A traumatic pneumothorax is a collection of air inside the chest, between the lung and inner chest wall, which causes the lung to collapse.

See also: Pneumothorax

Traumatic pneumothorax occurs when a physical injury causes the lung to collapse. It can be caused by chest injury from a gunshot or knife wounds. It may also be caused by automobile accidents, or can happen after certain medical procedures.

High-risk medical procedures include transbronchial biopsy, pleural biopsy, thoracentesis, central venous catheter placement, intercostal needle anesthesia, and esophagoscopy.

Hemothorax, a collection of blood between the lung and chest wall, often happens with traumatic pneumothorax.

History of recent chest injury or high-risk procedure, plus:

• Breathing, rapid
• Chest pain
• Chest tightness
• Shortness of breath

Listening to the chest with a stethoscope may reveal decreased breath sounds on one side of the chest. There may be a bluish coloration of the skin caused by lack of oxygen. The affected person may have a rapid heart rate.

Tests:

• Arterial blood gas (will reveal low oxygen level in blood)
• Chest x-ray
• Pulse oximetry

The goal of treatment is to remove the air from the pleural space, allowing the lung to re-expand. Small pneumothoraces may get better on their own.

Aspiration of air through a catheter to a vacuum bottle may re-expand the lung.

When aspiration is not successful or the pneumothorax is large, the placement of a chest tube between the ribs into the pleural space allows the air to be removed from the pleural space. Re-expansion of the lung may take several days with the chest tube left in place.

Hospitalization is required for chest tube management. Antibiotics may be given while the chest tube is in place.

Surgery may be needed to repair tears in the lungs or air passages.

How well a patient does depends on how serious the injuries are. However, there are usually no long-term effects after successful treatment for a pneumothorax.

• If untreated, tension pneumothorax can develop.
• There is a small risk of infection from placement of a chest tube.

Call your health care provider if symptoms come back after treatment of a traumatic pneumothorax.

Use safety measures such as seat belts to prevent injuries.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000. 

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.