Citation, DOI, disclosures and article data
Citation:
Rezaee A, Sharma R, Menon S, et al. Pneumothorax ex vacuo. Reference article, Radiopaedia.org (Accessed on 25 Mar 2025) https://doi.org/10.53347/rID-36767
Pneumothorax ex vacuo is an uncommon complication of lobar lung collapse, particularly right upper lobe collapse.
Patients are usually asymptomatic 3.
Acute bronchial obstruction for any reason, such as lung cancer, mucus plugs, foreign bodies, or malpositioned endotracheal tubes, can cause acute lobar collapse and a marked increase in negative intrapleural pressure around the collapsed lobe which results in gas - that is, nitrogen from surrounding tissues and blood vessels - being drawn into the pleural space around the collapsed lobe while the seal between the visceral and parietal pleura around aerated lobes remains intact.
It is also seen following removal of pleural effusion by thoracentesis when the collapsed lung struggles to re-expand. It is thought that this type of ex vacuo pneumothorax occurs because (a) co-existing pleural disease precludes normal re-expansion of the lung 6 or (b) pulmonary surfactant production is insufficient due to pulmonary edema, decreased blood flow and chronic atelectasis 4,5.
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See article on pneumothorax. Also, there may be signs of lobar lung collapse.
Treatment and prognosis
The pneumothorax spontaneously resolves when the bronchial obstruction is relieved and the lobe re-expands. The noncompliant lung is usually unresponsive to chest drain insertion and so it should not be used in asymptomatic patients unless there is a concern for trapped lung 5,7,8.
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1. Berdon W, Dee G, Abramson S, Altman R, Wung J. Localized Pneumothorax Adjacent to a Collapsed Lobe: A Sign of Bronchial Obstruction. Radiology. 1984;150(3):691-4. doi:10.1148/radiology.150.3.6695068 - Pubmed
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2. Woodring JH, Baker MD, Stark P. Pneumothorax ex vacuo. Chest. 1996;110 (4): 1102-5. Pubmed citation
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3. Panigrahi MK, Pradhan G. Pneumothorax Ex Vacuo Following Chemotherapy for Malignant Pleural Effusion. (2016) Journal of clinical and diagnostic research : JCDR. 10 (8): OJ03-4. doi:10.7860/JCDR/2016/20587.8297 - Pubmed
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4. Staes W & Funaki B. "Ex Vacuo" Pneumothorax. Semin Intervent Radiol. 2009;26(1):82-5. doi:10.1055/s-0029-1208386 - Pubmed
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5. Ponrartana S, Laberge JM, Kerlan RK, Wilson MW, Gordon RL. Management of patients with "ex vacuo" pneumothorax after thoracentesis. (2005) Academic radiology. 12 (8): 980-6. doi:10.1016/j.acra.2005.04.013 - Pubmed
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6. Huggins J, Doelken P, Sahn S. The Unexpandable Lung. F1000 Med Rep. 2010;2:77. doi:10.3410/M2-77 - Pubmed
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7. Boland GW, Gazelle GS, Girard MJ, Mueller PR. Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions. (1998) AJR. American journal of roentgenology. 170 (4): 943-6. doi:10.2214/ajr.170.4.9530040 - Pubmed
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8. Pien G, Gant M, Washam C, Sterman D. Use of an Implantable Pleural Catheter for Trapped Lung Syndrome in Patients with Malignant Pleural Effusion. Chest. 2001;119(6):1641-6. doi:10.1378/chest.119.6.1641 - Pubmed
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