Pneumothorax

WHAT IS PNEUMOTHORAX?

Written By: Prof.Dr. Semih Halezeroglu

Pnömotoraks filmi

The image of right Pneumothorax of our 25-year-old male patient.

  • PNEUMONIA in Latin: AIR, Thorax: Means the CHEST. Under normal conditions, the chest does not contain air. If there is air in the thoracic cavity for any reason, the condition is called pneumothorax.
  • In case of air accumulation in the thoracic cavity, the collapse in the lung begins to emerge.
  • It is also known as collapsed lung.

CAUSES OF PNEUMOTHORAX?

The causes of pneumothorax are classified in 3 categories:

1. Spontaneous pneumothorax

  • Although it is said to occur spontaneously, it is a type of pneumothorax arisen in consequence of the blowup of the small bubbles (blebs) in the lung, which cannot be seen in normal chest X-rays.
  • This type of pneumothorax is the most common type of pneumothorax.

2. Pneumothorax that arise due to a disease (secondary)

They are pneumothoraxes that emerge as a result of the damages caused by big bubbles and some diseases such as emphysema, pneumonia or tuberculosis in the lung.

3. Pneumothorax that arise as a result of a medical intervention (iatrogenic)

An air accumulation in the thoracic cavity after a needle biopsy of the lung, insertion of a catheter, or an abdominal surgery etc. may cause this type of pneumothorax.

What are the Symptoms of Pneumothorax?

Its symptoms are severe back and chest pain, cough, and shortness of breath.

In case of such complaints that begin suddenly, the disease is diagnosed with a chest X-ray taken for a suspected pneumothorax.

In case of a tension pneumothorax, these complaints may increase gradually and cause serious consequences. In case of mild air accumulation, the complaint may decrease spontaneously in the course of time. However, it is risky to wait for its recovery. It should be kept under physician supervision.

The People, In Whom Pneumothorax Develops More Commonly

Spontaneous pneumothorax is seen mostly in tall and slender men. It is less common in women, compared to men.

What are the Treatment Methods for Pneumothorax?

Treatment of Pneumothorax

  • It is related to some factors such as the degree of patient’s complaint (cough, shortness of breath, back and chest pain etc.),
  • amount of pneumothorax,
  • whether there is any other disease (heart and lung diseases), and
  • whether he/she had suffered pneumothorax in the past.

Accordingly, it can be possible to just monitor the patient in some cases of pneumothorax, without carrying out any process; but in some other cases, it may be required to remove the air from the thoracic cavity (aspiration), insert a drain (chest tube) or doing an endoscopic or open surgery.

Among these, the most commonly used method is to remove the air by means of a thin silicon drain under sedation anesthesia, ensuring that the patient does not feel any pain.

When is Surgery for Pneumothorax Needed?

If any one of the following conditions exists:

  • Pneumothorax that occurs for the second time,
  • Pneumothorax that appears at both the right and left,
  • Big blebs observed in the lungs,
  • Cases where any recovery cannot be obtained in 5 days, despite the drain insertion,
  • Vocational reasons (e.g. pilots),
  • Pneumothorax that appears for the first time in those who live in regions away from a health care institution.

What do the International Sources Recommend?

Both British (BTS) and the American (ACCP) Thoracic Associations have prepared guidelines on this subject.

By using the following link, you can reach the guideline prepared by The British Association of Chest Diseases (BRITISH THORACIC SOCIETY).

BTS: http://thorax.bmj.com/content/58/suppl_2/ii39.full

What are the Surgery Methods for Pneumothorax?

Insertion of a chest tube (drain)

Under sedation anesthesia, a silicon drain with a thickness approximately equal to the thickness of a pencil is inserted between the 7th and 8th ribs at the affected side, and is pushed forward in the thoracic cavity. This drain is connected to a sterilized unit that consists of a bottle with water in its bottom. When the air in the thoracic cavity is evacuated, the collapsed lung reverts back to its original condition.

Open-surgery

An opening is formed between the 3rd and 4th ribs by means of a retractor, with an incision about 7-8cm in length made in the armpit. Air sacs in the lung are removed with a special method. The top portion of the outer membrane of the lung called pleura can be removed (pleurectomy), or the lung can be ensured to be adhered by creating a reaction there (pleurodesis).

By this way, any collapse of the lung and air accumulation in the thoracic cavity is prevented. At the end of the operation, one drain is placed into the thoracic cavity, and the layers are closed in accordance with the anatomical layout. The drain is removed 1 or 2 days after surgery.

Closed- Endoscopic (VATS) Surgery for Pneumothorax

In this method, a camera inserted through a single incision of 2 cm (uniportal method) is pushed forward in the thoracic cavity, and the processes specified under the topic title ‘open surgery method for thymoma’ are carried out.

It is the most harmless operation method for patients.

This method called Single-Port VATS must be preferred to open-surgery.

After this method, the pain will be less, the surgical incision will be smaller (2cm), and the time required for the patient to return to his/her normal life will be shorter.

The following video shows a Single Port VATS Surgery for pneumothorax, which has been prepared for doctors.

What are the Risks of Surgery?

Some risks such as the formation of air leak from the lung, bleeding, and recurrence of the disease can be encountered. In such cases, the surgeon takes the required measures to minimize the risks.

The incidence rate of these complications after a closed-surgery for pneumothorax is 2%.

How Many Days Should I Stay in Hospital for Surgery?

On the average, 3 days of hospitalization is needed in case of only a drain insertion, while 4 to 5 days of hospitalization is needed after an open surgery, and 2 to 3 days of hospitalization is needed after an endoscopic surgery.

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