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[Conditions](https://durgical.com/en/conditions/) · [Chest](https://durgical.com/en/anatomy/region/chest/)

# Pneumothorax

A pneumothorax is air trapped between the lung and the chest wall that partly or fully collapses the lung; the tension type is life-threatening.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Pleura](https://durgical.com/en/anatomy/pleura/)
- [Right upper lobe](https://durgical.com/en/anatomy/superior-lobe-of-right-lung/)
- [Left upper lobe](https://durgical.com/en/anatomy/superior-lobe-of-left-lung/)
- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [Intercostal nerves](https://durgical.com/en/anatomy/intercostal-nerves/)
- [Posterior intercostal arteries](https://durgical.com/en/anatomy/posterior-intercostal-arteries/)
- [Superior vena cava](https://durgical.com/en/anatomy/superior-vena-cava/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)

## In histology

- [Serous membranes: pleura and peritoneum](https://durgical.com/en/histology/serous-membranes-pleura-and-peritoneum/)

## In the clinical exam

- [Chest palpation: expansion and tactile fremitus](https://durgical.com/en/clinical-exam/chest-palpation-expansion-and-tactile-fremitus/)
- [Chest percussion: resonance, dullness and hyperresonance](https://durgical.com/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/)
- [The pleuropulmonary syndromes: the comparison table to know](https://durgical.com/en/clinical-exam/the-pleuropulmonary-syndromes-the-comparison-table-to-know/)
- [Pneumothorax syndrome](https://durgical.com/en/clinical-exam/pneumothorax-syndrome/)
- [Respiratory distress and respiratory failure: the signs](https://durgical.com/en/clinical-exam/respiratory-distress-and-respiratory-failure-the-signs/)
- [Pulmonary hyperinflation syndrome (emphysema)](https://durgical.com/en/clinical-exam/pulmonary-hyperinflation-syndrome/)

## In physiology

- [Diving, decompression and hyperbaric oxygen](https://durgical.com/en/physiology/diving-decompression-and-hyperbaric-oxygen/)
- [Aviation and space physiology](https://durgical.com/en/physiology/aviation-and-space-physiology/)
- [Mechanics of breathing: pressures and muscles](https://durgical.com/en/physiology/mechanics-of-breathing-pressures-and-muscles/)
- [Pleural fluid: formation and drainage](https://durgical.com/en/physiology/pleural-fluid-formation-and-drainage/)

## Why it happens

- [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/)
- [Lung and chest wall compliance](https://durgical.com/en/physiology/lung-and-chest-wall-compliance/)

## What it is

Air in the pleural space that partly or fully collapses the lung. It can be spontaneous, traumatic or iatrogenic; tension pneumothorax is a life-threatening emergency.

## Who gets it

Primary spontaneous pneumothorax typically affects tall, thin young men, many of them smokers. Secondary forms occur in older people with lung disease such as COPD or tuberculosis; traumatic pneumothorax is common after chest injury.

## Causes

- Primary spontaneous: rupture of small apical blebs, no known lung disease
- Secondary spontaneous: COPD, tuberculosis, pneumonia, cystic lung disease
- Traumatic: penetrating or blunt chest injury, rib fractures
- Iatrogenic: central line insertion, lung biopsy, mechanical ventilation

## Risk factors

- Tall, thin young male
- Smoking (tobacco and cannabis)
- Underlying lung disease
- Previous pneumothorax
- Positive-pressure ventilation
- Family history (rare connective tissue or genetic conditions)

## Pathophysiology

Air enters the pleural space and the lung's elastic recoil makes it collapse. In tension pneumothorax a one-way valve lets air in but not out, so pressure rises, shifts the mediastinum, kinks the great veins and cuts venous return, causing obstructive shock.

## Classification

- Primary spontaneous
- Secondary spontaneous
- Traumatic (open or closed)
- Iatrogenic
- Tension pneumothorax (any cause)

## Symptoms and signs

- Sudden one-sided pleuritic chest pain
- Shortness of breath
- Reduced breath sounds on the affected side
- Hyper-resonant percussion
- Reduced chest expansion
- Tension: distress, tachycardia, hypotension, distended neck veins, tracheal deviation away from the affected side

## Red flags

- Hypotension, tachycardia or signs of shock
- Tracheal deviation and distended neck veins
- Severe hypoxaemia
- Rapid deterioration in a ventilated or trauma patient
- Bilateral pneumothorax

## Diagnosis

**Clinical**
Sudden pleuritic pain and breathlessness with reduced breath sounds. Tension pneumothorax is a clinical diagnosis: it is treated immediately, without waiting for imaging.

**Tests**
Pulse oximetry and blood gases assess oxygenation; ECG to exclude cardiac causes of [chest](https://durgical.com/en/anatomy/region/chest/) pain.

**Imaging**
Chest X-ray shows a visceral pleural line without lung markings beyond it. Bedside ultrasound (absent lung sliding) is fast and sensitive; CT for small or complex cases.

## Differential diagnosis

- Pulmonary embolism
- Acute myocardial infarction
- Pneumonia
- Large bulla in emphysema
- Cardiac tamponade (in trauma)

## Goal of treatment

Relieve tension immediately when present, re-expand the lung, relieve symptoms and prevent recurrence.

## Treatment

**Acute**
Tension pneumothorax: immediate needle or finger decompression followed by a chest drain.

**Conservative**
Small primary spontaneous pneumothorax with few symptoms: observation with oxygen and follow-up imaging.

**Procedure**
Needle aspiration for larger or symptomatic primary pneumothorax, according to guidelines.

**Procedure**
Chest drain (tube thoracostomy) for secondary, traumatic or recurrent cases and for patients on ventilation.

**Surgical**
Video-assisted thoracoscopic surgery with bleb resection and pleurodesis for persistent air leak or recurrence.

## Complications

- Tension pneumothorax and cardiac arrest
- Persistent air leak
- Recurrence
- Re-expansion pulmonary oedema
- Haemopneumothorax

## Prognosis

Primary spontaneous pneumothorax usually resolves well, but recurrence is common, especially in those who keep smoking. Secondary pneumothorax carries higher risk because lung reserve is low.

## Prevention

- Smoking cessation
- Pleurodesis or surgery after recurrence in selected patients
- Careful technique during central line insertion and ventilation

## Test yourself

Think of the answer, then tap the question to see it.

## Who typically develops a primary spontaneous pneumothorax?

Tall, thin young men, often smokers, from rupture of small apical blebs without known lung disease.

## Why must tension pneumothorax be treated before imaging?

It is a clinical diagnosis of obstructive shock; delay to get an X-ray can be fatal, so immediate decompression is done.

## Which way does the trachea deviate in tension pneumothorax?

Away from the affected side, because rising pleural pressure pushes the mediastinum to the opposite side.

## What ultrasound sign suggests pneumothorax?

Absent lung sliding at the pleural line; a lung point, where sliding reappears, confirms it.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/pneumothorax/)

## Related conditions

- [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/)
- [Pleural effusion](https://durgical.com/en/conditions/pleural-effusion/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/)
- [Acute pericarditis](https://durgical.com/en/conditions/acute-pericarditis/)
- [Rib fractures](https://durgical.com/en/conditions/rib-fractures/)
- [Flail chest](https://durgical.com/en/conditions/flail-chest/)
- [Haemothorax](https://durgical.com/en/conditions/haemothorax/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Acute Pneumothorax Evaluation and Treatment](https://www.ncbi.nlm.nih.gov/books/NBK538316/) (StatPearls (NCBI Bookshelf), 2025).

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Source: https://durgical.com/en/conditions/pneumothorax/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/pneumothorax/