What is a pneumothorax?
Pneumothorax is a collection of air between the lung membranes (pleura) in the chest cavity. In some people, there are congenital or later developed air sacs on the surface of the lung, specifically on the upper part of the lung, which is called “blebs”, reaching up to 1 cm in size. As a result of the spontaneous rupture of these air sacs, the air taken into the lungs escapes out of the lung and accumulates in the plerura, and when it increases, it causes the lung to deflate and shrink.
Since the patient cannot use the lung on that side, shortness of breath may develop as a result and there is usually pain on the same side in the chest, back, shoulder and sometimes even in the abdomen.
What causes pneumothorax?
While there is no clear information about why pneumothorax occurs, it may occur after trauma or surgical procedures on the lungs. However, the most common type of pneumothorax is ‘spontaneous pneumothorax’.
What are the symptoms of pneumothorax?
The most common symptoms of pneumothorax:
– shortness of breath,
– chest pain that starts suddenly and can be very severe,
– low blood pressure,
– cough, rapid pulse,
– bruising of the lips
Symptoms may be exacerbated depending on the effect of the pneumothorax on the lung.
How is pneumothorax diagnosed?
The diagnosis of pneumothorax is made in a patient presenting with the above symptoms based on physical examination findings and chest X-ray. Chest X-ray typically shows free air accumulation in the chest and the lung on that side deflates and shrinks. Very rarely, if there is a suspicious or complicated situation, chest tomography is diagnostic.
How is pneumothorax treated?
Chest tube insertion: Surgical intervention is necessary if the amount of pneumothorax is moderate or severe or if the patient complains of shortness of breath. With surgical intervention, a catheter or drain must be inserted into the chest cavity and the accumulated air must be drained out. After this surgical intervention, the air in the chest is usually emptied within a few days, the lung expands and returns to its normal state, and the drainage is terminated when the air stops coming from inside.
Endoscopic surgery: If the pneumothorax recurs or if the air leak does not resolve the first time, it is necessary to correct the problem with the help of endoscopic surgery. With endoscopic surgery, the problematic area on the lung surface is repaired by entering through a single hole. Patients are discharged 2 or 3 days after the operation.
Can pneumothorax recur?
Spontaneous pneumothorax is usually seen in the young age group and when there is no underlying disease, and can recur at a rate of about 10% after a pneumothorax occurs once. Recurrence may be in the same side lung or in the opposite lung. The most appropriate treatment for recurrent pneumothorax is videothoracoscopic surgery (VATS) without re-insertion of a thoracic tube (chest tube). The possibility of recurrence is almost negligible in those who have undergone surgery.
What is done in pneumothorax surgery?
When surgery is performed for a pneumothorax, the air leak is initally searched for on the surface of the lung. When water is introduced into the chest cavity and the air bubbles are followed, the air leak is found and then is closed by using a surgical closure material called “stapler”. Moreover, if there is any air sac formation (bullae or bleb) on the lung, this area is also removed with the help of a stapler. Generally, there is an area with air sacs at the top of the lungs. This 2-3 cm lung area, which has the potential to cause pneumothorax, is removed. In addition, it is necessary to peel or abrasion (irritate) the uppermost part of the outer membrane of the lung called pleurectomy. These surgical procedures has no effect regarding the functioning and capacity of the lungs and do not give harm to the patient.
