Spontaneous Pneumothorax

What is a spontaneous pneumothorax?

A spontaneous pneumothorax is a condition in which air collects in the pleural space (the space between your lung and chest wall). When a pneumothorax occurs, the lung can collapse, making it hard for you to breathe. This happens because the air between the lung and the chest wall prevents the lung from filling with air. A spontaneous pneumothorax can happen in one or both of your lungs. A primary spontaneous pneumothorax occurs in a person with no known lung problems. A secondary spontaneous pneumothorax is when a person has a known lung disease or medical condition.

What causes a spontaneous pneumothorax?

While a pneumothorax is often caused by trauma, a spontaneous pneumothorax usually happens without a clear cause. A spontaneous pneumothorax may occur when an air pocket or bleb (fluid-filled sac) in the lung breaks open. This allows air to leak out and become trapped in the pleural cavity. Air may also enter the pleural space if your lung tissue is damaged and becomes porous (has small tissue openings).

What increases my risk of having a primary spontaneous pneumothorax?

• Being a tall, thin male.
  
  
• Having had a spontaneous pneumothorax before.
  
  
• Scuba diving, flying, or climbing to high altitudes (heights).
  
  
• Smoking.
  
  
• Loud music.

What increases my risk of having a secondary spontaneous pneumothorax?

Ask your caregiver for more information about these and other risk factors for a secondary spontaneous pneumothorax:

• Lung diseases and conditions: Conditions including chronic obstructive pulmonary disease (COPD), emphysema, and severe asthma can cause a secondary pneumothorax. Cystic fibrosis may also increase your risk for a pneumothorax. Conditions that cause abnormal tissue growth in your lungs can cause a spontaneous pneumothorax. Pulmonary fibrosis occurs with an overgrowth of tissue in the lungs and may lead to a pneumothorax.
  
  
• Cancer: Cancer occurs when abnormal cells grow without control or order and often form a tumor (growth). A tumor in your lung may lead to a pneumothorax.
  
  
• Infections: An infection in your lungs is caused by germs called bacteria and viruses. Lung infections, such as pneumonia and tuberculosis may increase your risk for a pneumothorax.
  
  
• Autoimmune disorders: Your immune system protects your body against infection and disease. When you have an autoimmune disorder, your body attacks itself instead. Autoimmune disorders that may lead to a pneumothorax include ankylosing spondylitis, rheumatoid arthritis, scleroderma, and sarcoidosis. This also includes connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome.
  
  
• Catamenial: This is when a pneumothorax occurs between one and three days after a woman's monthly period begins. A catamenial spontaneous pneumothorax is more common in women with endometriosis.

What are the signs and symptoms of a spontaneous pneumothorax?

You may have one or more of the following:

• Shortness of breath.
  
  
• Chest pain.
  
  
• Uneven chest movement when you breathe.
  
  
• Rapid heartbeat.

How is a spontaneous pneumothorax diagnosed?

Your caregiver will ask about your signs and symptoms and do a physical exam. He will listen to your breathing and your lungs. Your caregiver may also check the level of oxygen in your blood and your blood pressure. You may also need the following:

• Chest x-ray: A chest x-ray is a picture of your lungs and other tissues in your chest. The x-ray may show your caregiver if you have a pneumothorax, and how large it is. A chest x-ray may also show if you have fluid around your lungs and heart.
  
  
• Computerized tomography scan: A computerized tomography (CT) scan uses a special x-ray machine to take pictures of your chest and lungs. A CT scan may show a small pneumothorax not seen on x-rays. You may be given dye through an IV before the pictures are taken. The dye will help the pictures show up better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies.
  
  
• Ultrasound: An ultrasound uses sound waves to show pictures of your organs and tissues on a TV-like screen. An ultrasound may be used to view your lungs and see if you have a pneumothorax.

How is a spontaneous pneumothorax treated?

Treatment will depend on the size of your pneumothorax. If your pneumothorax is small, it may resolve on its own. Caregivers may watch over you for a period of time to make sure your symptoms do not get worse. The goal of treatment is to remove the air from your pleural cavity that is causing your lung to collapse. Once your lung is able to fill with air, you will be able to breathe easier. You may need any of the following:

• Oxygen: You may need to get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose.
  
  
• Chest tube: A chest tube may be placed to remove air, blood, or fluid from around your collapsed lung. This allows your lung to fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to remove air and collect any blood or fluid. You may need a chest tube to treat your spontaneous pneumothorax or after having surgery to treat your pneumothorax.
  
  
• Needle aspiration: During needle aspiration, a needle, with a tube over it, is put through your skin and into your pleural cavity. Your caregiver will use a syringe to pull the air out of your pleural space.
  
  
• Pleurodesis: For pleurodesis, your caregiver will use chemicals, powder, or pieces of cloth to irritate the walls of your pleural space. Before the procedure, fluid and air may be drained from the pleural space. Pleurodesis causes the walls of your pleural space to become attached to each other. This may help prevent air or fluid from collecting in your pleural space. Pleurodesis may be done alone or after surgery to treat your spontaneous pneumothorax.
  
  
• Surgery:
  
  
  • Thoracotomy: During a thoracotomy, an incision (cut) is made in your chest to repair your lung.
    
    
  • Video-assisted thoracoscopic surgery: Video-assisted thoracoscopic surgery (VATS) is surgery done to look inside your chest with a video scope. During surgery, 2 to 3 small cuts are made between your ribs. The video scope and other special instruments are inserted into these incisions to repair your lung.
  
  
• Medicines:
  
  
  • Pain Medicine: Caregivers may give you medicine to take away or lessen your pain.
    
    
  • Antibiotic medicine: You may be given antibiotic (germ-killing) medicine if a lung infection caused your spontaneous pneumothorax.

What are the risks of treating a spontaneous pneumothorax?

• Some treatments may cause breathing problems or problems in your heart or blood vessels. Treatments needing cuts in your skin to get to your lung area may lead to empyema. Empyema is an infection in the lung area. Air may become trapped under your skin causing your skin to bulge out or feel crackly. The needle used during needle aspiration may injure your lung or cut a blood vessel. This can cause bleeding around your lung. Chest tubes may cause pain and may become kinked or clogged, or could leak or fall out. Chest tubes could also cause a lung infection. Chest tubes may also damage blood vessels or other organs and cause bleeding, injury, and even death. Even with treatment, you may continue to have an air leak or you may have another spontaneous pneumothorax.
  
  
• Air may continue to enter the pleural space and you may get a tension pneumothorax. With a tension pneumothorax, the injured lung and trapped air push against your uninjured lung. A tension pneumothorax can lead to low blood pressure, decreased oxygen in your blood, and heart problems. Without treatment of your spontaneous pneumothorax, your lung or lungs may completely collapse. Your heart could stop working, and you could die. Ask your caregiver if you have any questions about your treatment, condition, or care.

What can I do to prevent a pneumothorax from happening again?

• Avoid diving and climbing: Do not dive underwater or climb to high altitudes after having a spontaneous pneumothorax without asking your caregiver. The change of pressure could cause another pneumothorax.
  
  
• Avoid flying: Do not fly if you have an untreated or recurring pneumothorax, without first asking your caregiver. Ask your caregiver when it is safe for you to fly.
  
  
• Do not smoke: If you smoke, it is never too late to quit. Smoking harms your body in many ways. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. If you quit smoking, your health and the health of those around you will improve. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You hear a crackling noise or feel popping when touching your skin. This may occur when touching any skin area including in your chest and neck.
  
  
• You have questions about your condition or treatment.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have sudden or increased trouble breathing or chest pain.
  
  
• Your throat or the front of your neck looks like it is pushing to one side.
  
  
• Your heart is beating much faster than normal for you and you are sweating.
  
  
• You feel weak and lightheaded and are breathing very fast.
  
  
• Your fingernails, toenails, and lips begin to turn blue.
  
  
• You have trouble thinking clearly.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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