A pneumothorax is a collection of gas in the layers of pleura that cover the lungs. A pneumothorax can happen spontaneously in a person with healthy lungs or in someone who has lung disease. A pneumothorax can be asymptomatic or associated with severe breathlessness and low blood pressure. If the pneumothorax is associated with increasing pressure on the adjacent chest structures then this can be life threatening.
A pneumothorax on chest X-ray is diagnosed as a thin white line with absence of lung markings above it. Often an estimate of the size is made by the radiologist to assist with treatment. In some cases, additional views may be necessary to help detect the pneumothorax. These may include X-rays where you breathe in and out or on your side. Sometimes a pneumothorax can only be seen on a cat scan.
There are appearances on chest X-ray which can mimic a pneumothorax. Skin folds or normal structures such as the edge of a bone such as the scapula can given a similar appearance. Lack of lung markings can be seen with emphysema. Even clothing can give the appearance of a pneumothorax. Fortunately, this is rarely a concern when interpreted by a certified radiologist. In uncertain cases, additional views or a cat scan can be done.
Cystic lung disease such as emphysema and cystic fibrosis can be associated with pneumothorax. Lung cancer, abscess and pneumonia are some other causes. Patients who have had a procedure such as a biopsy or trauma can have a pneumothorax. It is important to make sure that there is no pneumothorax when a patient breaks a rib.
The decision to observe versus treat depends on the size, symptoms and any underlying lung disease. Your physician may choose to observe the pneumothorax with serial X-rays, place a needle to remove the air or insert a drain. In certain cases, a pleuordesis may be performed where the coverings of the lungs are adhered to prevent future recurrence.
Pneumothorax is a potentially life threatening condition which is often diagnosed on X-ray. Your doctor will decide to observe or treat based on a number of factors. Your radiologist will play an important role in diagnosis. A search for any underlying causes and prevention of future occurrences can be done by your clinical doctors.