Spontaneous Pneumothorax

What is a spontaneous pneumothorax?

A spontaneous pneumothorax is the sudden onset of a collapsed lung without any apparent cause. A collapsed lung is caused by the collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath.

In most cases of spontaneous pneumothorax, a small pocket or blister on the lung that is filled with air, called a bleb, ruptures, causing the air to leak into the space around the lung. In most cases of spontaneous pneumothorax, the cause is unknown. Tall and thin adolescent males are typically at greatest risk, but females can also have this condition. Other risk factors include traumatic injury to the chest or a known lung disease, connective tissue disorders, smoking, and activities such as scuba diving, high altitude activities and flying.

A spontaneous pneumothorax can be either small or large. A small spontaneous pneumothorax may resolve without treatment, while a larger pneumothorax may need surgical intervention.

What are the signs and symptoms of a spontaneous pneumothorax?

  • Sharp chest pain on one side of the chest, made worse by a deep breath or cough
  • Shortness of breath
  • Chest tightness
  • Easy fatigue
  • Rapid heart rate
  • Nasal flaring
  • Chest wall retractions

How is a spontaneous pneumothorax diagnosed?

If your child has a sudden onset of shortness of breath or sharp chest pain that is worsened by breathing, go to the Emergency Department to be evaluated or call 911. In order to make an accurate diagnosis, the medical team will evaluate your child’s symptoms and perform a physical exam, including the following:
  • History:Your physician will obtain your child’s full medical history, in addition to assessing the symptoms he or she is currently experiencing. You may be asked questions about when the symptoms started, the severity of the pain or shortness of breath, and length of time you waited prior to arriving to the Emergency Department. 
  • Physical exam: Using a stethoscope, your child's physician will listen for decreased or no breath sounds on the affected side. 
  • Chest X-ray: This radiologic test will show a pneumothorax if it is present.
Arrows show the edge of the collapsed lung.

How is a spontaneous pneumothorax treated?

Treatment of spontaneous pneumothorax depends on the duration, severity of symptoms and size of the pneumothorax.

Patients who seek treatment for minimal or resolving symptoms after more than 24 hours will receive a chest X-ray to determine treatment. If the imaging reveals only a small pneumothorax, the patient may only require oxygen supplementation and observation in the hospital for a brief period of time.

Patients with large pneumothorax who seek treatment within a short time of the onset and present more severe symptoms may require placement of a chest tube (inserted between the ribs) to remove the accumulated air and reexpand the lung. In most cases, the placement of the chest tube allows the lung to re-expand fully and quickly. Insertion of the chest tube will likely be done at the bedside. Sedatives and pain medicine may be required prior to placement to help calm your child and treat the discomfort. A small incision will be made between your child’s ribs and into the space between the inner lining and the outer lining of their lung. The tube is then passed using a guide wire and a stitch is placed to maintain position. The area is then covered with a clear dressing, also known as a Tegaderm. The dressing will remain in place until the tube is removed and be reinforced as needed.

The chest tube can be left in place for several days. During that time, your child must stay in the hospital for continued evaluation. He or she will undergo a series of chest X-rays to monitor the pneumothorax and determine if it is improving or worsening.

Some patients with a pneumothorax may also receive supplemental oxygen, which may improve symptoms and can help the air around the lung be reabsorbed more quickly. The rate of recurrence varies among studies, but may occur in one third of patients.

Will my child need surgery?

Patients with a persistent air leak despite the chest tube or those with recurrent or bilateral spontaneous pneumothorax may be candidates for surgery. In some cases, your surgeon may order a CT scan of the chest to better evaluate the lung anatomy, but this is not required in all cases. The operation is usually performed using a video-assisted thoracic surgery (VATS), with two to four small incisions. Using the camera, the surgeon is able to…
  • Identify bullae (blebs) responsible for the air leak and remove them if they are present. 
  • Obliterate the pleural space and minimize the chances for future lung collapse.

After surgery:

If your child has surgery to treat a spontaneous pneumothorax, he or she will spend an hour or so recovering in the post-acute care unit before returning to the pediatric surgical unit. A chest tube will likely be in place during the operation, which may need to remain in place for a number of days. After several days the tube will be removed at the bedside after pain medications are administered.

Your child will experience some pain and will receive pain medications throughout the stay. Some patients will initially require IV pain medications and then transition to oral pain medications. The pain management team will work with the surgical team and your child to provide adequate pain control.

Your child may have chest incisions with a clear adhesive glue dressing or gauze covering the site. The clear adhesive, known as steri-strips, will dissolve and peel off naturally usually in 2 weeks; the gauze dressings will be removed 48-72 hours after surgery.

When to call the doctor:

After your child has been treated for spontaneous pneumothorax, it is important that you carefully monitor their health. Call the doctor if your child experiences any of the following symptoms:
  • Fever greater than 101 degrees Fahrenheit 
  • Signs of infection of incision sites, including: redness, yellow or green discharge, tenderness, warmth or foul odor 
  • Any other concerns
If your child suffers any of the following signs or symptoms, they must be brought to the Emergency Department as quickly as possible to receive proper treatment:
  • Sudden onset of chest pain 
  • Shortness of breath or difficulty breathing 
  • Symptoms similar to those that first occurred which caused the seeking of healthcare

Follow-up care:

If your child has an operation or receives inpatient treatment with a chest tube or oxygen therapy to treat spontaneous pneumothorax, you will need to make an appointment to see the surgeon for follow-up two to three weeks after discharge. In some cases, a chest x-ray may be requested prior to your visit with the surgeon on the same day to evaluate the lung and ensure it has remained expanded. The office will make all necessary arrangements.