Pneumothorax

3 things to know first

1. It can range from small to life-threatening. A tiny pneumothorax may be watched, while a large one needs urgent treatment.
2. Sudden chest pain and shortness of breath are the key warning signs. These symptoms should never be ignored.
3. It always needs medical assessment. Even a small pneumothorax should be evaluated by a doctor.

What it is

A pneumothorax occurs when air leaks into the pleural space — the area between the lung and the chest wall. The air pushes on the lung and can cause it to collapse partially or completely. A tension pneumothorax is a rare but dangerous form in which pressure builds up and shifts the heart and other structures; this is a medical emergency.

Why it appears on your report

On a chest X-ray or CT scan, a pneumothorax appears as a visible thin white line marking the edge of the collapsed lung, with black space between the lung and the chest wall. The radiologist reports it so the clinical team can decide whether observation or immediate treatment is needed.

How serious is it

The seriousness depends on the size of the pneumothorax and whether you have symptoms:

• Small pneumothorax in a person with no symptoms may be monitored with oxygen and repeat imaging.
• Large pneumothorax or one causing breathlessness usually needs treatment to remove the air.
• Tension pneumothorax is an emergency that can be life-threatening and requires immediate release of pressure.

Recurrent pneumothorax or pneumothorax in people with underlying lung disease also needs specialist follow-up.

When to seek care urgently

Call emergency services or go to the nearest emergency department if you have:

• Sudden, sharp chest pain, often on one side
• Severe shortness of breath
• Bluish lips or fingertips
• Rapid heartbeat or low blood pressure
• Confusion or fainting

What usually happens next

1. Oxygen and observation. Small, stable pneumothoraces may be managed with supplemental oxygen and close monitoring.
2. Needle aspiration or chest tube. If the pneumothorax is large or symptomatic, a needle or tube is inserted to remove the air and allow the lung to re-expand.
3. Investigate the cause. Your doctor may look for underlying lung disease, blebs, or recent trauma.
4. Follow-up imaging and referral. Repeat X-rays confirm the lung has re-expanded. Recurrent cases may be referred to a thoracic surgeon.

A simple analogy

Think of a balloon inside a jar. If air leaks between the balloon and the jar wall, the balloon shrinks. A tiny leak may let the balloon slowly refill, but a large leak needs to be released so the balloon can expand again.

Further reading

• NHS — Pneumothorax
• Mayo Clinic — Pneumothorax