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Understanding Lung Collapse: Causes and Mechanisms

Pneumothorax (collapsed lung) occurs when air enters the pleural space, eliminating the negative pressure that keeps the lung expanded against the chest wall.

Mechanism

Normal: Visceral pleura (lung surface) and parietal pleura (chest wall) are opposed by pleural fluid surface tension → lung expands with chest wall.
Air in pleural space → equalizes pressure → lung elastic recoil collapses it.

Types & Causes

Clinical Presentation

Sudden pleuritic chest pain, dyspnea.
Decreased breath sounds, hyperresonance on affected side.
Tension: tracheal deviation, hypotension, distended neck veins, cyanosis.

Diagnosis

Chest X‑ray (upright): visible pleural line, absent lung markings.
Point‑of‑care ultrasound (lung sliding absent, lung point sign).
CT for complex/occult cases.

Management

Small PSP (<2 cm rim, asymptomatic): Observation, O₂, repeat imaging.
Large PSP / SSP: Aspiration or chest tube (thoracostomy).
Tension: Immediate needle decompression (2nd ICS midclavicular) → chest tube.
Recurrent / persistent air leak: Video‑assisted thoracoscopic surgery (VATS) pleurodesis / bleb resection.

Pneumothorax is a mechanical problem: air where it shouldn't be. Prompt recognition and decompression are lifesaving in tension physiology.

Breathwork - Related Articles

Type	Cause	Typical Context
Primary spontaneous (PSP)	Rupture of subpleural bleb (congenital weak spot)	Tall, thin males 10–30 yrs; smokers
Secondary spontaneous (SSP)	Underlying lung disease (COPD, CF, TB, cancer, LAM, endometriosis)	Older, known lung disease
Traumatic	Penetrating (stab, gunshot) or blunt (rib fracture, CPR)	Any age; iatrogenic (central line, biopsy)
Tension pneumothorax	One‑way valve air entry → progressive pressure ↑ → mediastinal shift, cardiovascular collapse	Medical emergency; needle decompression → chest tube
Iatrogenic	Central line placement, lung biopsy, mechanical ventilation (barotrauma)	Hospital setting