Pneumothorax Treatments and Surgery

Small pneumothoraces do not need treatment. Based on the chest X-ray, the medical team might decide not to intervene and instead repeat the X-ray in a few hours or a few days. This is to see if the pneumothorax has healed itself. Usually, a pneumothorax will recover at about 1% of the volume of the thorax per day even without treatment.

For slightly larger pneumothoraces, it is sometime possible to remove most of the air using a small plastic cannula attached to a syringe. A doctor will often remove about 1 or 1.5 litres of air and then repeat the X-ray to see if it has helped. If the pneumothorax has improved, they may choose to repeat the X-ray in a few days’ time as the small amount of remaining air can then be absorbed naturally.

Chest tube thoracostomy (known as a chest drain)

A thoracostomy is a medical procedure where the skin is numbed with local anaesthetics an then a small hollow plastic tube is inserted between the ribs. This is done to drain air from the chest cavity. Sometimes the drain can be removed the following day. However,  it can take several days to drain the air.

Occasionally, if the lung does not inflate after a few days, a suction device is used to suck out the air. This helps speed up the reinflation. Traditionally, the chest tube is connected to a bottle filled with sterile water that acts as a one-way valve. This requires a stay in hospital until the drain is removed.

A more common and modern method includes a small one-way valve attached to the chest drain. These can allow the patient to be treated as an out patient (you can leave hospital) and is called an ambulatory drain.

When you are fitted with an ambulatory drain you will be advised to avoid strenuous activities such as heavy lifting, digging or working out in the gym. This is so the drain stays in place whilst your lung heals.

Sometimes thoracostomy is combined with another type of treatment, such as pleurodesis.

Pleurodesis sticks the outside surface of the lung to the chest wall. This stops air or fluid from being able to build up on the outside of the lung. This prevents the lung from collapsing again.

There are two types of pleurodesis. They are chemical and mechanical.  They both work in similar ways, by irritating the outside of the lung so it sticks to the chest wall.

Chemical pleurodesis uses chemicals to irritate the lung. Most commonly talc (magnesium silicate) is used. Chemical pleurodesis can be performed during surgery. They can also be done via a chest tube if you already have one in place. Pleurodesis can cause some pain. You will be given painkillers before the procedure for this. However if you continue to feel pain during the procedure, you can tell your doctor and they can give more painkillers to help this.

In mechanical pleurodesis, a surgeon uses a piece of gauze to gently scratch the surface of the chest wall (the pleura). This causes it to stick to the chest wall and helps prevent further pneumothoraces.

Pleurectomy

A pleurectomy is when a surgeon peals away the inner lining of the chest wall (the pleura), which allows the lung to stick to the chest wall and preventing further pneumothoraces. This procedure is done under general aneasthetic so you would be unconscious. A pleurectomy requires a stay in hospital.

Lung resection is the surgical removal of part or all of a lung. A blebectomy or bullectomy is the removal of lung cysts. Removing lung cysts via surgery only removes a small amount of lung tissue. This is why after these procedures, your lung function is usually only mildly affected. In some cases, more cyst can form in the future and this will be discussed with you by your doctor.

Pleural covering is a relatively new surgical technique. It involves covering either all of the lung (total pleural covering, referred to as a TPC) or just the lower areas of the lung (lower pleural covering, referred to as an LPC) with a mesh. This mesh dissolves into the surface and strengthens the lung. Further studies are required to establish this approach and determine its effectiveness as a treatment for pneumothorax.