This article provides detailed information on Pneumothorax (Collapsed Lung), including what it is, how it occurs, its symptoms, diagnosis, treatment, and surgical methods.

What is Pneumothorax?

Normally, there is no air inside the chest cavity. When air accumulates inside the chest cavity for any reason, it is called pneumothorax. When air accumulates in the chest cavity, a collapse of the lung occurs. This is why it is commonly referred to as a collapsed lung. This article provides information about the causes, symptoms, and treatments of pneumothorax.

Causes of Pneumothorax

Pneumothorax can occur in the following three situations:

1. Spontaneous Pneumothorax

• Although it is said to occur spontaneously, spontaneous pneumothorax actually occurs due to the rupture of small bubbles (blebs) in the lungs, which are not visible in normal chest X-rays.
• This is the most common type of pneumothorax.
• It is more common in tall, slender, young men.

The CT scan image of a patient with pneumothorax and partial lung collapse due to small bubbles (blebs) in the left upper lobe is shown here.

• Spontaneous pneumothorax occurs in 22 out of every 100,000 men.
• Its frequency increases with smoking.

2. Secondary Pneumothorax

This type of pneumothorax occurs as a result of pre-existing lung conditions such as emphysema, pneumonia, tumors, or tuberculosis. Damage to the affected areas of the lungs causes air to accumulate in the closed chest cavity from the airways (bronchi). The X-ray image below shows a patient with large air spaces (bullae) in both lungs and a tumor in the right lower lobe. These bullae are likely to rupture during sudden coughing, straining, or trauma, leading to pneumothorax. Patients are advised to avoid such activities.

3. Iatrogenic Pneumothorax

This occurs due to medical procedures, such as needle biopsies from the lung, the insertion of a catheter, or after abdominal surgery, leading to air accumulation in the chest cavity.

Symptoms of Pneumothorax

The treatment history of a patient who had recurring pneumothorax can be watched in the following video. https://youtube.com/watch?v=U1aStxPvF24 Symptoms include severe back and chest pain, cough, and shortness of breath. Pneumothorax is diagnosed by chest X-ray in cases of sudden onset of these symptoms. In cases of tension pneumothorax, these symptoms can progressively worsen and lead to serious consequences. If the air accumulation is mild, symptoms may resolve spontaneously over time, but it is risky to wait for this and should be monitored by a doctor.

Who is More Likely to Have Pneumothorax?

Spontaneous pneumothorax is more common in tall, thin men aged 20-35 years.

It is less common in women compared to men.

Treatment of Pneumothorax

• The degree of the patient’s symptoms (cough, shortness of breath, back and chest pain),
• The amount of pneumothorax,
• Whether the patient has other conditions (heart and lung diseases),
• Whether the patient has had pneumothorax before,

Depending on these factors, in some cases, the patient may only need observation without any procedure, while in other cases, air in the chest cavity may need to be aspirated with a syringe, or a chest tube may be inserted, or surgery may be required. The most common method involves draining the air with a fine silicone tube under sedation, with the patient feeling no pain.

When is Pneumothorax Surgery Required?

Surgery may be required in the following situations:

• Recurrent pneumothorax,
• Pneumothorax occurring on both sides simultaneously,
• Presence of large bullae in the lungs,
• Cases that do not improve within 5 days despite chest tube insertion,
• Occupational reasons (e.g., pilots),
• First pneumothorax in people living in remote areas.

What Do International Sources Recommend for Pneumothorax Treatment?

Both the British Thoracic Society (BTS) and the American College of Chest Physicians (ACCP) have prepared guidelines on this subject. The guideline prepared by the British Thoracic Society (BTS) can be accessed via the link below. BTS: http://thorax.bmj.com/content/58/suppl_2/ii39.full

What are the Surgical Methods for Pneumothorax?

Chest Tube (Drain) Insertion

Under sedation, a silicone drain, about the width of a pen, is inserted into the chest cavity between the 7th and 8th ribs on the affected side. This drain is connected to a sterile unit with a water-filled bottle at the bottom. Once the air in the chest cavity is drained, the collapsed lung returns to its normal state.

Open Surgery

Open surgery is rarely preferred today. A 7-8 cm incision is made from the armpit, and the space between the 3rd and 4th ribs is opened with an instrument. The air sacs in the lungs are removed using a special technique. The upper part of the pleura, the outer lung membrane, can be removed (pleurectomy), or the pleura may be reacted to make the lung stick to the chest wall (pleurodesis). This prevents the lung from collapsing and air from accumulating in the chest cavity. At the end of the surgery, a drain is placed in the chest cavity, and the layers are closed anatomically. The drain is removed 1 or 2 days after surgery.

Closed-Endoscopic (VATS) Pneumothorax Surgery

This is the most commonly used method. In this method, a camera is inserted into the chest cavity through a single 2 cm incision (uniportal method), and the procedures described in open surgery are performed. This is the least invasive surgery method.

In pneumothorax surgeries, the closed VATS method is preferred over open surgery.

After this method, the pain is lower, the incision (2 cm) is much smaller, and the patient can return to normal life much faster.

What Are the Risks of Pneumothorax Surgery?

The risks include air leakage from the lungs, bleeding, infection, and recurrence of the disease. The surgeon takes necessary precautions to minimize these risks. The complication rate after closed surgery for pneumothorax is between 2% and 10%.

How Many Days Should I Stay in the Hospital After Pneumothorax Surgery?

On average, the hospital stay is 3 days after chest tube insertion, 4-5 days after open surgery, and 2-3 days after closed-endoscopic surgery.

What Are the Recurrence Rates for Pneumothorax?

• In people who have had pneumothorax once and have been treated with a chest tube (drain), the chance of recurrence is 20%.
• In people who have had pneumothorax twice and were treated only with a chest tube, the chance of recurrence is 50%.
• In people who have had surgery, the chance of recurrence is between 3% and 5%.

If a patient who has had pneumothorax once shows air bubbles in the lungs in a CT scan, surgery with the VATS method can be performed to prevent recurrence.