Punctured Lungs

An Overview

A punctured lung occurs when air collects in the space between the two layers of the tissue lining your lung. This causes pressure on the lungs and prevents them from expanding. The medical term is known as pneumothorax. There are several variations of this issue, all of which are referred to as a punctured or collapsed lung. If air collects in the pleural space outside of the lung, it has nowhere else to go. This air presses on the outside of your lung, causing it to collapse in full or in a portion. The lung can then not expand properly, preventing oxygen from entering the bloodstream efficiently.

Types and causes

A punctured lung can be categorized in different ways depending on its cause:
Traumatic pneumothorax: This happens when there has been a direct trauma to the chest, such as a broken rib or an injury from a stab or gunshot. Some medical procedures deliberately collapse the lung, which would also fall under this category.
Primary spontaneous pneumothorax: This is when the punctured lung occurs without any exact cause. It typically happens when there is a rupture of a small air sac on the outside of the lung. This causes air to leak into the cavity around the lung.
Secondary spontaneous pneumothorax: This happens when a punctured lung is caused by pre-existing lung disease, such as lung cancer, asthma, or chronic obstructive pulmonary disease (COPD).

Causes of Punctured Lungs

Depending on the cause of a punctured lung, it may be categorized in one of three ways:

Traumatic pneumothoraxA direct trauma to the chest, like a broken rib or an injury from a stab wound or gunshot, causes this type of pneumothorax. There are also medical procedures that deliberately collapse the lung in a controlled environment, which would also be considered this form of the condition. The air puts pressure on the lung, preventing proper expansion and causing it to collapse.

The size of a pneumothorax can vary with only a small portion of the lung collapsing in some cases. A punctured lung can occur due to a violent injury, such as a knife wound or gunshot to the chest. The condition can also develop as a complication from being on a mechanical ventilator. More commonly, a spontaneous punctured lung occurs in people who have an underlying lung disease. It is called a secondary spontaneous pneumothorax when it occurs in people with lung disease.

A punctured lung in someone without lung disease is called a primary spontaneous pneumothorax.
A chest injury can cause a lung to collapse, including a car accident. The impact itself of blunt force to the chest can be a factor, or a broken rib may puncture the lung. Other physical assaults, use of weapons, and sports injuries can have similar outcomes. It is also possible for a medical procedure to purposefully or accidentally cause a puncture, such as during the insertion of a needle into the chest.

Damaged lungs are more likely to collapse. Underlying diseases like pneumonia or cystic fibrosis are, therefore, potential causes. Cystic lung diseases, like Birt-Hogg-Dube syndrome, can cause round, thin-walled air sacs in the lung tissue to rupture and cause pneumothorax. People who need mechanical assistance to breathe can also experience an imbalance of air pressure within the chest that causes the lungs to collapse completely.

Symptoms for lung puncture

It is critical to identify a collapsed lung as soon as possible to seek early treatment and avoid the injury becoming life-threatening. If you have experienced any trauma to the chest or have existing lung conditions, look for these signs:
• Chest pain that worsens with coughing or breathing deeply
• Shortness of breath
• Abnormalities in breathing patterns
• Tightness in the chest
• A rapid heart rate
• Pale or blue skin (due to reduced oxygen)
• Fatigue

The most common and effective way of dealing with a punctured lung is by the insertion of a chest tube or hollow needle.
For this procedure, the doctor inserts a hollow needle or chest tube into the pleural space to let the air out. A syringe is attached to the needle to draw the excess air out of the space.
A chest tube is made of plastic and inserted into the body, in a similar way to a needle, to remove the air. The chest tube can be connected to a suction machine to remove the excess air from the pleural cavity

Diagnosis of a Punctured Lung

If it is suspected that you have suffered from a punctured lung, your doctor will first specifically listen to your chest using a stethoscope. They may tap your chest while you breathe in order to listen for hollow sounds. They may also suggest an arterial gas test to assess if you are experiencing high levels of carbon dioxide and low levels of oxygen, which can indicate a problem.
In order to get a definite diagnosis, you will need to undergo imaging like an x-ray, an ultrasound, or a CT scan. Very small cases can be missed on a routine chest x-ray, and a doctor may take multiple films, including x-rays in full expiration to ensure they identify any signs of a collapsed lung.

Treatment 

The treatment for a punctured lung will vary based on the severity of the trauma, cause of the condition, and amount of damage to the lung. The goal is to reduce pressure on the lung and allow it to re-inflate.
In the case of a small pneumothorax, it may heal on its own under the supervision of your doctor. Oxygen and rest are often prescribed as the primary treatment in these cases, or a doctor may release additional air by sucking it out through a needle and allowing the chest to expand fully. If this isn’t performed, the excess air can be re-absorbed over time. Repeated x-rays are used to monitor the condition and ensure it has resolved.
Surgery may be required for people who experience repeated pneumothorax. A large puncture wound would also require surgery, as the lung tissue would not be able to close immediately and repair itself. The surgeons will likely work to repair the injury by going through tubes placed down the throat into the bronchial airways.

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