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Abnormal presence of air in the pleural cavity. NIH - National Cancer Institute

About Pneumothorax

Air or gas can build up in the pleural space. When this happens, it's called a pneumothorax (noo-mo-THOR-aks). A lung disease or acute lung injury can cause a pneumothorax.

Some lung procedures also can cause a pneumothorax. Examples include lung surgery, drainage of fluid with a needle, bronchoscopy (bron-KOS-ko-pee), and mechanical ventilation.

Sometimes the cause of a pneumothorax isn't known.

The most common symptoms of a pneumothorax are sudden pain in one side of the lung and shortness of breath. The air or gas in the pleural space also can put pressure on the lung and cause it to collapse.

A small pneumothorax may go away without treatment. A large pneumothorax may require a procedure to remove air or gas from the pleural space.

A very large pneumothorax can interfere with blood flow through your chest and cause your blood pressure to drop. This is called a tension pneumothorax... Read more about Pneumothorax

What works? Research summarized

Evidence reviews

Percutaneous aspiration versus tube drainage for spontaneous pneumothorax: systematic review and meta-analysis

Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission.

Management of traumatic occult pneumothorax

STUDY OBJECTIVE: Occult pneumothorax (OPTX) is defined as a pneumothorax seen on computed tomography but not apparent on supine plain radiography. Though increasingly common, the acute management of OPTX after trauma remains controversial. This evidence-based review evaluates the existing evidence regarding the safety and efficacy of observation as compared to tube thoracostomy (TT) for management of OPTX in emergency department trauma patients.

Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax: a systematic review

BACKGROUND: The initial treatment of a primary spontaneous pneumothorax (PSP) is controversial. Guidelines of the British Thoracic Society recommend simple aspiration for all PSP requiring intervention. The placement of chest tubes is only advocated for patients who fail simple aspiration. However, the American College of Chest Physicians Delphi Consensus Statement found simple aspiration to be rarely appropriate in the management of PSP.

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Summaries for consumers

Observation alone versus drain tube or needle insertion (interventional) for primary spontaneous pneumothorax in adults without previous lung disease.

Review question: A primary spontaneous pneumothorax (PSP) is a collection of air in the lining of the lung that occurs on its own or without a traumatic event. When this occurs, people can have chest pain and shortness of breath. Most of the time, the air in the lung is absorbed by the body and slowly decreases with time. Most of the guidelines in managing this condition recommend draining the air by sucking it out with a small needle, or placing a larger tube into the chest that drains the air over a period of time (both called 'interventional' management'). We aimed to examine the evidence for the recommendation.

Simple aspiration versus leaving a drainage tube in (intercostal tube drainage) for primary spontaneous pneumothorax in adults without obvious underlying lung disease

When air collects between the lung and the chest wall (the pleural space) this is described as a pneumothorax. This may be caused by trauma or lung disease, but sometimes it happens spontaneously without any obvious cause. When this happens the lungs cannot expand properly, which makes it difficult to breathe effectively. The person becomes breathless and has chest pain. It is important to treat the pneumothorax by removing the collection of air and allowing healing of the pleura, a thin membrane that covers the lungs to make a lining for them in the chest. For initial management where medical intervention is needed, the air can be removed either by simple aspiration, drawing the air out through a thin tube, or by insertion of a much larger chest tube in the space between the ribs (intercostal tube drainage). Both are done using local anaesthesia. Simple aspiration is technically easier to do. The review authors searched the medical literature and identified one randomized controlled study eligible for inclusion. The included study comprised a total of 60 patients with primary spontaneous pneumothorax; 27 of these underwent simple aspiration and 33 underwent intercostal tube drainage. The review found that simple aspiration is immediately as effective as intercostal tube drainage for primary spontaneous pneumothorax. However, simple aspiration is associated with less likelihood of being hospitalized. There was no significant difference between the two treatments with regard to the following: duration of hospitalization, early failure rate and one year success rate. The inclusion of only one small study in this review may have led to important differences between these two treatments being undetected.

Chemicals for sticking the outer lung surface to surrounding membranes compared to surgery to stop air persistently collecting in the chest

Cystic fibrosis is an inherited disease which irreversibly damages the lungs. People with cystic fibrosis are prone to getting a pneumothorax. A pneumothorax is defined as the presence of air in the space between the two linings of the lungs. It can potentially kill people with cystic fibrosis because of the added stress on the heart and lungs. It can be treated by surgical and non‐surgical interventions. However, although these treatments are generally effective, they are far from perfect. Certain treatments work in some people but not others. Also, the treatments do have side effects and can be dangerous for people with cystic fibrosis. Currently, physicians do not know the safest and most effective way of treating pneumothorax in people with cystic fibrosis. We did not find any randomised controlled trials that compared the surgical and non‐surgical treatments for pneumothorax in people with cystic fibrosis. Therefore, more research is needed in this field. Future studies should compare the safety and efficacy of surgical and non‐surgical interventions for pneumothorax in people with cystic fibrosis. There is currently no research being undertaken in this area. We will continue to search for evidence, but will not be updating the review until we find new evidence.

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Terms to know

A procedure that uses a bronchoscope to examine the inside of the trachea, bronchi (air passages that lead to the lungs), and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing.
A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
A thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity. It protects and cushions the lungs. This tissue secretes a small amount of fluid that acts as a lubricant, allowing the lungs to move smoothly in the chest cavity while breathing.
Having to do with the chest.

More about Pneumothorax

Photo of an adult

See Also: Pleurisy, Hemothorax, Pleural Effusion

Other terms to know: See all 5
Bronchoscopy, Cavity, Lungs

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