Spontaneous pneumothorax

Causes and Risks:
In spontaneous pneumothorax, there may be no underlying cause, or it may be caused by a rupture of a bleb or bullae (a small air or fluid filled sac in the lung). The disease affects tall, thin men between 20 and 40 years old most frequently. Cigarette smoking and a family history of pneumothorax are contributing factors. A previous history of asthma , emphysema , pneumothorax , rapid ascent to high altitude, or histiocytosis (a rare disease caused by an overgrowth of a type of tissue cell called a histiocyte ) are risk factors. The incidence is 1 out of 10,000 people.

Prevention:
There is no other prevention than to decrease the risk by stopping smoking .

Symptoms:
  • chest pain or chest tightness
    • dull or sharp or stabbing
    • begins suddenly
    • worsened by breathing deeply or by coughing

  • shortness of breath
  • rapid respiratory rate
  • abnormal breathing movement
    • splinting of ribs with breathing (for example, by bending over or holding the chest)
    • little chest wall motion when breathing

  • cough

Note: The symptoms often begin suddenly, and may occur during rest or sleep.

Signs and Tests:
Listening to the chest ( auscultation ) during a physical examination reveals decreased breath sounds .

Tests performed include:



Treatment:
The objective of treatment is to remove the air from the pleural space, allowing the lung to re-expand. Small pneumothoraces may resolve on their own.

Aspiration of air through a Teflon catheter to a vacuum bottle may reexpand the lung.

The placement of a chest tube between the ribs into the pleural space allows the evacuation of air from the pleural space when simple aspiration is not successful, or 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 indicated for recurrent episodes.

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

Prognosis:
Up to half of patients with spontaneous pneumothorax experience recurrence, but there are no long-term complications following successful therapy.

Complications:
Spontaneous pneumothorax can recur.

Call Your Healthcare 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 reexperience the same or similar symptoms.


Pneumothorax occurs when air leaks from inside of the lung to the space between the lung and the chest wall. The lung then collapses. The dark side of the chest (right side of the picture) is filled with air that is outside of the lung tissue.