These are a closed pneumothorax , and an open pneumothorax . The symptoms of pneumothorax can be subtle , especially in those with PSP , and confirmation with medical imaging is usually required . In contrast , tension pneumothorax is ideally treated before imaging , especially if there is severe hypoxia , very low blood pressure , or an impaired level of consciousness ; however , X-rays are sometimes required if there is doubt about the location of the pneumothorax .