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Causes
By Mayo Clinic staff
Your lungs and chest wall are both elastic. As you inhale and exhale, your lungs recoil inward while your chest wall expands outward. The two opposing forces create a negative pressure in the space between your rib cage and lung. When air enters that space, either from inside or outside your lungs, the pressure it exerts can cause all or part of the affected lung to collapse.
There are several types of pneumothorax, defined according to what causes them:
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Primary spontaneous pneumothorax. Primary spontaneous pneumothorax is thought to develop when a small air blister (bleb) on the top of the lung ruptures. Blebs are caused by a weakness in the lung tissue and can rupture from changes in air pressure when you're scuba diving, flying, mountain climbing or, according to some reports, listening to extremely loud music. Additionally, a primary spontaneous pneumothorax may occur while smoking marijuana, after a deep inhalation, followed by slow breathing out against partially closed lips that forces the smoke deeper into the lungs. But most commonly, blebs rupture for no obvious reason.
Genetic factors may play a role in primary spontaneous pneumothorax because this condition may run in families. A primary spontaneous pneumothorax is usually mild because pressure from the collapsed portion of the lung may in turn collapse the bleb.
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Secondary spontaneous pneumothorax. This develops in people who already have a lung disorder, especially emphysema, which progressively damages your lungs. Other conditions that can lead to secondary spontaneous pneumothorax include tuberculosis, pneumonia, cystic fibrosis and lung cancer. In these cases, the pneumothorax occurs because the diseased lung tissue is next to the pleural space.
Secondary spontaneous pneumothorax can be more severe and even life-threatening because diseased tissue may open a wider hole, allowing more air into the pleural space than does a small, ruptured bleb. Additionally, people with lung disease already have reduced lung reserves, making any reduction in lung function more serious. A secondary spontaneous pneumothorax almost always requires chest tube drainage for treatment.
- Traumatic pneumothorax. Any blunt or penetrating injury to your chest can cause lung collapse. Knife and gunshot wounds, a blow to the chest, even a deployed air bag can cause a pneumothorax. So can injuries that inadvertently occur during certain medical procedures, such as the insertion of chest tubes, cardiopulmonary resuscitation (CPR), and lung or liver biopsies.
- Tension pneumothorax. The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air becomes trapped in the pleural space or because the entering air is from a positive-pressure mechanical ventilator. The force of the air can cause the affected lung to collapse completely. It can also push the heart toward the uncollapsed lung, compressing both it and the heart. Tension pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated quickly.
- Pneumothorax. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec05/ch060/ch060g.html. Accessed Feb. 17, 2009.
- What are pleurisy and other disorders of the pleura? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_all.html. Accessed Feb. 17, 2009.
- Smith DA. Pulmonary emergencies. In: Stone CK, et al. Current Diagnosis & Treatment: Emergency Medicine. 6th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3106264. Accessed Feb. 17, 2009.
- Noppen M, et al. Music: A new cause of primary spontaneous pneumothorax. Thorax. 2004;59:722.
- Light RW. Disorders of the pleura and mediastinum. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2861952. Accessed Feb. 17, 2009.
- Light RW. Primary spontaneous pneumothorax in adults. http://www.uptodate.com/home/index.html. Accessed Feb. 17, 2009.
- Spontaneous pneumothorax fact sheet. American Lung Association. http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35772. Accessed Feb. 17, 2009.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 24, 2009.
