Pneumothorax

A double membrane, called the pleura, surrounds the lungs and lines the ribs. The space in between the two membranes is called the pleural cavity. Pneumothorax is when air penetrates the pleural cavity. Air that comes from a weak area in the lung (a  “hole” in the lung) causes it to collapse. This phenomenon may be local, at the top of the lung (apex), or it may extend to the entire lung.

Pneumothorax is more common in men and affects mostly young people (between 20 and 40 years old). Smoking is an aggravating factor.

There are several types of pneumothorax: 

• Primary spontaneous pneumothorax is the most common and occurs without any particular cause in patients without lung problems.
• Secondary spontaneous pneumothorax is more rare. It can occur as a result of a lung disease such as emphysema, asthma, chronic obstructive pulmonary disease (COPD) or a lung tumor.
• Pneumothorax can also be caused by trauma. This is called post-traumatic pneumothorax.
•  Tension pneumothorax happens when the air pocket cannot escape and continues to increase in the pleural cavity. The increase in pressure can even compress the heart and great vessels, in which case it becomes life threatening. An operation is then crucial for the survival of the patient.

The treatment of pneumothorax varies from simple rest to surgery. Initially, an attempt is made to remove the accumulated air, under local anesthesia, by means of a needle (pleural aspiration) or by drainage. In tension, recurrent or bilateral pneumothorax, surgical treatment is considered.

Pneumothorax surgery

The intervention involves surgical removal of the area of lung weakness that is causing the pneumothorax. In order to reduce the risk of recurrence, surgeons perform  pleurodesis, which sticks the two pleural walls together.  

Pleurodesis is performed in three ways: 

• through resection of the pleura that lines the ribs (pleurectomy)
• through mechanical abrasion (by rubbing the pleura)
• by dusting talcum powder in the pleural cavity.

These three surgical procedures are performed by thoracoscopy.

For more information on surgical treatment and hospitalization, please visit the website of the Lung Surgery Unit.