A collapsed lung, or pneumothorax, occurs when air leaks into the space between the lung and the chest wall. This air accumulation exerts pressure, causing the lung to partially or completely deflate. This article explores treatment, including when surgery becomes necessary.
What is a Collapsed Lung?
The lungs are surrounded by the pleura, a double-layered membrane forming the pleural cavity. This space normally contains lubricating fluid, allowing smooth lung expansion. A pneumothorax develops when air enters this pleural space, disrupting the negative pressure that keeps the lung inflated. Air can originate from a damaged lung or a chest wall injury.
Collapsed lungs are categorized as spontaneous or traumatic. Spontaneous pneumothorax occurs without external injury, often due to ruptured air sacs (blebs or bullae) on the lung surface, common in tall, thin individuals or those with underlying lung conditions. Traumatic pneumothorax results from injuries like rib fractures, stab wounds, or gunshot wounds that penetrate the chest wall or lung. Common indicators include sudden chest pain and shortness of breath, varying with collapse intensity.
Non-Surgical Treatments
Non-surgical methods are often used for smaller collapses or stable patients. Very small pneumothoraxes, especially in asymptomatic or mildly symptomatic individuals, may be observed. Observation involves monitoring with serial chest X-rays for air reabsorption and lung re-expansion. Supplemental oxygen can accelerate air reabsorption, aiding lung re-expansion.
For larger air volumes or pronounced symptoms, active intervention is required. Needle aspiration (thoracentesis) involves inserting a needle and catheter into the pleural space to withdraw trapped air. This minimally invasive procedure is effective for many first-time spontaneous pneumothoraxes. For significant air collections or persistent air leaks, a chest tube is often inserted through the chest wall. Connected to a drainage system, it continuously removes air, allowing lung reinflation.
When Surgery is Necessary
Surgery for a collapsed lung is considered when non-surgical treatments are insufficient or recurrence risk is high. A primary indication is recurrent pneumothorax, especially after a second episode on the same side, as future collapse likelihood increases significantly. Persistent air leaks, where air escapes despite days of chest tube drainage, also necessitate surgical repair. This indicates an ongoing lung defect non-surgical methods cannot resolve.
Certain pneumothorax types carry a higher surgical recommendation. Bilateral pneumothorax, affecting both lungs, is often treated surgically due to severe implications. Underlying lung conditions, like large bullae or blebs prone to rupture, or catamenial pneumothorax linked to endometriosis, may also lead to surgery. If a lung fails to fully re-expand with chest tube drainage, it indicates a trapped lung or large air leak requiring surgical correction for re-inflation and to prevent future episodes.
Surgical Procedures
Surgery for a collapsed lung aims to prevent future episodes by addressing air leaks and promoting adhesion between the lung and chest wall. Video-assisted thoracic surgery (VATS) is the most common minimally invasive surgical technique. During VATS, a surgeon inserts a camera and instruments through small chest wall incisions to visualize and operate within the pleural space. This allows precise targeting of air-leaking sites, like stapling ruptured blebs or bullae.
After air leak repair, pleurodesis is often performed to encourage lung adhesion to the chest wall, obliterating the pleural space. Mechanical pleurodesis involves abrading pleural surfaces, creating inflammation and scarring that binds the lung to the chest wall. Chemical pleurodesis introduces an irritant, like talc slurry, into the pleural space to induce inflammation and adhesion. In rare cases, like extensive lung disease or complex trauma, open thoracotomy, a more invasive procedure with a larger incision, may be necessary for direct access to the chest cavity.
Life After Treatment
Recovery after collapsed lung treatment, surgical or non-surgical, involves healing and careful monitoring. Pain management is often part of immediate recovery, especially after surgery or chest tube insertion. Patients are advised to gradually resume normal activities, with restrictions on strenuous exercise, heavy lifting, and activities involving significant air pressure changes. These aim to prevent complications and allow full lung and pleural healing.
Follow-up appointments monitor lung function and ensure complete pneumothorax resolution. Lifestyle adjustments, such as avoiding high-altitude travel and scuba diving, are often recommended, especially for those with spontaneous pneumothorax, due to recurrence risk in pressure-altered environments. Awareness of recurrence symptoms, like sudden chest pain or shortness of breath, and seeking immediate medical attention is important.