Centers of Excellence

The Lung Center

Rib Fractures

Rib fractures are commonly caused by trauma to the chest wall. Extremely painful, rib fractures can represent an isolated injury or be part of a larger multi-system injury. A rib may be fractured in one place, two places (flail), or be shattered.

Rib fractures are most commonly caused by blunt injuries to the chest caused by a car accident, fall or assault. Penetrating injuries such as gunshot wounds are a less frequent cause. When severe, rib fractures can lead to flail chest (open chest wound) and cause breathing issues, pulmonary contusion, bleeding and pneumothorax. When untreated, rib fractures will lead to serious short-term consequences such as severe pain when breathing, pneumonia and, rarely, death. Long-term consequences include chest wall deformity, chronic pain and decreased lung function.

The Lung Center at Brigham and Women’s Hospital offers proven treatments for patients with fractured ribs. Our board-certified thoracic surgeons use rib plating, a pioneering technique for repairing broken ribs that dramatically reduces pain and recovery time. Although most broken ribs heal without surgery, a severely crushed chest with many broken ribs will likely benefit from this new operative technique.

What are the risk factors for pneumothorax?

There are several known causes of pneumothorax:

  • Chest injury (blunt or penetrating)
  • Medical procedures involving insertion of needles into the chest
  • Underlying lung diseases, such as:
    • Asthma
    • COPD
    • Cystic fibrosis
    • Pneumonia
    • Tuberculosis
    • Whooping Cough
  • Smoking: the more you smoke, and the longer you have smoked both increase your risk
  • Male
  • Genetics: some types of pneumothorax run in families
  • Being tall and thin
  • History of previous pneumothorax

What are the symptoms of pneumothorax?

If you have these symptoms, you should seek immediate attention either at your doctor’s office or in an emergency room where you will likely have a thoracic surgery consultation.

There are clear warning signs of a collapsed lung:

  • Sudden, sharp chest pain, which worsens with coughing or taking a deep breath
  • Shortness of breath

If the leak in the lung is a large one, more severe symptoms can occur:

  • Skin turns a bluish color due to lack of oxygen
  • Tightness in the chest
  • Fatigue
  • Rapid heart rate
  • Nasal flaring

How is pneumothorax diagnosed?

After taking your medical history and performing a careful physical examination, your Lung Center team may order the following tests to confirm a pneumothorax:

  • Chest CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat and organs.
  • Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media.

What are the treatment options for pneumothorax?

Depending on the severity of your pneumothorax, there are several treatment options:

  • Observation: If your lung collapse is small, your condition will be monitored with a series of chest X-rays, usually in the hospital. You may need to use supplemental oxygen. Sometimes the air can be reabsorbed and your lung returns to normal after a week or two.
  • Needle or chest tube insertion: If your lung collapse is larger, or air continues to leak, a needle or chest tube is inserted to remove the air.
  • Minimally invasive surgical treatment: If the needle or chest tube does remove the air successfully, video-assisted thoracic surgery (VATS) may be required to close the leak particularly when this is a recurrent problem. A small telescope is inserted and the source of the air leak is stapled closed. After surgery, you can expect to stay in the hospital for a few days recovering.

What should you expect?

When you become a patient of The Lung Center, you will meet many members of the team who specialize in pneumothorax. You will receive a thorough diagnostic evaluation and careful monitoring.

If you have had a pneumothorax in the past that was treated without surgery, it is recommended that you do not participate in sports that involve changes in barometric pressure (scuba diving, mountain climbing, sky diving). If you would like to participate in these sports, but have had a pneumothorax in the past, specialists at The Lung Center can assess your risk for participating in such sports.

Team-based care

Pneumothorax patients benefit from the wide range of specialists at the Lung Center, including pulmonologists, thoracic surgeons, cardiovascular medicine physicians and thoracic imaging experts. This multidisciplinary collaboration ensures comprehensive evaluation and treatment. If your medical team discovers an underlying illness or concern, you will be referred to a BWH physician for an expert evaluation.

Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon, in collaboration with a pulmonologist and anesthesiologist, as well as nurses and physicians, all of whom are experts in taking care of patients with pneumothorax.

Where are you located?

What are some additional resources I can read?

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

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