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It's usually not a good thing to see the word "collapsed" before any body part. A collapsed lung is no exception. And that's what two-time All-Star Detroit Pistons guard Cade Cunningham has apparently just suffered.
The collapse seems to have happened during the first quarter of Tuesday's game against the Washington Wizards when he "lung"-ed for a loose ball. In the process, he collided with Wizards guard Tre Johnson. Cunningham's breathing then looked très labored until he checked out of the game 1:04 later.
Although the initial thought was that Cunningham was suffering back spasms, the medical staff soon rolled back on that diagnosis. Further evaluation revealed a left-sided pneumothorax, which left Cunningham literally breathless. Cunningham, in turn, will be left out of the lineup for at least two weeks, which will span eight games. After that time period, docs will re-evaluate the 24-year-old MVP candidate to see if he can return to the court.
What Is A Collapsed Lung
To understand what is meant by a collapsed lung, picture your lungs as being composed of trees of airways with each branch ending in a cluster of grape-like structures that are actually tiny little bags normally filled with air. These bags are known as alveoli -- which may sound like some kind of a pasta dish but shouldn't be mistaken for ravioli.
When you breathe in oxygen-filled air, it goes down your airways, all the way to the alveoli, filling them so that your lungs expand. These alveoli have blood vessels running through them. There, the oxygen in the air moves into the blood stream and the carbon dioxide in the blood moves into the alveoli to ultimately go backwards up your airways when you exhale. Even when you exhale and your lungs contract, most of your alveoli still remain inflated to some degree with air. In other words, they stay uncollapsed.
When the air for some reason goes completely out of these alveoli, they can collapse, sort of like removing all the contents from your Prada bag and flattening it. Having some of your alveoli collapsed may be OK, especially if they can get re-inflated again. However, at some point, having too many alveoli collapsed can affect the amount of oxygen and carbon dioxide exchange that you lungs can do. When noticeable parts of your lung are affected, it's considered some kind of lung collapse. The greater proportion of your lung that's collapsed, the worse your gas exchange gets -- potentially becoming a dangerous and even life-threatening situation.
A Pneumothorax Is A Common Cause Of A Collapsed Lung
There are several different ways such a deflating situation can result. One is when your airways get blocked so that air can longer get through to keep that part of the lung inflated. Another is getting your alveoli damaged to the point that they are either leaking or too rigid to get inflated.
Then there's the whole collapse under pressure scenario. This isn't where your lung can't handle public speaking or something like that. Instead, the pressure is physical -- where some force outside the alveoli compresses them, keeps them from inflating. This can happen, for example, when your lungs get filled with fluid.
It can also happen with a pneumothorax. The prefix "pneumo" stands for "air" and "thorax" is another way of saying "chest." So, pneumothorax literally means "air in the chest -- but air where its not supposed to be. It's in the pleural space, where there isn't air.
The pleural space is formed by two layers of pleura -- a membrane structure that wraps around the lungs sort of like how Saran Wrap might wrap around a fruitcake. One of the two layers is the visceral one directly covering the lungs; and the other is the parietal layer than runs abuts the inner chest wall. Inside the pleural space between these two layers, there is normally some lubricating fluid that helps your lungs expand and contract more smoothly.
Puncturing this pleural membrane somehow can allow air into the pleural space, causing a pneumothorax. This is what happened to Rob Gronkowski, the former New England Patriots' tight end, when he suffered a puncture injury during a game in 2016, as I described in Forbes at the time.
But a puncture injury doesn't have to happen for a pneumothorax to occur. Different types of lung diseases can lead to a pneumothorax -- especially when air can get into the lungs but not readily out, leading to more tension on the pleura. Changes in air pressure can be a culprit, too. A pneumothorax can even be spontaneous, as well meaning -- poof -- it happens suddenly with no clear cause.
Regardless, a pneumothorax can turn the pleura itself into somewhat of a balloon. This balloon can, in turn, can push against the alveoli in the lung. That pressure can result in a partial or even total lung collapse.
How Do You Treat A Collapsed Lung
Now, if you are suffering the symptoms of a collapsed lung -- like chest pain on one side, shortness of breath, unusually fast breathing or bluish skin, lips or nails -- you shouldn't just try to walk it off or soothe it with pizza. Getting a chest X-ray or other imaging like a chest CT can show how inflated your lungs are, whether any collapse is present and what might be causing it. For example, imaging can detect the presence of a pneumothorax.
Should you have a collapsed lung, what you should do depends on what's causing it and how much of your lung is collapsed. A small pneumothorax, for example, compressing only a very small portion of your lung can be minor and require no more than monitoring. The air in the pleural space can just be resorbed over time. In the meantime, if you are having trouble getting enough oxygen, oxygen therapy can help.
A larger pneumothorax may be much harder to just monitor and may call for a thoracentesis. This is when the doctor inserts a needle between your ribs into your pleura space to then suck the air out of there. The doc may even insert a chest tube there to keep draining the air from there.
If there are concerns that a hole in the pleura may form again, the doctor may perform a pleurodesis. This entails inserting chemicals such as doxycycline or talcum powder into the area so that the two layers of the pleural membrane remain stuck together. If a significant puncture hole is present in your pleura, surgery may be necessary to repair it.
It can take anywhere from a few days to a few weeks for a punctured lung to heal. Word is that Cunningham's lung collapse wasn't major. It's not clear what exactly was done with his pneumothorax and whether he had any procedures done. But in keeping him out at least two weeks for his collapsed lung, the Pistons could always be "airing" on the side of caution.