What a pneumothorax is

A pneumothorax, or collapsed lung, happens when air leaks into the space around the lung, between the lung and the thin layer that covers it, called the pleura. The leak comes from a tear in the pleura, caused by disease or by injury. In a small group of patients, typically younger ones, the tear results from a congenital weakness in the pleura.

Symptoms and diagnosis

Patients usually develop chest pain and difficulty breathing when a pneumothorax occurs. Most pneumothoraces can be diagnosed with a simple chest X-ray, but in a number of patients a CT scan is needed to find any underlying cause.

Observation, aspiration or a drain

For some patients a small leak settles on its own with observation, while others need a drain placed to let the lung re-expand. A small pneumothorax can often be observed carefully, in hospital or even as an outpatient, with serial chest X-rays. In those with minimal symptoms, drawing the air out with a needle at the bedside can relieve symptoms and help the pneumothorax resolve.

A large pneumothorax usually needs a chest drain, a tube inserted into the chest cavity to let the air out. The tear in the pleura usually heals and closes over time, but a small group of patients need surgery to close it. For those who are not fit for surgery, an inert powder can be instilled through the chest tube to help the defect heal and seal.

Can it come back?

The more difficult question comes afterwards, as a pneumothorax can come back. How likely that is depends on the cause. In spontaneous pneumothorax, which occurs in younger patients with no known lung disease, recurrence in the first year can range from 30 to 70%, and the risk rises steeply in those who smoke. Stopping smoking lowers the risk of recurrence and is a key part of treatment in this group.

Keyhole surgery and pleurodesis

For those who have had a recurrence, or who have an underlying lung condition, we discuss definitive options such as keyhole surgery or pleurodesis, in which talc is used to help the lung stick to the chest wall. Surgical or talc pleurodesis is offered when a pneumothorax does not resolve, or when the risk of recurrence must be reduced as far as possible; there are occupations, such as pilots and commercial divers, in which a pneumothorax can be life-threatening. These procedures use talc or surgical clips to physically close the defects in the pleura.

Flying and diving

We also advise on practical matters such as air travel and diving, which should be avoided until you have been cleared. It is generally considered safe to fly two weeks after a chest X-ray showing complete resolution of the pneumothorax, though this may not apply to every patient, and airlines and insurers may have their own rules. Most patients should never scuba dive again; swimming and simple diving in a pool are generally fine, and most dive operators will not allow recreational diving in anyone with a history of pneumothorax.

Lung and Respiratory Conditions: A Patient Guide · Pleural Effusion: Not Just Water in Your Lungs · The Aeden Physicians

Frequently Asked Questions

What is a pneumothorax?

A pneumothorax, or collapsed lung, happens when air leaks into the space around the lung through a tear in the pleura, the thin layer that covers it. Patients usually develop chest pain and difficulty breathing.

Can a pneumothorax happen again?

Yes. In spontaneous pneumothorax in younger patients with no known lung disease, recurrence in the first year can range from 30 to 70%, and the risk rises steeply in those who smoke. Keyhole surgery or pleurodesis can reduce the risk.

Can I fly or dive after a pneumothorax?

Flying is generally considered safe two weeks after a chest X-ray showing complete resolution, subject to your doctor's advice and your airline's rules. Most patients should never scuba dive again, though swimming in a pool is fine.