Heart Information

Pneumothorax

2025/01/14
What is it?

Pneumothorax is a condition where air gets trapped between the lung and chest wall, causing the lung to collapse partially or fully. This can make breathing difficult and painful.

  • Primary pneumothorax occurs spontaneously in otherwise healthy people, often due to small air blisters on the lung surface that burst.
  • Secondary pneumothorax happens as a result of an underlying lung disease or injury, making it more serious and potentially life-threatening. Other causes of secondary pneumothorax are malignancies, lymphanigiomatosis & infections.

Pneumothorax can also occur along with other conditions, and in some cases, is associated with trauma or complication of a medical procedure.

Other Variations of Pneumothorax:

  • Haemopneumothorax - abnormal collection of blood within the space of the lungs, requires chest drain
  • Traumatic pneumothorax - caused by blunt or penetrating chest trauma (e.g. stab wound to chest)
  • Iatrogenic pneumothorax - air enters the spacec of the lungs during a medical procedure
  • Catamenial pneumothorax - collapsed lung that occurs within 72 hours before or after the start of menstruation, often associated with endometriosis, causing symptoms such as chest or shoulder pain and shortness of breath
  • Tension pneumothorax - excessive air collected within the space of the lungs causes severe pressure on the heart, major blood vessels and the opposite lung, compromising blood circulation
What are the symptoms?
  • Sudden chest pain, neck or back pain
  • Shortness of breath or difficulty breathing

If not treated promptly, the severity of pneumothorax, a life-threatening condition, can vary. In some cases, the accumulating air can even cause pressure on the heart, pushing it across the chest cavity. This can lead to serious complications, making quick medical intervention crucial.

How is it diagnosed?

Pneumothorax is generally diagnosed by using Chest X-ray.

In cases of suspected secondary pneumothorax, Computerised Tomography (CT) Scan may be needed to provide more detailed images.

Seek immediate medical attention if breathing becomes increasingly difficult. Surgical repair is required when there is:

  • Persistent air leak for more than 3 days
  • Recurrent pneumothorax
  • Pneumothorax with bleeding
  • Bilateral pneumothorax
  • Pneumothorax of the opposite lung; or
  • In the case of high-risk professionals (e.g. pilots, divers)
What are the treatments?

Treatment for pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own.

Surgical treatment for pneumothorax has become increasingly refined, given moden advances such as the development of minimally invasive techniques, which demotes less trauma and burden to patients. A leading example of this approach is Uniportal Video-Assisted Thoracic Surgery (UVATS) - allows lung surgery to be performed with just a single 3cm cut. NUHCS is proud to be the only centre in Singapore with a full team of thoracic surgeons experienced in this single-incision surgery.

UVATS offers several key benefits:

  • Recovering within 2-6 weeks
  • Lesser post-operative pain
  • Lower incidences of post-operative pneumonia
  • Early discharge within a day or two

There are also other types of surgeries for pneumothorax, based on the cause.

  1. Simple Surgery: For young and healthy individuals, doctors may perform a simple procedure called blebectomy or bullectomy. This involves removing small blisters (blebs) from the lung and sometimes taking out a layer of tissue from the rib cage. This helps the lung stick to the rib cage, preventing future collapses.
  2. Surgery for Severe Cases: In older patients or those with serious lung damage, the surgery might involve the same blebectomy or bullectomy, but with an additional step called talc poudrage - which refers to the spraying of a sterile powder into the chest cavity and lung surface to stimulate inflammatory reaction leading to inflammatory adhesions, which helps the lung stick to the rib cage.
  3. Lung Volume Reduction: In some cases, doctors may recommend lung volume reduction surgery. This involves removing a part of the damaged lung to help the remaining healthy lung expand better, improving breathing and quality of life.
  4. Catamenial Pneumothorax: For women experiencing pneumothorax related to their menstrual cycle, the surgery include removing the damaged lung tissue and a procedure to tighten the diaphragm. This helps prevent the spread of endometrial cells into the chest cavity.

Overall, the type of surgical treatment depends on the patient's age, health and the specific issues with the lungs.

How is the recovery process after pneumothorax surgery?

At NUHCS, most surgeries are minimally invasive - performed through a small 3cm incision, allowing patients to be discharged within a day or two after the procedure. This approach offers several benefits compared to traditional open surgery or multiport video-assisted thoracic surgery, including less post-operative pain, lower chances of pneumonia, and quicker recovering times. Typically, patients can expect to recover nearly completely, both physically and mentally, within two to six weeks after surgery.

However, for those with secondary pneumothorax, recovery may take longer due to underlying chronic lung conditions or other health issues that require ongoing medical treatment.

Life after pneumothorax

As pneumothorax carries a risk of recurrence, lifestyle changes are often recommended to reduce the likelihood of future episodes. For many, this means making long-term changes to their habits:

  • Quit smoking
  • Avoid extreme activities (e.g. sky diving and deep-water diving)

For those without underlying lung disease, recovery is generally quicker, and the risk of further episodes is significantly reduced following surgery. Return to work and getting back to normal activities is allowed once all symptoms
have eased.

Pneumothorax is a common but sometimes overlooked condition. However, with advances in surgery and timely treatment, full recovery and a healthy, active life are possible. The key is catching it early and acting quickly. The journey doesn’t end with treatment, though. By embracing lifestyle changes, you can reduce your chances of recurrence and set the stage for a vibrant, active future.

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