Tokushukai Medical Group

Treatment of Disease

Treatment of Disease

Respiratory Surgery Disease: Pneumothorax

Breathing difficulty status due to air accumulation in chest cavity.

Pneumothorax is indicated as the status of air accumulation in chest cavity, and it is a disease where the more accumulated air in chest cavity, the more breathing becomes difficult since the lung has shrunk. The causes are; spontaneous pneumothorax is the most common, and disease are developed by small cyst on the surface of the lung brows up so that air leaks from lung to inside of chest cavity.

It has a tendency that the disease is common among the male on the slender side at the age of 20s to 30s.

Other than spontaneous pneumothorax, there is so called secondary pneumothorax which is developed from intrinsically diseased lung. Pneumothorax comes along with emphysema, interstitial pneumonia or merely lung cancer. Other than these and as particular kind of disease, there are eosinophils granulomatosis, catamenial pneumothorax which can be seen only for women, or pulmonary lymphangiomatosis. Furthermore, pneumothorax developed by external injury is called as traumatic pneumothorax. Here mainly discuss about spontaneous pneumothorax.

Treated with air removal by tube placement or surgical operation.

As for the symptom, it is common that breathing difficulty is raised with following to the minor chest pain then visiting hospital in one to two days later from the occurrence. It can be easily diagnosed with verifying shrunk lung by chest X-ray image.

Treatment differs depend on the deflation of lung, i.e., collapse degree of lung. In case collapse degree is mild enough, deair is made by prognosis or one-time paracentesis of the pleural cavity. In case of middle to high degree, deair in the lung cavity is made with detaining tube inside of the chest cavity. Purpose of these treatment is first to make patient breath smooth with planning for the lung re-expansion. In case when air leaks continuously from chest cavity tube, surgical operation is conducted to repair leakage portion. Surgical operation is mainly conducted under the mirror vision and is selected in portion resection method for the lung including cyst.

Preventive surgery may be conducted in consideration of recurrence.

In general, prognosis is favorable excluding secondary pneumothorax, but treatment plan keeping likelihood of recurrence in mind is inevitable. Recurrence rate for the preservative treatment like puncture deairing or tube treatment is high as approximately 50%, on the contrary, recurrence rate after the surgical treatment is 2 to 5%. For the case of recurrent pneumothorax, because of the re-recurrence ratio is getting higher, surgical treatment is recommended. Or, for the case where larger cyst still remains even after the air leakage disappeared, preventive surgical operation may be conducted in consideration of the recurrence.

As for the special clinical condition, there are tension pneumothorax and idiopathic blood pneumothorax. Tension Pneumothorax is the critically fatal condition where air leakage continues in the chest cavity so that lung has totally shrunk, and internal pressure of chest cavity increases to die. Emergency deair procedure becomes necessary. Blood pneumothorax is developed by continuous bleeding in the chest cavity due to the cut of wire-like thing formed in between chest wall and lung when lung shrunk by pneumothorax. It is diagnosed by excessive blood loss when detaining the chest cavity tube, hence emergency surgical treatment is necessary in combining with hemostasis.