🫁 Pneumothorax (Collapsed Lung): Causes and Thoracoscopic Treatment | Prof. Dr. Mahmoud El Degwy
Sudden chest pain and shortness of breath may be the first signs of pneumothorax, a condition that some people may commonly describe as a "burst lung." The more accurate medical term is pneumothorax, which occurs when air enters the space between the lung and the chest wall. This air can put pressure on the lung and cause part or all of it to collapse, depending on the severity of the condition.
Treatment for pneumothorax varies from one patient to another. Small, stable cases may sometimes be managed with observation, while other patients may require air aspiration or chest tube drainage. In recurrent cases or when there is a persistent air leak, thoracoscopic surgery (VATS) may be considered to treat the source of the air leak and reduce the risk of recurrence.
📞 Consultation with Prof. Dr. Mahmoud El Degwy Ahmed
Prof. Dr. Mahmoud El Degwy Ahmed – Professor and Consultant of Cardiothoracic Surgery at Kasr Al Ainy Faculty of Medicine, Cairo University.
Dr. Mahmoud El Degwy has more than 20 years of experience in cardiothoracic surgery. His areas of practice include open-heart surgery, coronary artery surgery, heart valve repair and replacement, congenital heart surgery in children, as well as a range of chest, lung, and thoracoscopic procedures.
His thoracic surgery services include:
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Lung and chest tumor surgery.
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Thoracoscopic thymectomy.
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Tracheal stenosis surgery.
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Surgical treatment of selected lung and chest conditions.
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Minimally invasive thoracic surgery when clinically appropriate.
Consultation fee: EGP 600.
Appointments: By prior booking at the available branches.
Booking numbers: 01223822588 / 01110691461.
WhatsApp: 01110691461.
Clinics:
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Heliopolis: 70 Abdel Aziz Fahmy Street, Saint Fatima Square, Heliopolis, Cairo.
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Mohandessin: ABC Hospital Clinics, beginning of Syria Street from Gameat El Dowal El Arabia Street, Mohandessin, Giza.
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Maadi: El Horreya Street, Western Basatin, El Basatin District, Maadi, Cairo.
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Dokki: 45 Dokki Street, 4th Floor, above Farghaly Juices, next to Dokki Metro Station, Giza.
🫁 What Is Pneumothorax or a Collapsed Lung?
Pneumothorax is the presence of air in the pleural space, which is the space between the lung and the chest wall. The trapped air can put pressure on the lung and prevent it from expanding normally, resulting in partial or complete lung collapse.
The commonly used expression "burst lung" does not accurately describe the condition. In some cases, pneumothorax occurs when small air-filled sacs called blebs on the surface of the lung rupture, allowing air to escape into the pleural space. This does not necessarily mean that the entire lung has literally "burst."
The severity of pneumothorax depends on the amount of air accumulated, the degree of lung collapse, the presence of underlying lung disease, and the patient's overall condition.
⚠️ What Are the Symptoms of Pneumothorax?
Symptoms may appear suddenly. Common symptoms include:
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Sudden chest pain, which may occur on one side.
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Shortness of breath or difficulty breathing.
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Rapid breathing or an increased heart rate in some cases.
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A feeling of being unable to take a comfortable breath.
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More pronounced symptoms when the pneumothorax is extensive.
Symptoms alone cannot confirm pneumothorax because chest pain and shortness of breath can occur with many other medical conditions.
Severe chest pain or worsening shortness of breath requires urgent medical assessment.
🔎 What Causes Pneumothorax?
There is no single cause of pneumothorax. Several factors and medical conditions can contribute to its development.
1. Spontaneous Pneumothorax
Pneumothorax can occur without an obvious chest injury. This is known as spontaneous pneumothorax.
One possible cause is the presence of small air-filled sacs called blebs on the lung surface. When these blebs rupture, air can leak into the pleural space.
2. Smoking
Smoking is a risk factor associated with pneumothorax and can also contribute to lung diseases that weaken or damage lung tissue.
3. Underlying Lung Diseases
Pneumothorax can occur in association with diseases that affect lung tissue, including some cases of chronic obstructive pulmonary disease (COPD), cystic lung diseases, and other pulmonary conditions.
Identifying the underlying cause can therefore be important, particularly when pneumothorax occurs in a patient with a known lung disease.
4. Chest Trauma
Blunt or penetrating chest injuries can cause pneumothorax. It may also occur as a complication of certain medical procedures.
5. Mechanical Ventilation
In some patients requiring mechanical ventilation, increased pressure within the chest can contribute to pneumothorax, particularly under certain ventilation conditions.
🩻 How Is Pneumothorax Diagnosed?
Diagnosis is based on the patient's symptoms, physical examination, and appropriate imaging studies.
Chest X-Ray
A chest X-ray is commonly used to help diagnose pneumothorax and assess the degree of lung collapse.
CT Scan of the Chest
A chest CT scan may be requested when more detailed information about the lungs is needed or when the physician is looking for a possible underlying cause, such as blebs or other changes in lung tissue.
Ultrasound
In certain clinical settings, ultrasound can also help detect pneumothorax. The physician determines the most appropriate imaging method based on the patient's condition.
💊 How Is Pneumothorax Treated?
Not every patient with pneumothorax requires surgery.
Treatment depends on the size of the pneumothorax, the severity of symptoms, the underlying cause, the presence of other lung diseases, and the likelihood of recurrence.
Medical Observation
Some small and stable pneumothoraces, particularly when symptoms are limited and there are no signs of clinical deterioration, may be managed with observation and follow-up imaging according to the physician's assessment.
Air Aspiration or Chest Tube Drainage
When the pneumothorax is larger or causes significant symptoms, the physician may need to remove the air from the pleural space.
This may involve:
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Air aspiration using a needle or catheter in appropriate cases.
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Insertion of a chest tube to drain air and allow the lung to re-expand.
The appropriate method depends on the patient's condition and the severity of the pneumothorax.
🔬 When Does Pneumothorax Require Thoracoscopic Surgery?
Thoracoscopic surgery is commonly known as:
Video-Assisted Thoracoscopic Surgery – VATS
VATS is a minimally invasive surgical technique that uses small incisions in the chest wall to introduce a camera and surgical instruments. It allows the surgeon to examine the chest cavity and perform the required procedure through limited incisions compared with traditional open surgery.
However, not every pneumothorax requires thoracoscopic surgery.
A thoracic surgery team may consider surgery in selected cases, including:
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Recurrent pneumothorax.
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Persistent air leakage.
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Cases in which reducing the risk of recurrence is particularly important.
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Selected cases of tension pneumothorax according to the clinical assessment.
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A clear surgical cause that can be treated thoracoscopically.
The British Thoracic Society guidelines recommend considering surgery after a second pneumothorax on the same side or a first pneumothorax on the opposite side. Surgery may also be considered earlier in selected cases when preventing recurrence is particularly important.
🩺 What Happens During VATS for Pneumothorax?
The procedure is performed under general anesthesia. The surgeon introduces a small camera and surgical instruments through small openings between the ribs.
During the procedure, the surgeon may:
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Examine the lung and pleural cavity.
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Identify the source of the air leak or visible blebs when present.
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Remove or surgically resect appropriate blebs or bullae through a procedure known as bullectomy.
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Perform pleurodesis or another appropriate pleural procedure to reduce the risk of recurrent pneumothorax, depending on the patient's condition and surgical plan.
BTS guidance supports the use of thoracoscopic surgery in appropriate cases. Bullectomy and/or pleural procedures may be used in selected patients with spontaneous pneumothorax to reduce the risk of recurrence.
🩹 Is VATS Better Than Open Surgery?
There is no single answer that applies to every patient.
The choice between VATS and open surgery depends on the nature of the condition, the purpose of the operation, the surgeon's experience, and the desired outcome.
BTS guidance indicates that thoracoscopic surgery may be associated with a shorter hospital stay and less pain and fewer complications compared with open surgery. However, open surgery may be considered in selected situations when achieving the lowest possible recurrence rate is particularly important, such as in certain high-risk occupations.
Therefore, it is not appropriate to state that VATS is the best option for every patient without a proper medical assessment.
⏳ What Does Persistent Air Leakage After Chest Tube Placement Mean?
In some cases of pneumothorax, air leakage may continue despite the placement of a chest tube.
Persistent air leakage after several days of chest tube treatment may be a reason to discuss the case early with a thoracic surgery team when appropriate. Modern BTS quality standards define prolonged air leak as persistent leakage after 3–5 days of chest tube treatment.
Persistent air leakage does not automatically mean that surgery is required. However, it requires careful assessment to determine the most appropriate treatment option.
🔄 Can Pneumothorax Recur After Treatment?
Yes. Pneumothorax can recur, and the risk varies depending on the type and cause of pneumothorax, underlying lung disease, and other individual factors.
For this reason, some surgical procedures are intended not only to re-expand the lung during the current episode but also to reduce the risk of future pneumothorax.
BTS guidance recommends considering surgery to prevent recurrence in patients who have experienced recurrent pneumothorax on the same side or a first pneumothorax on the opposite side when surgery is medically appropriate.
🚨 When Is Pneumothorax a Medical Emergency?
Pneumothorax can become dangerous in certain situations, particularly when increasing pressure inside the chest affects breathing and circulation. This condition is known as tension pneumothorax.
Patients should not wait or attempt to manage severe chest pain and shortness of breath at home when symptoms are severe or getting worse.
Sudden chest pain accompanied by increasing difficulty breathing requires urgent medical attention.
🚭 Can Pneumothorax Be Prevented?
Not all cases of pneumothorax can be prevented because some episodes may occur suddenly without an obvious cause.
However, some risk factors can be reduced by:
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Avoiding smoking.
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Proper management and follow-up of existing lung diseases.
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Following the physician's instructions after pneumothorax.
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Attending recommended follow-up appointments after treatment.
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Discussing air travel and scuba diving with a physician after pneumothorax, as these activities may require temporary or specific restrictions depending on the individual case.
👨⚕️ Why Does Pneumothorax Treatment Require Assessment by a Thoracic Surgeon?
Treatment decisions depend on more than simply detecting air around the lung. Several factors must be considered, including:
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The size of the pneumothorax.
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Severity of symptoms.
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The cause of the pneumothorax.
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Presence of underlying lung diseases.
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Persistent air leakage.
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Whether the patient has experienced pneumothorax before.
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Whether it occurred on the same or opposite side.
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The patient's overall health.
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Whether surgery is appropriate for the individual case.
Therefore, choosing VATS treatment for pneumothorax should be based on a medical assessment rather than simply choosing a specific surgical technique.
👨⚕️ Prof. Dr. Mahmoud El Degwy Ahmed
Prof. Dr. Mahmoud El Degwy Ahmed is a Professor and Consultant of Cardiothoracic Surgery at Kasr Al Ainy Faculty of Medicine, Cairo University, with more than 20 years of professional experience in cardiothoracic surgery.
His areas of practice include heart surgery, coronary artery surgery, valve surgery, as well as thoracic and lung surgery and minimally invasive procedures. These include lung and chest tumor surgery, thoracoscopic thymectomy, and selected tracheal procedures.
The appropriate surgical procedure for each patient is determined after reviewing the medical history, conducting a clinical examination, and assessing the required imaging and diagnostic tests.
📞 Book an Appointment with Dr. Mahmoud El Degwy
Consultation fee: EGP 600.
Appointments: By prior booking at all branches.
Booking numbers:
01110691461 – WhatsApp available
📍 Clinic Branches
Heliopolis:
70 Abdel Aziz Fahmy Street, Saint Fatima Square, Heliopolis, Cairo.
Mohandessin:
ABC Hospital Clinics, beginning of Syria Street from Gameat El Dowal El Arabia Street, Mohandessin, Giza.
Maadi:
El Horreya Street, Western Basatin, El Basatin District, Maadi, Cairo.
Dokki:
45 Dokki Street, 4th Floor, above Farghaly Juices, next to Dokki Metro Station, Giza.
❓ Frequently Asked Questions About Pneumothorax
Is pneumothorax the same as a burst lung?
No. "Burst lung" is a common but medically inaccurate expression. The correct medical term is pneumothorax. In some cases, pneumothorax occurs because a small air-filled bleb on the lung ruptures and allows air to enter the pleural space.
Does every pneumothorax require surgery?
No. Some small and stable pneumothoraces can be managed with observation, while other cases may require air aspiration or chest tube drainage. Surgery may be considered in selected cases, including recurrent pneumothorax, persistent air leakage, or situations where preventing recurrence is particularly important.
Can pneumothorax be treated with VATS?
Yes. Video-Assisted Thoracoscopic Surgery (VATS) can be used in selected cases that require surgery. The procedure may involve removing blebs or bullae and performing a pleural procedure to reduce the risk of recurrence. Whether VATS is appropriate depends on the assessment of a thoracic surgeon.
Is pneumothorax dangerous?
Pneumothorax may be mild in some cases, but it can become dangerous if it is extensive or causes significant pressure on the lung and affects breathing or circulation. Sudden chest pain accompanied by shortness of breath therefore requires medical assessment and may require emergency care.
Can pneumothorax happen again?
Yes. Pneumothorax can recur. For this reason, preventive surgery may be discussed in selected patients, particularly after recurrent episodes or when preventing another episode is medically important.
🩺 Medical Articles Related to Thoracic Surgery and Chest Wall Reconstruction:
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How Is the Chest Wall Reconstructed After Severe Accidents?
Tracheal Stenosis Surgery | Latest Surgical Treatment Methods to Restore Normal Breathing
⚠️ Medical Disclaimer: The medical information provided in this article is intended for educational and informational purposes only. It is not a substitute for a direct clinical examination or consultation with a qualified physician. Please consult a specialist to determine the most appropriate treatment plan for your individual condition.
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