A collapsed lung, medically known as a pneumothorax, occurs when air leaks into the space between the lung and the chest wall (the pleural space). Normally, this space maintains negative pressure, keeping the lung inflated. When air enters, it creates positive pressure that pushes on the lung, causing it to deflate partially or completely. While serious and requiring immediate medical attention, treatment varies widely based on the severity and cause of the air leak.
Understanding a Collapsed Lung
A pneumothorax involves a breach in the lung or chest wall, allowing air to enter the pleural cavity. This accumulation of air compromises the lung’s ability to expand, causing the sudden onset of chest pain and shortness of breath. The condition is categorized into three main types based on its cause.
Primary Spontaneous Pneumothorax (PSP) affects individuals without underlying lung disease, often young, tall men. It is linked to the rupture of tiny air sacs (blebs or bullae) on the lung surface. Secondary Spontaneous Pneumothorax (SSP) occurs as a complication of existing conditions, such as Chronic Obstructive Pulmonary Disease (COPD) or cystic fibrosis, where lung tissue is weakened. The third type, Traumatic Pneumothorax, results from an injury to the chest wall, such as a rib fracture or a penetrating wound.
Non-Surgical Approaches to Treatment
Most collapsed lung cases are managed without major surgical intervention, especially small collapses in healthy individuals. For a very small pneumothorax with minimal symptoms, physicians may recommend simple observation. Supplemental oxygen is often provided, which speeds up the body’s reabsorption of the trapped air.
When a larger volume of air needs removal, needle aspiration is often the first step. This minimally invasive procedure involves inserting a thin, hollow needle and small catheter between the ribs to manually draw the air out using a syringe. Needle aspiration can be highly successful in the initial treatment of primary spontaneous pneumothorax, often allowing for a shorter hospital stay.
For more significant collapses, or when aspiration fails, a chest tube insertion is typically performed. A flexible tube is placed into the pleural space for continuous drainage of air until the leak seals and the lung reinflates completely. The tube is attached to a drainage system that prevents air from re-entering the chest cavity. This invasive procedure is the definitive non-operative treatment for many moderate to large pneumothoraces.
Indications for Surgical Intervention
Surgery is reserved for specific situations where non-surgical methods have failed or the risk of future collapse is high. The most common reason for surgery is a recurrent pneumothorax, especially after a second episode on the same side. Surgery is also strongly considered if the air leak persists for more than five to seven days despite a properly placed chest tube.
High-risk professional groups, such as pilots or scuba divers, are often advised to undergo surgery even after a first collapse due to the severe consequences of recurrence in their occupation. The presence of a bilateral pneumothorax, affecting both lungs, also prompts surgical intervention. Additionally, surgery may be recommended for a first episode if imaging reveals large air-filled sacs (bullae) likely to rupture again.
The most common surgical technique is Video-Assisted Thoracoscopic Surgery (VATS). This minimally invasive approach uses a small camera and instruments inserted through tiny incisions. During VATS, the surgeon typically performs a bullectomy, identifying and removing the defective air sacs that caused the collapse. To prevent future recurrence, the surgeon combines this with pleurodesis, which intentionally creates controlled inflammation between the lung lining and the chest wall.
Pleurodesis can be mechanical (involving the roughening of the pleural surface) or chemical (using agents like talc or doxycycline to induce scarring). The goal is to cause the two layers of the pleura to adhere to each other, permanently closing the space where air could collect. While less common, an open chest procedure (thoracotomy) may be necessary in complex cases or when VATS cannot be performed.
Recovery and Recurrence
Recovery time depends heavily on the treatment method used. Patients managed with simple observation or needle aspiration may be discharged within a day or two, with the lung fully healed within a few weeks. Recovery following a chest tube insertion is generally longer, lasting until the air leak resolves and the tube can be safely removed, which often takes several days.
Surgical intervention, typically VATS with pleurodesis, offers the strongest protection against future episodes, though it requires a longer initial recovery period. The recurrence rate after conservative treatment, including chest tube drainage, can be as high as 30%. Surgical procedures that include pleurodesis dramatically reduce this risk, with recurrence rates reported to be less than 5%.
Following any treatment, patients are advised to avoid activities involving significant pressure changes, such as flying or scuba diving, for a period of time. The risk of recurrence is highest within the first six months. Patients who undergo surgery should be aware that while the procedure significantly lowers the risk, a small chance of a future collapse remains.