What Exactly Is a Collapsed Lung?

A collapsed lung, or pneumothorax, happens when air leaks out of the lung and gets trapped between the lung and the chest wall. This air builds up pressure, pushing the lung inward so it can’t expand properly when you breathe. It doesn’t mean the lung is destroyed - it just can’t do its job. You might hear it called a spontaneous pneumothorax if it happens without injury, or traumatic if it’s from a car crash, stab wound, or even a medical procedure like a biopsy.

It’s not rare. About 1 in 5,000 people will have one in their lifetime. Young, tall men who smoke are at highest risk, but anyone can get it. Even healthy people with no lung disease can develop a primary spontaneous pneumothorax. The scary part? It can turn deadly fast if it becomes a tension pneumothorax - where pressure keeps building and starts squeezing the heart and other lung.

How Do You Know If It’s a Collapsed Lung?

The symptoms don’t sneak up. They hit hard and fast. The first sign? Sharp, stabbing chest pain on one side - usually worse when you breathe in or cough. It’s not a dull ache. It’s like someone stuck a knife between your ribs and twisted it. About 9 out of 10 people with pneumothorax feel this pain, and it often shoots up into the shoulder on the same side.

Then comes the shortness of breath. Not the kind you get after running. This is breathing hard even when you’re sitting still. If more than 30% of your lung has collapsed, you’ll feel it at rest. If it’s less than 15%, you might only notice it climbing stairs. But if your oxygen level drops below 90%, that’s a red flag.

Doctors check for three key signs: no breath sounds on the affected side (heard with a stethoscope), a hollow, drum-like sound when tapping the chest (hyperresonance), and reduced vibration when you place your hand on the chest while the person says "ninety-nine" (decreased tactile fremitus). In the worst-case scenario - tension pneumothorax - you’ll see a racing heart (over 134 bpm), low blood pressure, blue lips or fingernails, and sometimes the windpipe shifts sideways. That’s a medical emergency. Every second counts.

When Seconds Matter: Emergency Response

If someone has a suspected tension pneumothorax - meaning they’re struggling to breathe, their blood pressure is crashing, or their skin is turning blue - don’t wait for an X-ray. The diagnosis is clinical. The treatment is immediate: a needle inserted into the chest to let the air escape. This isn’t optional. Delaying by even a few minutes can kill. The American Heart Association says this must happen within two minutes of recognizing the signs.

For less severe cases - where the person is stable and oxygen levels are above 92% - doctors will order a chest X-ray. It’s the first test because it’s fast, cheap, and widely available. But it’s not perfect. In people lying flat after trauma, it misses up to 60% of cases. That’s why emergency rooms are using ultrasound more now. With a trained hand, point-of-care ultrasound can spot a collapsed lung with over 94% accuracy by finding the "lung point" - the exact spot where the lung stops sliding against the chest wall.

CT scans show the full picture and can detect air as small as 50 milliliters, but they’re not used for initial diagnosis in emergencies. Too slow. Too much radiation. Used only when the X-ray is unclear or the patient has complex lung disease.

Treatment: From Observation to Surgery

Not every collapsed lung needs a tube shoved into your chest. If the air leak is small - less than 2 cm on X-ray or under 30% of the lung - and you’re breathing okay, doctors may just watch you. You’ll get extra oxygen through a mask. Oxygen speeds up the body’s natural ability to reabsorb the trapped air. In 8 out of 10 cases, the lung re-expands on its own within two weeks.

If it’s bigger, they’ll try needle aspiration. A thin tube is inserted, and air is sucked out with a syringe. It works about 65% of the time. If that fails, or if the patient is very short of breath, they’ll need a chest tube. This is a larger tube (usually 28F) placed between the ribs, connected to a drainage system. It pulls the air out and lets the lung inflate again. Success rate? Around 92%. But it’s not risk-free. Infection, bleeding, and re-expansion pulmonary edema (fluid rushing back into the lung) can happen.

If you’ve had two or more episodes on the same side, surgery is often recommended. Video-assisted thoracoscopic surgery (VATS) is the go-to. Tiny cameras and tools go in through small cuts. The doctor removes the blebs (air-filled sacs) that caused the leak and scrapes the lung lining to make it stick to the chest wall. This reduces recurrence to just 3-5%. Recovery takes a few days in the hospital. Cost? Around $18,500 in the U.S.

Who’s at Risk - And What You Can Do

Men under 40, tall and thin, are most likely to get a primary spontaneous pneumothorax. But smoking? That’s the biggest risk factor. If you’ve smoked more than 10 pack-years, your chances go up 22 times. Quitting cuts your risk of recurrence by 77% in the first year. That’s not a suggestion - it’s medical necessity.

People with COPD, cystic fibrosis, or tuberculosis are at risk for secondary pneumothorax. Their lungs are already damaged. The mortality rate for these cases is 16 times higher than for healthy people. If you have lung disease and suddenly feel chest pain or can’t catch your breath, don’t wait. Go to the ER.

After recovery, avoid air travel for 2-3 weeks. Pressure changes in planes can cause the lung to collapse again. Scuba diving? Not unless you’ve had surgery. The risk of recurrence underwater is over 12%. Even if you feel fine, you need a follow-up X-ray at 4-6 weeks to make sure the lung fully healed. About 8% of people develop complications if they skip this check.

What to Watch For After Discharge

You leave the hospital feeling better. That doesn’t mean you’re out of the woods. Recurrence is common - up to 40% within two years for first-time cases. The warning signs are the same as the first time: sudden sharp chest pain, trouble breathing, inability to speak in full sentences. If you feel any of those, call 911. Don’t drive yourself.

Patients who get clear discharge instructions - written, verbal, and repeated - have 32% fewer return visits. Know your signs. Know your limits. Know when to act. The most important thing? Don’t ignore the pain. A collapsed lung doesn’t heal on its own if it’s large. And it doesn’t wait. It can kill in minutes if it turns into tension pneumothorax.

Final Takeaway

Pneumothorax isn’t something you can treat at home. It’s not a pulled muscle or a bad cough. It’s a medical emergency that needs fast, correct action. Whether you’re a healthy teen or someone with COPD, if you feel sudden, sharp chest pain with shortness of breath, get checked. Don’t wait. Don’t hope it goes away. The difference between life and death often comes down to minutes - and knowing when to act.