For Patients & General Readers

Pneumothorax, often called a collapsed lung, happens when air leaks into the space between your lung and chest wall. This can cause your lung to partially or completely collapse, making it hard to breathe. It can occur spontaneously, due to injury, or from underlying lung conditions.

Clinical Overview

Pneumothorax is the presence of air in the pleural space, leading to partial or complete lung collapse. It can be spontaneous (primary or secondary), traumatic, or iatrogenic, presenting with varying degrees of respiratory distress and hemodynamic compromise.

Clinical Presentation

Sudden onset of pleuritic chest pain, often sharp and localized.
Dyspnea, ranging from mild to severe, depending on the size of the pneumothorax.
Tachycardia and tachypnea are common compensatory mechanisms.
Hypoxemia may be present, particularly in larger or tension pneumothoraces.
In tension pneumothorax, signs of circulatory compromise, such as hypotension and jugular venous distension, are evident.

Signs & Symptoms

Symptoms (Patient-Reported)

Sudden, sharp chest pain
Shortness of breath or difficulty breathing
Feeling of tightness in the chest
Rapid breathing
Dry cough
Anxiety

Signs (Clinician-Observed)

Decreased or absent breath sounds on the affected side
Hyperresonance to percussion over the affected area
Tracheal deviation away from the affected side (in tension pneumothorax)
Subcutaneous emphysema (crepitus) may be palpable
Tachycardia
Hypotension (in tension pneumothorax)

Differential Diagnoses

Condition	Distinguishing Feature
Pulmonary Embolism	Often presents with pleuritic chest pain and dyspnea, but typically lacks unilateral decreased breath sounds and hyperresonance. D-dimer and CT pulmonary angiography are key diagnostic tools.
Pleural Effusion	Characterized by fluid in the pleural space, leading to dullness to percussion and decreased breath sounds, but typically not hyperresonance. Chest X-ray or ultrasound can differentiate.
Pneumonia	Involves inflammation of lung parenchyma, often with fever, cough producing sputum, and crackles on auscultation. Chest X-ray shows infiltrates.
Myocardial Infarction	Chest pain is typically substernal, crushing, and may radiate. ECG changes and cardiac enzyme elevation are diagnostic. Pneumothorax pain is usually pleuritic.
Pericarditis	Chest pain is often pleuritic and positional, relieved by sitting up and leaning forward. ECG may show diffuse ST elevation. Pericardial friction rub may be present.
Musculoskeletal Chest Pain	Pain is often reproducible with palpation or movement. Pneumothorax pain is typically more constant and associated with respiratory symptoms.

Red Flags — Seek Immediate Care

Tension pneumothorax (tracheal deviation, hypotension, severe dyspnea, distended neck veins)
Hemodynamic instability (hypotension, shock)
Severe respiratory distress with hypoxia
Bilateral pneumothoraces

Key Investigations

Chest X-ray (PA and lateral views) is the initial diagnostic modality to identify the presence and size of pneumothorax.
CT scan of the chest may be used for detailed assessment, especially in cases of trauma, suspected underlying lung disease, or when diagnosis is uncertain on X-ray.
Arterial blood gas (ABG) analysis to assess oxygenation and ventilation status.
Electrocardiogram (ECG) to rule out cardiac causes of chest pain, especially in patients with risk factors.

Management Overview

Management of pneumothorax depends on its size, presence of symptoms, and whether it is spontaneous or traumatic. Small, asymptomatic pneumothoraces may be managed with observation, while larger or symptomatic ones often require needle aspiration or chest tube insertion to re-expand the lung. Tension pneumothorax is a medical emergency requiring immediate needle decompression followed by chest tube placement.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. TruelyserMD does not replace clinical judgement.