudden and sharp, although it may be barely more than a sensation of discomfort. You may also have a feeling of tightness across your chest. The severity of the symptoms depends on the size of the damaged area and on your general health. If you are young and in good condition, you may have little pain and little difficulty in breathing, even if you have a large pneumothorax and a large portion of your lung collapses. If you are middle-aged and have chronic bronchitis, a small pneumothorax can be extremely painful and cause extreme difficulty in breathing.
What are the risks?
Pneumothorax is reliably rare. It occurs chiefly in otherwise healthy young men, for no apparent reason, and in middle-aged people, both men and women, whose lungs are already damaged by asthma, chronic bronchitis, or emphysema.
The seriousness of a pneumothorax depends on how air is getting into the pleura. Often a small pneumothorax is inconsequential and heals by itself. But if there is a hole that allows the pneumothorax to get larger, you will have increasing breathlessness and pain as more and more of the lung collapses. If the disorder remains untreated, death from respiratory failure can follow.
What should be done?
If you suspect that you have this condition, consult your physician. An examination of your chest with a stethoscope should detect a large pneumothorax, but your doctor may need a chest X-ray to find a small one. In any case, even if there is only a suspicion of a pneumothorax, you will probably be admitted to a hospital. There you will be carefully observed by your own doctor and others. Some tests may also be performed.
What is the treatment?
The treatment depends on the size of the pneumothorax and the condition of your lungs. Since the disorder may heal itself, you may need only a few days of X-ray observation and bed rest to make sure that the air in the pleural space is gone and that the collapsed portion of the lung has regained its elasticity and is full of air again. Treatment, if required, consists primarily of trying to suck the air out of the pleural space with a tube known as a catheter, which is inserted between the rocks and into the pleural space. If this procedure does not improve the condition, your physician will need to get a clearer idea of the source of the problem. One possible approach is to inspect the inner side of each layer of the pleura, using an instrument called a thoracoscope. When a thoracoscope is inserted between the ribs and into the pleural space, it may be possible to find the hole through which air is seeing and seal it up.