Punctured Lung: Traumatic Pneumothorax Injuries

By Matthew Cenzon. May 7th 2016

A punctured lung is a type of classification for a pneumothorax, which is the medical definition for a collection of air in the ribcage causing pressure on the lungs, preventing them from expanding. There are several variations of pneumothorax, all of which can be referred to as a collapsed lung.

  • Traumatic Pneumothorax (punctured lung): this occurs due to direct trauma to the chest, like a broken rib, or a penetrating injury from a stab or gunshot. Certain medical procedures that deliberately collapse the lung also fall under this category of pneumothorax.
  • Primary spontaneous pneumothorax: this is when the collapsed lung occurs without any particular cause. This is typically caused by a rupture of a small air sac on the surface of the lung, causing air to leak into the cavity surrounding the lung.
  • Secondary spontaneous pneumothorax: this is used to define when a collapsed lung is caused by a degenerative lung disease like asthma, lung cancer or a chronic obstructive pulmonary disease (COPD) like chronic bronchitis or emphysema.

Who is at Risk?

Since a punctured lung is caused by some form of chest trauma, there are certain people who are at a greater risk for suffering this type of injury. Those who play contact sports, especially football, tend to suffer from a punctured lung after sustaining an injury to their rib cage. People who have been involved in a car accident and experience direct trauma to their chest should also be closely examined to check for the possibility of a punctured lung.

A case report in an article from the National Library of Medicine discusses the importance of recognizing a traumatic pneumothorax immediately to prevent a life-threatening situation. In the case report, an 18-year-old male athlete sustained a rib injury after being hit by another player on the right side of his chest wall. Since the player was wearing a rib protector, he was able to continue with the play, even after being hit, and was tackled after running an extra five yards. Upon examination, he only complained of soreness on the right side of his chest and difficulty breathing.

Although his initial symptoms seemed mild, the pain grew worse several minutes later, with increased difficulty breathing and a feeling of lightheadedness. Further examination by the team's physician led to the diagnosis of a possible fractured rib cage and punctured lung. The diagnosis was confirmed in a hospital emergency room where x-rays and further examination showed a fracture in the right fifth rib had caused a laceration in the lungs. The injured player was treated and hospitalized for 12 days, and eventually made a full recovery.


Treatment varies depending on the level of trauma and the extent of damage to the punctured lung. A small traumatic pneumothorax can heal on its own, and may only require oxygen and rest for recovery. A physician may release extra air around the lung by sucking it out through a needle to allow the lung to fully expand.

For a large traumatic pneumothorax, like the one suffered by the football player mentioned above, a chest tube is placed through the ribs in the area surrounding the lungs to help drain air. The chest tube can be left for both air drainage and to help inflate the lung. In some cases, the chest tube may have to be left in place for several days before the chest begins to expand again. For those who suffer from repeated pneumothorax, surgery may be required.

Symptoms of a Punctured Lung

Recognizing a traumatic pneumothorax as soon as possible is essential for treatment and to avoid a life-threatening situation. After suffering any form of trauma to the chest, look for the following symptoms:

  • Chest pain that increases after coughing or taking a deep breath
  • Shortness of breath
  • Abnormal breathing
  • A tight chest
  • Rapid heart rate
  • Pale or blue skin due to lack of oxygen
  • Fatigue

Seek medical attention immediately if you or anyone you know shows any of these signs or symptoms after experiencing direct trauma to the chest. While waiting to receive medical attention, conduct the following:

  • Try to remain quiet and calm
  • Avoid gasping or coughing
  • Do not consume any fluids
  • Stay in an upright, seated position


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