Dr. M.J. Bazos, MD. Patient Handout

About Your Diagnosis
Pneumothorax occurs when air is present in the pleural space, which is the space between the lung and the inside of the chest wall. A small amount of fluid in the pleural space normally keeps the outside of the lung “stuck” against the inside of the chest cavity, keeping the lung expanded. This is similar to the effect that a small amount of water has in keeping two pieces of plastic stuck together when the water is between the two plastic sheets. When air enters the pleural space, the lung becomes unstuck and partially or completely collapses. Pneumothorax results when air leaks into the pleural space either from the outside through a puncture in the chest wall, or from an air leak in the lung that lets air escape. Traumatic pneumothorax is the result of an injury that either causes a puncture wound through the chest wall, or a rib fracture that then allows a broken piece of rib to puncture the lung. A spontaneous pneumothorax can occur in individuals with emphysema, as well as in some tall, very thin individuals, when a hard cough causes a rupture of part of the lung and an air leak from the lung. Spontaneous pneumothorax may run in families. Around 9 of every 100,000 individuals in the United States will have a pneumothorax each year. A decrease in the loudness of breath sounds on one side of the chest detected with a stethoscope will raise suspicion of pneumothorax, and a chest x-ray will confirm it. Once found, it is fairly easy to treat.

Living With Your Diagnosis
The main symptoms of pneumothorax are increasing shortness of breath and chest pain. You may have a sense of tightness of the chest. You may become tired or fatigued more easily and may have a rapid heart beat. The lips or fingertips may appear blue with more severe cases. The result of pneumothorax is collapse of one lung, which makes that lung unable to take up oxygen when you breathe.

A small pneumothorax can be treated by allowing the air to reabsorb on its own or inserting a needle into the air and drawing it out, which will re-expand
the lung. A larger pneumothorax may need to have a tube (called a chest tube) inserted into the air. A suction machine is connected to the tube to draw out the air and re-expand the lung. If the leak is large, sometimes the tube may need to remain for a few days to keep the lung expanded till the leak has healed. The main side effect of the treatment is discomfort at the site that the needle or tube enters the chest wall. The main complications include a small risk of bleeding into the chest if insertion of the tube or needle injures a blood vessel. Infection at the puncture site is also a small risk.

The DOs
For a pneumothorax that requires a tube and suction, you will be admitted to the hospital. For a smaller pneumothorax that only requires drainage with a needle or that will reabsorb, you will probably go home. Your doctor will probably give you pain medicines, particularly if the pneumothorax is the result of an injury. If the pneumothorax is the result of a puncture wound or if pneumonia or bronchitis produced a severe cough that resulted in a spontaneous pneumothorax, you may receive an antibiotic. If you have a chest tube in, you need to keep your head elevated when you lie down. You should be at rest. More severe cases sometimes require oxygen. You should follow-up with your doctor as instructed because it is important to be sure that the pneumothorax is resolving.

The DON’Ts
You should avoid heavy exertion or coughing because both of these activities may increase air leaks. You should avoid smoking because this will interfere with your ability to draw oxygen from the air in the face of a partially or completely collapsed lung. In addition, smoking may cause coughing.

When to Call Your Doctor
You must call your doctor promptly if you are experiencing increasing shortness of breath. This could be a symptom of a collapsing lung. You should also call if you have a temperature of greater than 101.0°F. This may be a symptom of infection at the site of the needle or chest tube puncture, or at the wound site. It can also be a sign of developing pneumonia. As many as 50% of individuals who have had one spontaneous pneumothorax will have another. If you have a history of pneumothorax, you should call your doctor if symptoms reoccur.

Websites: http://www.familyinternet.com/peds/top/000087.htm