Spontaneous pneumothorax is caused by rupture of blebs or cysts on the surface of the lung. This causes air to leak into the pleural cavity collapsing the lung. Common symptoms include pain and shortness of breath. It is a common condition usually presenting in young adults. The underlying lungs are usually normal. Surgery is advised after a 2nd episode as the recurrence rate is very high, after bilateral pneumothoraces or after any complicated episode (for example when the lung remains collapsed despite treatment.) Rarely the lung collapses and pressure builds up inside the chest (tension). This can be life-threatening and surgery is always advised after such an episode.
Surgery consists of a minimally invasive (VATS) operation to remove the cysts, and attach the lung to the chest wall, preventing further collapse. While pleuradhesis (abrading the pleura, or instilling a foreign material such as talc to create adhesions) is often performed, I advise a pleurectomy, carefully stripping the pleura, as this has the lowest recurrence rate (<5%)
Secondary pneumothorax occurs in older patients and is associated with an underlying lung condition such as emphysema. the treatment is similar although talc powder pleuradhesis is often appropriate in such cases.
Bleb being removed by VATS