Have you just been diagnosed with a pneumothorax? And you are wondering which type you have got, how risk is it, treatment options, and risk of recurrence.
As a diagnostic radiographer who has seen so many x-rays with several types of chest pneumothorax.
I will rely on my knowledge to teach you what to expect if you are being treated with one and I will also rely on medical studies on the subject.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: April, 2026. Written by Juliet Semakula, a diagnostic radiographer.
▶️What is a pneumothorax in the chest?
A pneumothorax or (a collapsed lung or punctured lung) as called in medical terms.
It is a condition where air leaks into the pleural space between the lung and chest wall, creating pressure against your lung causing partial or full lung collapse.
In clinical practice, a 2 cm rule is used as a diagnostic threshold to classify a pneumothorax as “large” or “small“.
And this is normally identified on an erect posteroanterior (PA) chest X-ray.
A pneumothorax is considered large if there is a visible rim of air more than 2 cm greater between the lung margin (visceral pleura) and the chest wall.
A small Pneumothorax is less than 2cm (< 2 cm) often managed conservatively:
The rule originates from the British Thoracic Society (BTS) guidelines and serves as a major factor in determining treatment:
Source: McKnight,2023
The measurement should be taken horizontally at the level of the hilum (the area where the bronchi and blood vessels enter the lung).
Xray images showing a small and larger pneumothorax (images from radiology masterclass)
▶️What are three signs and symptoms of a pneumothorax?
Patients who are diagnosed with a collapsed lung normally come to x-ray with the following signs and symptoms.
🟤 Sudden, sharp, stabbing chest pain that often worsens with breathing.
🟤Struggling to breathe.
🟤If it is severe, it can cause rapid heart rate and low oxygen levels, and you may be given oxygen to help your breathing.
🟤Some people complain of shoulder pain that may radiate to the shoulder or shoulder blade.
🟤Fatigue: General tiredness.
🟤 Dry Cough: A non-productive cough may occur.
🟤Skin Colour Changes: Bluish skin, lips, or nails (cyanosis) due to lack of oxygen
And when you have a tension pneumothorax which is classified as a severe, life-threatening form, where trapped air compresses the heart and lungs, this can lead to these symptoms:
🟤Extreme distress and severe, rapid breathing.
🟤Extensive sweating (diaphoresis).
🟤Dizziness, light-headedness, or fainting.
🟤 Sometimes shock.
The image below shows a left side tension pneumothorax on a chest x-ray.
x-ray image showing a tension pneumothorax, (image from radiology masterclass)
Tension pneumothorax is one not to miss when an x-ray is taken:
♦️The left hemithorax is black due to air in the pleural cavity.
♦️The left lung is completely compressed with arrowheads.
♦️The trachea pushed to the right.
♦️The heart shifted to the contralateral side -note right heart border pushed to the right red arrow.
♦️The left hemidiaphragm raised yellow line
▶️How to tell if a patient has a pneumothorax?
When you go to the emergence with the outlined symptoms:
A physical examination checking your temperature, breathing sounds, bloods etc…. is done.
️Your doctor will request a chest x-ray which is the standard diagnosis because it shows a clear, dark area where lung markings are missing.
A confirmation is immediately seen with a chest X-ray or CT scan.
| Caution! Often when I x-ray a patient and I see a collapsed lung. I do seek clinical guidance before I send the patient away if it is an outpatient, because it can be a life-threatening emergency that requires immediate treatment. |
▶️What are the different types of collapsed lungs (pneumothorax)?
There are two main types of pneumothorax.
1️⃣Spontaneous
2️⃣Traumatic
▶️What is a spontaneous pneumothorax?
Is a collapsed lung that happens without an injury .It can be primary or secondary.
♦️ It is called primary spontaneous pneumothorax when no underlying health condition or disease causes the collapsed lung. This can happen if abnormal air pockets in your lung (blebs) break apart and release air.
♦️And it is called secondary spontaneous pneumothorax when you have certain lung diseases that can lead to a collapsed lung. This can happen when your lung is blocked, causing bulging areas (bullae) that can burst.
Source: Muhetaer,2022
▶️What is a traumatic pneumothorax?
♦️Injury related pneumothorax can happen when you have had injury to your chest, like a fractured rib or knife wound, punctures your lung causing air packets in the lung.
♦️Iatrogenic pneumothorax is when your lung is punctured during a medical procedure, like a lung biopsy or a central venous line insertion.
Source: Muhetaer,2022
There are also other types of pneumothoraxes apart from these two.
♦️Tension pneumothorax is when air can get into your lungs but cannot get out. This can be a medical emergency.
♦️ Catamenial pneumothorax is a rare condition that can affect people with endometriosis. Endometrial tissue can grow outside of your uterus forming cysts that can bleed into the pleural space, causing your lung to collapse.
Source: Huan 2021
▶️What really causes pneumothorax?
There are three main causes of a pneumothorax:
1️⃣Medical conditions such as asthma, pneumonia, COPD, cystic fibrosis, lung cancer, and acute respiratory distress syndrome etc… can cause lung collapse.
2️⃣Injuries such as stab wounds, gunshot, medical procedures, and blunt force trauma.
3️⃣ Lifestyle factors such as drug use especially inhaled drugs, smoking, deep sea diving and flying that involve drastic changes in air pressure.
▶️How would you treat a pneumothorax?
Treatment will depend on which kind of pneumothorax you have and may be prescribed on a case-by-case basis to relieve the symptoms of the disease.
Here are some treatment options:
🟠Tube thoracostomy (chest tube insertion drain)
If you have a pneumothorax greater than 20% of the thoracic volume on chest x-ray or greater than 35 mm on CT, measured radially from the chest wall to the lung parenchyma (Blank,2026)
This is normally treated with tube thoracostomy, it involves inserting a flexible plastic tube into the pleural space to facilitate drainage of air, blood, fluid, chyle, or infectious material.
Surgically Placed Chest Tube. The chest tube is inserted along the chest wall to a prespecified depth, ensuring that the sentinel port. Image from (Ravi 2025)
🟠Observation with oxygen for small cases
Pneumothoraxes smaller than 10 may be observed but if approximately 10% of these fail observation, then a tube thoracostomy treatment will be required (Blank, 2026)
🟠 Pleurodesis
This is a procedure that seals the space between the lungs and chest wall (pleural space) to prevent the recurrent build up of fluid (pleural effusion) or air (pneumothorax)
🟠Needle Aspiration:
A small needle or catheter is inserted into the chest wall to withdraw air, effective in about 50% of cases, often used for primary spontaneous, or after lung procedures.
▶️What happens if pneumothorax is left untreated?
If left untreated, a pneumothorax (collapsed lung) can range from a self-healing minor issue to a life-threatening medical emergency, depending on its size and cause.
While small cases may resolve on their own, the condition generally risks:
♦️Worsening oxygen levels.
♦️Heart failure.
♦️If it occurs in both lungs and in someone with existing lung disease, it is often fatal.
And if you have a significant pneumothorax (collapsed lung), this can lead to severe, life-threatening complications, including.
♦️Acute respiratory failure.
♦️Profound shock due to compression of the heart and major vessels: This can reduce blood flow back to the heart, leading to shock.
♦️️ Sometimes death due to a “tension pneumothorax”. If the heart cannot pump enough blood to the body and brain due to cardiovascular collapse, it can lead to cardiac arrest and death.
♦️Persistent collapse can lead to permanent lung damage or long-term breathing difficulties, especially in patients with pre-existing lung diseases.
♦️Internal Infections such as empyema or collection of pus due to untreated air or fluid in the pleural space can be a problem
It is important to always get yourself checked out if you develop any symptoms because leaving a pneumothorax to heal on its own without identifying the underlying cause (like ruptured “blebs”) normally results in a 20–30% chance of it happening again (McKnight,2023)
▶️How long can a person survive with a pneumothorax?
While most people survive a collapsed lung (pneumothorax) with prompt medical care, the survival timeframe without treatment depends entirely on the severity of the collapse
♦️If you have a small, partial collapse: You can live with a minor collapse for several days to weeks. In many cases, a small collapse may even resolve on its own as the body reabsorbs the trapped air.
♦️For a complete collapse is significantly more dangerous, with survival shrinking to hours or days.
♦️And if you have tension pneumothorax, this is an immediate life-threatening emergency where air pressure continues to build, compressing the heart and other organs.
▶️What is the recovery and Long-Term Outlook after treatment?
♦️Once treated the lung typically re-expands within 48 to 72 hours.
♦️Most individuals return to normal activities within 6 to 8 weeks.
♦️Mortality rates are generally very low (1–10%), though they are higher for elderly patients or those with underlying conditions like COPD.
♦️There is a 20–60% risk of the lung collapsing again within three years if preventive surgery is not performed (health.harvard.edu)
Summary: If you suspect a lung collapse due to sudden chest pain or shortness of breath, seek emergency medical care immediately to rule out a pneumothorax.
We have come to the end of this article and hope we have educated ourselves. Any questions let’s meet in the comments section. Wishing you a quick recovery!🙋
Resources used outlined below.
📚Source:
Huan NC, Sidhu C, Thomas R. Pneumothorax: Classification and Etiology. Clin Chest Med. 2021 Dec;42(4):711-727. doi: 10.1016/j.ccm.2021.08.007. PMID: 34774177.
Blank JJ, de Moya MA. Traumatic pneumothorax and hemothorax: What you need to know. J Trauma Acute Care Surg. 2026 Jan 1;100(1):12-17. doi: 10.1097/TA.0000000000004692. Epub 2025 Jul 3. PMID: 40604368.
Ravi C, McKnight CL. Chest Tube. [Updated 2025 Apr 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459199/
Muhetaer M, Paerhati K, Sun Q, Li D, Zong L, Zhang H, Zhang L. Effects of Different Treatment Regimens on Primary Spontaneous Pneumothorax: A Systematic Review and Network Meta-Analysis. Ann Thorac Cardiovasc Surg. 2022 Dec 20;28(6):389-402. doi: 10.5761/atcs.oa.22-00113. Epub 2022 Aug 25. PMID: 36002271; PMCID: PMC9763716.
McKnight CL, Burns B. Pneumothorax. [Updated 2023 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441885/
Image source: https://www.radiologymasterclass.co.uk/gallery/chest/pneumothorax/pneumothorax_c