Traumatic Pneumothorax

What is a traumatic pneumothorax?

• A traumatic pneumothorax is a condition in which air collects in the pleural space (the space between your lung and chest wall). A traumatic pneumothorax is caused by an injury that causes air to leak into your pleural space. A traumatic pneumothorax can be caused by a broken rib that tears your lung. Other causes include injuries that allow air to enter from the outside, such as a knife wound. The air that builds up in the pleural space stops the lung from filling with air, and the lung collapses. A pneumothorax can happen in one or both lungs. It can heal on its own, or it can become a persistent posttraumatic pneumothorax (PPP). A PPP is a pneumothorax that does not heal within a certain period of time after treatment.
  
  
• A traumatic pneumothorax can develop into a traumatic tension pneumothorax. This means your pneumothorax becomes serious enough to affect the way your heart and lungs work. With a traumatic tension pneumothorax, one or both of your lungs may completely collapse. A traumatic tension pneumothorax can result in death if not treated quickly.

What are the causes of a traumatic pneumothorax?

Some injuries that cause a traumatic pneumothorax include:

• A bicycle accident or a fall.
  
  
• A motor vehicle accident.
  
  
• An accidental injury that happens during a medical procedure, such as a lung biopsy.
  
  
• A gunshot wound.

What are the signs and symptoms of a traumatic pneumothorax?

You may have one or more of the following symptoms if you have a traumatic pneumothorax:

• Shortness of breath.
  
  
• Soft bulges under your skin caused by air bubbles. These bubbles may be found anywhere, such as your chest or neck.
  
  
• Chest pain.
  
  
• Uneven chest movement when you breathe.
  
  
• Rapid heartbeat.
  
  
• In rare cases, a person may also have a cough.

What are the signs and symptoms of traumatic tension pneumothorax?

If you develop a traumatic tension pneumothorax, you may have any of the symptoms of a traumatic pneumothorax. You may also have any of the following symptoms:

• Sweating.
  
  
• Feeling like you are going to pass out.
  
  
• Your fingernails, toenails, or lips begin to turn blue.
  
  
• Your neck veins become larger than usual.
  
  
• Your throat or the front of your neck is pushed to one side.

How is a traumatic pneumothorax diagnosed?

A traumatic pneumothorax or a traumatic tension pneumothorax can be diagnosed with one or more of the following:

• Chest x-ray: Chest x-rays are pictures of the bones, lungs, and other tissues in your chest. Caregivers use chest x-rays to see if you have broken ribs. These x-rays may show your caregiver how large your pneumothorax is. Chest x-rays may also show fluid around the heart and lungs.
  
  
• Computerized tomography scan: This test is also called a CT or CAT scan. A CT scan uses a special x-ray machine to take pictures of your chest and lungs. A CT may help caregivers find a pneumothorax that did not show up on chest x-rays. You may be given dye through an IV before the pictures are taken. The dye helps the pictures show up better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell caregivers if you are allergic to shellfish or you have other allergies.
  
  
• Physical examination: Your caregiver listens to your breathing and your lungs. He may also check the level of oxygen in your blood and your blood pressure. If you are on a ventilator to help you breathe, caregivers will check your airway pressure. An increase in airway pressure can mean that a traumatic tension pneumothorax has developed.
  
  
• 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 see if you have a pneumothorax.

How is a traumatic pneumothorax treated?

Your treatment options may change if your pneumothorax gets worse. You may have one or more of the following treatments. With fast and proper treatment, your pneumothorax may get better.

• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to you to prevent an infection caused by germs called bacteria.
    
    
  • Pain medicine: Caregivers may give you medicine to decrease your pain. Tell caregivers if the pain does not go away or it comes back.
    
    
  • Sedation: Caregivers may give you medicine to relax you.
  
  
• Procedures: You may receive a medicine called local anesthesia to make you feel more comfortable during your procedure or surgery. A shot of this medicine put into your skin numbs the area and dulls your pain. You may still feel pressure or pushing during the procedure or surgery after you get this medicine.
  
  
  • Decompression: A needle may be put in between your ribs to remove air from around your lungs. Your caregiver may put a catheter (rubber tube) through your skin and into your pleural space. A valve that lets air out of your pleural space may be connected to the catheter.
    
    
  • Pleurodesis: If your pneumothorax is not healing, caregivers may put blood, talc, or antibiotics into the pleural space. These products cause your lung to stick to the visceral pleura (a thin layer of tissue attached to your lung). Attaching the lung to the visceral pleura stops air from getting into your pleural space. These products can be placed during surgery or with the use of chest tubes.
    
    
  • Thoracostomy: A thoracostomy is a procedure in which caregivers put a chest tube through an incision (cut) in your skin. The chest tube is then placed into your chest. Chest tubes remove air, blood, or fluid from around your lungs or heart.
    
    
  • Thoracotomy: You may need surgery to treat injuries that cannot be treated in other ways. These injuries include tears in your lungs, bleeding blood vessels, and other injured tissues.
    
    
  • Video-assisted thoracoscopic surgery: This surgery is also called VATS. If air or blood continues to leak from around your lung, you may need VATS. During VATS, catheters are inserted through a cut in your skin and into the lung area. One catheter has a camera at the end that allows caregivers to see the lung. Other catheters may have special devices attached that are used to treat your lung injuries.
  
  
• Treatments:
  
  
  • Oxygen: You may need extra oxygen to help you breathe more easily.
    
    
  • Ventilation: You may need a machine called a ventilator to help you breathe. Caregivers may also put in a chest tube to decrease the risk of a traumatic tension pneumothorax.

What are the risks of having or treating or having a traumatic pneumothorax?

• Some treatments may cause breathing problems or problems in your heart or blood vessels. Treatments that require cuts in your skin to get to the area around your lung may lead to empyema. Empyema is an infection in the lung area. You could get a traumatic tension pneumothorax if you are put on a ventilator without chest tubes. You can also get a traumatic tension pneumothorax during pleurodesis.
  
  
• During decompression, the needle used for the procedure may injure your lung or cut a blood vessel. This can cause bleeding around the lung. Chest tubes could be painful, become kinked or clogged, or could fall out or leak. Chest tubes could also cause a lung infection, or fluid could fill the lung instead of air. Chest tubes could damage blood vessels or other organs and cause bleeding, injury, and even death.
  
  
• Without treatment of your traumatic pneumothorax, your 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.

Where can I get more information?

For more information contact the following:

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: http://www.lungusa.org
  

When should I call my caregiver?

Call your caregiver if:

• Your signs and symptoms get worse, or you have new signs or symptoms.
  
  
• You have questions about your condition or treatment.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have new or increased trouble breathing.
  
  

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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