This information from Great Ormond Street Hospital (GOSH) is about pneumothorax. A pneumothorax refers to a build-up of air in the pleural space, which causes the lung on the affected side to collapse and be unable to inflate.

The lungs and inside of the chest cavity have a smooth covering called the pleura that lets the lungs expand without rubbing on the inside of the chest. The two layers of pleura are usually in close contact with only a small space in between (pleural space) filled with a small amount of pleural fluid acting as lubrication. In pneumothorax, there is damage to this area causing air to enter this space.

What causes pneumothorax?

Pneumothorax has many causes. In young people, areas of weak tissue may develop which can lead to air leaking into the pleural space. It can also develop following hospital procedures such as chest surgery, insertion of a central venous catheter or lung biopsy. It can also occur following breathing support using a ventilator. 

Chest trauma is likely to cause ‘tension pneumothorax’ which needs immediate treatment as it can be life threatening.

What are the signs and symptoms of pneumothorax?

Pneumothorax can appear suddenly with chest pain and shortness of breath. 

How is pneumothorax diagnosed?

In most cases, listening to breath sounds and watching the chest movement on breathing is the initial step in diagnosing pneumothorax. This is usually followed by a chest x-ray which will show characteristic signs of air in the pleural space. Oxygen saturation – the amount of oxygen circulating in the blood – will also be measured and may show lower levels than usual.

If tension pneumothorax is suspected, treatment will begin without any imaging scans as it can be life threatening. 

How is pneumothorax treated?

In many cases, treatment will not be necessary as the pneumothorax may resolve without treatment. In tension pneumothorax, the air needs to be removed from the pleural space so that the lung can expand again. This is most commonly done by inserting a long needle in between the ribs into the pleural space. 

If this does not reduce the air in the pleural space effectively, a chest drain may need to be inserted. Most children at GOSH have chest drains inserted under anaesthetic in theatre.

Breathing exercises may be taught to help aid lung expansion.

What happens next?

Pneumothorax improves in a few days without long term effects. However, people who have had pneumothorax recently should avoid air travel for the period specified by your doctor as the lower air pressure inside the cabin at altitude can make it recur. 

The outlook for children with pneumothorax is usually good once it has been diagnosed and treated promptly. Long term lung damage is rare. They will also need regular follow up clinic appointments, usually involving a chest x-ray.

Compiled by: 
The Respiratory Medicine team in collaboration with the Child and Family Information Group
Last review date: 
January 2015

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