How is pneumothorax treated?

Written by Xia Bao Jun
Pulmonology
Updated on September 25, 2024
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The treatment of pneumothorax aims to promote the reexpansion of the affected lung and reduce recurrence, while considering the possibility of eliminating the cause of the disease. Treatment measures include non-surgical and surgical treatments. Non-surgical measures include observation, thoracic puncture for air evacuation, closed thoracic drainage, and pleural fixation. Surgical treatments include thoracoscopic surgery and open chest surgery. Choices should be made based on the type and frequency of occurrence of the pneumothorax, the degree of compression, the state of the condition, and the presence of complications, etc. Most patients can be cured through non-surgical treatment, while only a minority, approximately 10%-20% of patients, require surgical treatment.

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Written by Xia Bao Jun
Pulmonology
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Pneumothorax tracheal shift to which side?

When a patient suffers a pneumothorax, the trachea is displaced to the opposite side, and the heart is also shifted to the opposite side. In cases of left-sided pneumothorax, the heart's dullness boundary and the upper boundary of the liver during right-sided pneumothorax are both undetectable. There can be manifestations of subcutaneous emphysema in the neck, chest, and even the head and abdomen. The patient may exhibit diminished respiratory movements and a significant reduction or absence of breath sounds. When a small amount of air accumulates in the pleural cavity, weakened breath sounds on the affected side may be the only suspicious sign.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pneumothorax should be seen by which department?

If it is the patient's first pneumothorax occurrence and they are relatively young with no obvious lung bullae on the surface of their lungs, then seeing the emergency department should be sufficient to resolve the issue. Generally, if less than 20% of the lung is compressed, the patient can simply breathe oxygen at home or at a community hospital to gradually recover. However, if the patient is older and the degree of pneumothorax exceeds 20%, even reaching above 30%, it is advisable to insert a small tube between one and two millimeters into the pleural cavity to extract the air. At this point, it is recommended to consult thoracic surgery. After the air is released, a CT scan is also necessary to check for obvious lung bullae or small tears on the lung surface. If a small tear is found, it is best to use minimally invasive thoracoscopy to suture or seal the tear to prevent recurrence. Therefore, if possible, directly consider consulting thoracic surgery for pneumothorax; if thoracic surgery is not available, then consider seeing the emergency department.

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Written by Li Tao
Pulmonology
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What are the symptoms of pneumothorax?

Pneumothorax refers to the accumulation of air that occurs when air enters the pleural cavity, a closed space, which is known as pneumothorax. The most common clinical manifestations of pneumothorax depend on the speed of onset, the degree of lung compression, and the etiology of the primary disease causing the pneumothorax. Typically, patients may experience a high level of mental tension, fear, restlessness, shortness of breath, and a feeling of suffocation. Some individuals may sweat, have an increased pulse rate, with the most prominent symptom being difficulty in breathing. Additionally, some patients may experience coughing and chest pain, and some may develop mediastinal emphysema, leading to gradually worsening respiratory difficulties, and even manifestations of shock such as a drop in blood pressure.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pneumothorax is more likely to recur in which season?

Regarding the seasonal issue of pneumothorax recurrence, the causes of pneumothorax vary among patients of different ages, so the seasons prone to recurrence are also not exactly the same. For young patients, pneumothorax tends to recur easily, often in thin and tall patients, usually related to recent colds and coughs, or intense physical activities like basketball, soccer, or seasons with more outdoor activities; these times are relatively more prone to recurrence. Particularly, the cooler seasons of spring and fall are also prone to recurrences. However, for elderly patients, the causes of pneumothorax recurrence are usually associated with smoking in older patients, or a history of chronic obstructive pulmonary disease and bullae. For these elderly patients, recurrences typically occur in the autumn and winter seasons. This is because the autumn and winter seasons are comparatively more problematic for patients with chronic bronchitis and obstructive lung diseases. Thus, pneumothorax recurrence in young people often happens more in the spring and autumn, while in older people, it occurs more in the autumn and winter seasons.

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Written by Li Ying
Pulmonology
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How many days do you usually stay in the hospital for pneumothorax drainage?

This depends on whether the pneumothorax is a simple pneumothorax or is complicated by other diseases. If there are no other lung diseases present and it is just a simple pneumothorax, then typically, drainage by tube for 5 to 7 days can lead to a complete recovery and cure. However, if there are complications such as emphysema, pulmonary heart disease, pneumoconiosis, or lung infections, then it is necessary first to control the infections. During this time, the pneumothorax can easily become a communicating pneumothorax. If it lasts for more than 1 to 2 weeks, it may turn into a refractory pneumothorax. In the case of refractory pneumothorax, besides drainage, minimally invasive surgeries such as pleurodesis or pneumothorax occlusion procedures are required. These surgeries take time. Therefore, if a stubborn pneumothorax forms, especially when complications like emphysema are present, hospital stays often need to be 14 days or even longer.