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Traumatic Pneumothorax


What is a traumatic pneumothorax and what causes it?

A traumatic pneumothorax is when part of your lung collapses. A traumatic pneumothorax is caused by an injury that tears your lung and allows air to enter the pleural space. This is the area between your lungs and your chest wall. The air trapped in your pleural space prevents your lung from filling with air, which causes it to collapse. A pneumothorax can happen in one or both lungs. 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
  • A knife injury

What are the signs and symptoms of a traumatic pneumothorax?

You may have one or more of the following:

  • 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
  • A cough

How is a traumatic pneumothorax diagnosed?

Your healthcare provider will ask about your signs and symptoms and examine you. He will listen to your lungs. You may need any of the following tests:

  • Blood tests: You may need blood taken to give healthcare providers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  • Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell healthcare providers how well your lungs are working.
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  • Chest x-ray: This is a picture of the bones, lungs, and other tissues in your chest. Healthcare providers use chest x-rays to see if you have broken ribs. These x-rays may show your healthcare provider how large your pneumothorax is. Chest x-rays may also show fluid around the heart and lungs.
  • CT scan: This test is also called a CAT scan. An x-ray machine uses a computer to take pictures of your chest and lungs. Healthcare providers check for a pneumothorax that did not show up on a chest x-ray. You may be given dye in your IV to help your healthcare providers see the images better. Tell the healthcare provider if you are allergic to shellfish or iodine. You may also be allergic to the dye.
  • Ultrasound: An ultrasound uses sound waves to show pictures of your lungs on a monitor.

How is a traumatic pneumothorax treated?

Treatment will depend on the size of your pneumothorax. If your pneumothorax is small, it may resolve on its own. The goal of treatment is to remove the air from your pleural space. Once your lung is able to fill with air, you will be able to breathe easier. You may need any of the following:

  • Medicines:
    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    • Pain medicine: You may be given a prescription medicine to decrease severe pain if other pain medicines do not work. Take the medicine as directed. Do not wait until the pain is severe before you take your medicine.
    • Sedative: This medicine is given to help you stay calm and relaxed.
  • Procedures: You may receive a shot in your skin of medicine called local anesthesia. This is given to numb the area and dull your pain so you feel more comfortable during your procedure or surgery. You may still feel pressure or pushing after you get this medicine.
    • Needle aspiration: During needle aspiration, a needle covered with a tube is put through your skin and into your pleural space. Your healthcare provider will use a syringe to pull the air out of your pleural space.
    • 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.
    • Pleurodesis: Healthcare providers use chemicals, such as iodine or talc powder, to irritate the walls of your pleural space. This causes the walls of your pleural space to close together so air can no longer be trapped there.
    • 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.
    • Thoracotomy: During a thoracotomy, an incision is made in your chest to repair your lung.

What are the risks of a traumatic 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.
  • Treatments that require cuts in your skin to reach your lung may lead to an infection in the lung area. 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 and injury.
  • Without treatment, your lungs may completely collapse. Your heart could stop working. These risks can be life-threatening.

When should I contact my healthcare provider?

  • You have new or worse signs and symptoms.
  • You have questions about your condition or care.

When should I seek immediate care or call 911?

  • You have new or increased shortness of breath.
  • Your throat or the front of your neck is pushed to one side.
  • You are sweating and feel like you are going to pass out.
  • Your fingernails, toenails, or lips begin to turn blue.
  • Your neck veins become larger than usual.

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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. 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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