What is spontaneous pneumothorax?

A spontaneous pneumothorax is the sudden onset of a collapsed lung without any apparent cause, such as a traumatic injury to the chest or a known lung disease. 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 area in the lung that is filled with air, called a bleb, ruptures, causing the air to leak into the space around the lung.

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

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 connective tissue disorders, smoking, and activities such as scuba diving, high altitudes and flying.

Signs and symptoms

Spontaneous pneumothorax most commonly presents without severe symptoms.

Patients with a collapsed lung may experience a sudden onset of the following symptoms:

• Sharp chest pain, made worse by a deep breath or a cough
• Shortness of breath

A larger pneumothorax will cause more severe symptoms, including:

• Chest tightness
• Easy fatigue
• Rapid heart rate
• Bluish color of the skin caused by lack of oxygen
• Nasal flaring
• Chest wall retractions

Diagnosis of spontaneous pneumothorax

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 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.

Treatment for spontaneous pneumothorax

Treatment of spontaneous pneumothorax depends on the duration, severity of symptoms and size of 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 release the tension. In most cases, the placement of the chest tube allows the lung to re-expand fully and quickly.

The chest tube can be left in place for several days. During that time, your child must stay in the hospital for continued evaluation. 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.

Patients with a persistent air leak from the chest tube for more than five days or those with recurrent or bilateral spontaneous pneumothorax may be candidates for surgery. Learn more about surgery for collapsed lung.

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 three to four weeks after discharge.

When to call the doctor

After your child has been treated for spontaneous pneumothorax, it is important that you carefully monitor her 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, she 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