Pneumothorax-best treatment (no recurrence)

[nightflight]

I have got a 10% pneumothorax on the right side (1 week before I stopped smoking, however, I was not a strong smoker). Now, they doctors want to treat me with talc pleurodesis and pleurectomy. What is the best treatment in your opinion? Ant what is the recurrence rates (risks) in the described procedure above?

Cheers

[David Tinkelman, M.D.]

The following assessment is based on the assumption that this is your first episode of pneumothorax. If that is correct and especially since this is a quite small (10%) pneumothorax, no therapy, especially any type of surgical therapy, is warranted.  You should be followed closely by your doctor, with periodic chest X-rays, until complete spontaneous resolution of the pneumothorax is documented.  It is appropriate to consider pleurodesis and/or thoracoscopy  when one has two or more recurrences of pneumothorax, of the same lung.  Thoracoscopy allows for direct visualization of the lung surface and thus, the opportunity to cauterize a bleb or resect lung tissue that exhibits emphysema-like changes.

Pleurectomy offers no advantage over the preceding approach, even with a history of recurrent pneumothorax, and is associated with a higher incidence of chronic pain.  It should be avoided.

You should definitely not proceed with talc pleurodesis or pleurectomy,at this time, especially if the 10% pneumothorax has spontaneously resolved.  You should, however, consider seeking a second opinion from a board certified pulmonary disease specialist, to address your current situation and to speak to your options, should you experience recurrence.  If it is subsequently recommended that you have a pleurodesis, be it with or without thoracoscopy, be sure that the procedure is performed by a specialist familiar with these techniques; with performance and with indications and potential complications.  Do not hesitate to ask this doctor about his/her experience and outcomes.

[Dave469]

Thank you for posting the above information, which has been helpful to me in understanding  my present condition. I need to get more information and I am hoping you may be able to help.  I experienced several episodes of recurrent spontaneous pneumothorax of the left lung between 1991and 1994. In 1994 at age 26, pluerodesis and thoracotomy was performed and 8 blebs were removed and stapled. Recovery was uneventful and my doctor said I would probably never have another pneumothorax. I resumed a normal active lifestyle until June 2008 when I again experienced spontaneous pneumothorax of the same lung. X-Ray and CT scan indicated 2 blebs and approximate 10% collapse. The thoracic surgeon recommended surgery. He said he anticipated there would be significant scar tissue from the first surgery and that he would probably not be able to do the VATS procedure and would have to do a thoracotomy.HOWEVER, AT THE TIME OF SURGERY, HE ELECTED TO DO THE VATS PROCEDURE. The post-surgery report indicates "significant adhesions were present and the lung was difficult to decorticate". The report also indicates that the bullous disease was minimal on the CT scan and was at the very apex of the chest, and he elected not to remove them because at that point the lung was quite plastered and he was "nervous decorticating this in order to gain access to the small bullous seen on the CT scan". When I was finally able to meet with the surgeon, he said he had decided to do the VATS procedure because it "is the surgery of choice for that problem". He said he had to close without removing the blebs or all of the adhesions because it "would have been dangerous to do so".  Since the surgery was performed on November 24, 2008, I have experienced considerable ongoing pain, breathing distress and tightness in my chest, and with some cross-over symptoms in the right lung. This has affected my life significantly, and I cannot work in my former employment which required moderate physical ability. At the age of 40, I am now looking for a "sedentary position". I would like to know if anything can be done to alleviate the pain/breathing problems?  Even atmospheric pressure affects my ability to function. and the pulmonary specialist told me I should not fly because I could have a spontaneous pneumothras. I'd like to know why I am experiencing so many problems, when the first surgery was so successful.  Could the vagus or phrenic nerves damaged during surgery? If so, Do they regenerate/heal over time?  Do you have any suggestions?