How to Read a Pneumothorax X-ray

Written by Li Hu Chen
Imaging Center
Updated on May 26, 2025
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Pneumothorax has typical manifestations on a chest X-ray. Normally, the pulmonary markings on both sides are quite clear and visible. However, when a pneumothorax occurs, the part of the lung tissue with these markings tends to be compressed due to the accumulation of a large amount of gas in the surrounding pleural cavity, pushing the lung to contract towards the center. Around the periphery, these lung margins, which are outside the lung, meaning inside the pleural cavity, display the gas as very uniform and fine, without any markings. This is because it is pure gas, simply air, hence it is impossible for it to have markings. There is a particularly distinct demarcation line, a thin line, between this part of the pleural cavity and the lungs. Through these features, one can determine the presence of a pneumothorax.

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Written by Han Shun Li
Pulmonology
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Can pneumothorax recover by itself?

Pneumothorax is caused by a rupture of the pleura, allowing air to enter the pleural space. Patients often display symptoms such as coughing, chest pain, chest tightness, and shortness of breath. A lung radiograph can confirm the presence of a pneumothorax. Whether a patient with pneumothorax can recover on their own depends on the size of the pneumothorax. If it is a large pneumothorax, especially a communicative or tension pneumothorax, self-recovery is not possible, and treatment generally involves pleural puncture or pleural drainage tube placement. However, if the amount of air in the pneumothorax is small and the patient does not exhibit severe symptoms, then it is possible for the condition to resolve itself with bed rest.

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What are the main signs of pneumothorax?

If it is a small amount of pneumothorax, the physical signs are generally not obvious, especially when patients with emphysema develop pneumothorax, it is difficult to detect any signs. However, when a larger amount of pneumothorax occurs, inspection will reveal that the affected side of the chest is bulging and respiratory movements are reduced. Upon palpation, the trachea usually shifts towards the healthy side, tactile fremitus on the affected side is reduced, percussion results in hyperresonance or tympany, and auscultation shows reduced breath sounds, which can disappear in severe cases.

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Written by Li Ying
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How many days do you usually stay in the hospital for pneumothorax drainage?

This depends on whether the pneumothorax is a simple pneumothorax or is complicated by other diseases. If there are no other lung diseases present and it is just a simple pneumothorax, then typically, drainage by tube for 5 to 7 days can lead to a complete recovery and cure. However, if there are complications such as emphysema, pulmonary heart disease, pneumoconiosis, or lung infections, then it is necessary first to control the infections. During this time, the pneumothorax can easily become a communicating pneumothorax. If it lasts for more than 1 to 2 weeks, it may turn into a refractory pneumothorax. In the case of refractory pneumothorax, besides drainage, minimally invasive surgeries such as pleurodesis or pneumothorax occlusion procedures are required. These surgeries take time. Therefore, if a stubborn pneumothorax forms, especially when complications like emphysema are present, hospital stays often need to be 14 days or even longer.

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Can pneumothorax patients take a plane?

Pneumothorax is a relatively common clinical condition, usually caused by a rupture of the pleura, allowing air to enter the pleural cavity. Patients often experience symptoms such as chest pain, difficulty breathing, and coughing. So, can someone with pneumothorax fly on an airplane? Patients with pneumothorax are prohibited from flying because the high altitude may aggravate the condition, leading to serious consequences. Even after pneumothorax has healed, it is advised not to fly within a year, as flying may cause the pneumothorax to recur.

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Pneumothorax pleurodesis: what are the advantages and disadvantages?

Pleurodesis for pneumothorax involves injecting a sclerosant into the pleural cavity to induce a sterile inflammation, causing adhesion of the parietal and visceral pleurae, thereby eliminating the pleural space. This can be used to treat pneumothorax. The benefits include a high success rate, simple operation, and low recurrence rate. The downside is that there can be adverse reactions, the most common being chest pain and fever; severe cases may cause acute respiratory distress syndrome. Therefore, extra care is needed during the pleurodesis procedure.