Can pneumonia cause collapsed lung?

Pneumonia is an infection of the lungs that can cause inflammation and fluid buildup, making it difficult to breathe. In severe cases, the infection and inflammation can damage lung tissue and cause a lung to collapse, which is known as a pneumothorax. While not a common complication, a collapsed lung can occur in cases of severe pneumonia. Let’s explore the link between pneumonia and collapsed lung in more detail.

Table of Contents

What is Pneumonia?

Pneumonia is an infection of one or both lungs caused by bacteria, viruses, or fungi. The air sacs in the lungs (alveoli) become inflamed and may fill up with fluid or pus. This makes breathing painful and limits oxygen intake.

The most common cause of pneumonia is bacteria, with Streptococcus pneumoniae being the leading culprit. Viral pneumonia may be caused by influenza, respiratory syncytial virus (RSV), or SARS-CoV-2 (COVID-19). Fungal pneumonia is less common but seen in people with weakened immune systems.

Pneumonia symptoms include:

Cough producing green, yellow, or bloody mucus
Fever and chills

Shortness of breath
Chest pain with breathing
Fatigue

Without treatment, the lungs can become severely inflamed and fluid-filled, resulting in respiratory failure. Pneumonia can range from mild to life-threatening. Those at highest risk include young children, older adults, and people with underlying medical conditions.

What is a Collapsed Lung?

A collapsed lung, also called a pneumothorax, occurs when air leaks into the space between the lung and chest wall, causing the lung to collapse. This prevents normal inflation of the lung during breathing. A pneumothorax may be categorized as:

Primary spontaneous – occurs for no apparent reason in healthy people.

Secondary spontaneous – occurs as a complication of an underlying lung disease.
Traumatic – caused by blunt chest injury, damage from medical procedures, or mechanical ventilation.

Symptoms of a collapsed lung include:

Sudden, sharp chest or shoulder pain
Shortness of breath
Rapid heartbeat

Fatigue and anxiety

A collapsed lung is considered a medical emergency. Without treatment, the condition can become life-threatening. Prompt medical attention is needed to re-expand the lung.

Can Pneumonia Cause a Collapsed Lung?

Yes, pneumonia can sometimes lead to a collapsed lung, although this is an uncommon complication. Researchers estimate that pleural complications, including collapsed lung, occur in about 6% of pneumonia cases requiring hospitalization.

Here’s how pneumonia may cause a pneumothorax:

The inflammation and fluid buildup in the lung damages the thin lining between the lung and chest cavity (pleural space).
This damaged pleural lining can develop a tear or hole, allowing air to leak into the pleural space.

As more air fills the pleural space, it puts pressure on the outside of the lung, causing it to collapse away from the chest wall.

Several factors raise the risk of a collapsed lung in pneumonia patients:

Underlying lung disease, like COPD or cystic fibrosis

Severe pneumonia affecting multiple lobes of the lung
Pneumonia in older adults or those with weakened immune systems
Spread of infection to the pleural space (empyema)

Need for mechanical ventilation

Bacterial pneumonias, especially from Streptococcus pneumoniae, are more likely to cause pleural complications compared to viral pneumonias.

Symptoms of Collapsed Lung with Pneumonia

The symptoms of a pneumonia-related collapsed lung may include:

Sudden, sharp chest pain on the side of the collapsed lung. This worsens with deep breathing or coughing.
Shortness of breath that begins suddenly
Rapid, shallow breathing

Fast heart rate and palpitations
Chest tightness or shoulder pain
Fatigue, lightheadedness, and anxiety

Bluish discoloration of lips and skin (cyanosis) in severe cases

These symptoms often arise abruptly, whereas pneumonia symptoms like fever, cough, and phlegm develop more gradually. Seeking prompt medical treatment is crucial for a collapsed lung.

Diagnosing a Pneumonia-Related Collapsed Lung

If pneumonia is suspected to have caused a collapsed lung, doctors will carry out:

Physical exam – Using a stethoscope, reduced or absent breath sounds may be noticed on the side of the collapsed lung. The chest wall may appear flattened or concave.
Imaging tests – A chest X-ray or CT scan can confirm a collapsed lung and detect the presence of pneumonia. These images show an inflated lung on one side but little to no inflation on the other side.
Arterial blood gas – A blood sample measuring oxygen levels may show low oxygen and elevated carbon dioxide.

Pulse oximetry – This noninvasive test measures oxygen saturation in the blood, which may be low with a pneumothorax.

Identifying the underlying pneumonia is also important. Sputum cultures can detect bacterial pneumonia, while viral tests like PCR diagnose viruses like influenza or COVID-19.

Treating a Collapsed Lung Caused by Pneumonia

Treatment focuses first on re-expanding the collapsed lung. This may involve:

Oxygen therapy – Extra oxygen is given through a mask or nasal cannula to help relieve shortness of breath.
Needle aspiration – A needle and syringe are used to remove excess air from the pleural space.
Chest tube insertion – A hollow plastic tube is inserted into the pleural space and attached to a suction device to remove air and fluid.

Thoracoscopy or thoracotomy – In severe cases, surgery may be needed to re-inflate the lung and close any holes in the pleura.

The underlying pneumonia also requires appropriate treatment, which may include:

Antibiotics – Used to treat bacterial pneumonia and pneumonia complications like empyema.

Antivirals – May be used in viral pneumonia cases, like oseltamivir for influenza.
Oxygen therapy and breathing support – May be required if oxygen levels are very low.
Drainage of fluid – Excess fluid may need to be drained from the lungs via tube thoracostomy.

IV fluids and nutrition – Supplemental hydration and nutrition may aid recovery.

With proper treatment, most cases of pneumonia-related collapsed lung will recover within 1-2 weeks. However, hospital monitoring is often needed due to risks like re-collapse of the lung. Severe or recurring cases may need thoracic surgery.

Preventing Collapsed Lung from Pneumonia

Some ways to help prevent pneumonia complications like a collapsed lung include:

Getting vaccinated against respiratory infections like influenza, COVID-19, and pneumococcal disease.
Quitting smoking and avoiding secondhand smoke exposure.
Practicing good hand hygiene to avoid infectious respiratory illnesses.

Seeking treatment quickly at the first signs of pneumonia.
Taking prescribed antibiotics fully to clear bacterial lung infections.
Avoiding underlying lung diseases like COPD through healthy lifestyle habits.

For people hospitalized with severe pneumonia, preventing a pneumothorax may involve:

Careful airway management if mechanical ventilation is required.
Regular monitoring and chest x-rays to check for early signs of lung collapse.

Pleuracentesis to drain fluid buildup in the pleural space.
Avoiding barotrauma from high ventilation pressures.

Complications from Collapsed Lung

Possible complications of a collapsed lung include:

Respiratory failure – If a large enough pneumothorax compromises breathing, respiratory failure can occur. Mechanical ventilation may be required.
Shock – A severe lung collapse can cause reduced oxygen intake, low blood pressure, and shock.
Infection – A chest tube or pleural catheter raises infection risk. Empyema may develop.

Re-collapse of lung – The affected lung may collapse again after initial treatment. Surgery may be eventual needed.
Lung scarring – The pleural inflammation can cause fibrothorax, scarring the lung’s pleural surface.

Rare complications include accumulation of air or fluid around the heart (cardiac tamponade) and partial lung collapse on the opposite side.

Outlook for Pneumonia Patients with Collapsed Lung

With appropriate medical care, the prognosis for a pneumonia-related collapsed lung is generally good, especially in otherwise healthy individuals. Underlying medical conditions can increase risks from the pneumothorax and pneumonia itself.

Overall, studies show:

Rates of pneumonia-associated collapsed lung range from 2-12% in hospitalized pneumonia patients.

Pleural complications are more common with bacterial pneumonia compared to viral pneumonia.
Up to one-third of pneumothoraces related to pneumonia require surgery to correct.
Advanced age, impaired immune function, COPD, and delayed treatment raise risks.

With treatment, survival rates are over 90% in patients with pneumothorax from pneumonia.

Prompt recognition and treatment of both the lung collapse and pneumonia infection are key to preventing complications. Following up with pulmonology specialists after hospital discharge is also recommended.

Key Points

Pneumonia, an infection of the lungs, can sometimes lead to a collapsed lung or pneumothorax.

Inflammation and fluid buildup in pneumonia can damage the lung’s pleural surface, causing air leaks into the pleural space.
Resulting pressure collapses the lung so it cannot inflate normally.
Symptoms include sudden chest pain and shortness of breath.

A pneumothorax is treated by removing excess air and re-expanding the lung.
Antibiotics, antivirals, oxygen therapy, and drainage address the underlying pneumonia.
Prevention aims to prevent respiratory infections and maintain lung health.

With proper medical care, most pneumonia-related collapsed lungs recover well.

Conclusion

While not a very common occurrence, pneumonia does carry a risk of causing a collapsed lung or pneumothorax in some cases. The infection and inflammation can damage the lung’s delicate pleural surface, allowing air leaks that put pressure on the lung. Prompt treatment is needed to re-expand the lung and address the underlying pneumonia. Prevention through vaccination, lung health, and medication adherence can reduce the likelihood of this potentially serious complication.