Spontaneous pneumothorax is the collapse of a lung, leading to the accumulation of air in the chest cavity. It occurs in two main groups of patients. The first group has no known lung disease and is attributed to rupture of small blebs on the surface of the lung. It usually occurs in thin young males, with cigarette smoking increasing its risk by 20 fold. The second group of patients are older chronic smokers with emphysema, who experience a rupture of a bleb. Both groups of patients present with shortness of breath or pain on taking a deep breath (pleurisy).
Treatment varies from observation for a small pneumothorax, to chest tube placement for a larger pneumothorax. After the first episode, there is a 30% chance of recurrence and after the second episode, the recurrence rate is 70%. For this reason, surgery is recommended for recurrent spontaneous pneumothorax.
Surgery is done minimally invasively with a video-assisted approach and involves stapled resection of the blebs if present and pleurodesis (abrasion of the chest lining) to facilitate adhesion of the lung to the chest wall and prevent recurrences. Most patients are in the hospital for 2-3 days and return to full activity in a few weeks after surgery.