Pneumothorax

Diagnosis

A pneumothorax is usually diagnosed using a chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more detailed images. Ultrasound imaging can also be used to identify a pneumothorax.

Treatment

The primary goal in treating a pneumothorax is to relieve pressure on the lung and allow it to re-expand. A secondary goal, depending on the cause, may be to prevent recurrence. Treatment depends on the severity of the lung collapse and your overall health.

Observation
• Small lung collapses may only require monitoring with a series of chest X-rays until the air is absorbed and the lung re-expands. This process may take several weeks.

Needle aspiration or chest tube insertion
• Needle aspiration involves inserting a hollow needle and flexible tube between the ribs to remove excess air. The catheter may remain in place for a few hours to ensure lung re-expansion.
• Chest tube insertion uses a flexible tube attached to a one-way valve to continuously remove air until the lung is fully re-expanded.

Nonsurgical repair
If a chest tube does not fully re-expand the lung, nonsurgical options may include:
• Using a substance to irritate tissues around the lung so they stick together and seal leaks
• Autologous blood patch, where blood from your arm is introduced into the chest tube to create a seal
• Bronchoscopy to place a one-way valve in the air passages, allowing the lung to re-expand while the leak heals

Surgery
Surgery may be necessary to close an air leak. Most surgeries are minimally invasive, using small incisions, a fiber-optic camera, and long-handled tools to locate and close the leak. Rarely, a larger incision between the ribs may be required to access multiple or larger leaks.

Ongoing care
After healing, you may need to avoid activities that put extra pressure on your lungs, such as flying, scuba diving, or playing wind instruments. Follow-up appointments are important to monitor your recovery and ensure the lung remains fully expanded.