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Lung diseases

Surgery after Spontaneous Pneumothorax

09/27/2005

Question:

At the age of 21, I had a partial pneumothorax where I received no medical treatment and was released. At the age of 27, I experienced a full spontaneous pneumothorax where a chest tube was inserted and I remained in the hospital for 5 days. At this point, I stopped smoking. Two years later, now being 29, my lung collapsed again and I was treated with yet another chest tube. By the next day, and with the tube in my chest, my lung collapsed for the 4th time. This time surgery was necessary. I`ve experienced years of chest pain, sometimes mild, sharp, stabbing and other times severe. What seems to be the case, is that unless the lung actually collapses, there`s no way to know what`s going on. It`s been 10 years since I stopped smoking and eight years since the surgery. I have only experienced occasional chest pain over the years. Except for the occasional pain, I feel great and my experiences with 4 pneumothoraxes have become memories. This past few months, I have experienced an increase in chest pain after being exposed to cigarette smoke. I`ve realized that I do not know much about this causing me to search for information with regard to surgery after a spontaneous pneumothorax and I cannot find much information. Can a lung collapse again, even after surgery? I know smoke causes my lungs to be irritated, but will cigarette smoke cause complications? In searching for information, I`ve seen lots of don`t do`s, like flying and scuba diving. Does this apply, even after surgery. Any information would be helpful.

Answer:

Collapsed lungs or pneumothoraces are caused when air enters the space around lung, the pleural space.  The air can enter this space when cysts within the lung leak air into pleural space or the air tracks along the airways and then enters the pleural space.  The air can also be introduced from the outside such as during surgery or by a needle or knife puncture.

Usually after 2 spontaneous pneumonthoraces, surgery is indicated.  The goal of this surgery is to obliterate the pleural space by causing the lung to adhere or stick to the inner aspect of the chest wall.  This process does not usually interfere with normal breathing and should prevent the recurrence of any further pneumothorax.  If the surgery is incomplete or there are areas where the lung does not totally adhere to the chest wall, there is the potential for recurrence or partial recurrence of the pneumothorax.

After a spontaneous pneumothorax on one side, there is an increased risk of pneumothorax on the other side.  Although, from your note, all of your pneumothoraces occurred on the same side, this increased risk is the reason for caution with flying and scuba diving where changes in pressure may increase the chance of pneumothorax in predisposed individuals. 

If you have a keen interest in pursuing these activities, it would be worthwhile to see a lung doctor, a pulmonologist, who could review your imaging studies such as x-rays and CT scans and better assess your potential risk for another pneumothorax.

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Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati