How to treat recurrent pneumothorax for the second time?

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on December 13, 2024
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Patients with recurrent pneumothorax, we recommend proactive minimally invasive surgical intervention. For patients experiencing their first recurrence of pneumothorax, the likelihood of a second recurrence is about 20-30%. For those who have had two episodes of pneumothorax, it indicates the presence of a small rupture on the lung, or an area that has not healed well, or is particularly weak. Thus, for patients who have had two episodes or a second occurrence of pneumothorax, if they do not receive active treatment, the probability of a third recurrence rises to about 70-80%. Whether using minimally invasive surgery or the conservative method of simple tube insertion, both are certainly burdensome for the patient. However, for patients with a second occurrence of pneumothorax, undergoing a small minimally invasive surgery, which involves a small incision of one to two centimeters under the armpit to treat the pneumothorax, dramatically reduces the likelihood of subsequent occurrences from the previous 70-80% to below 10%. Therefore, the best treatment for a second pneumothorax episode is through minimally invasive surgical intervention.

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Is pneumothorax the same as emphysema?

Pneumothorax and emphysema can both manifest symptoms such as chest tightness, difficulty breathing, and coughing. However, is pneumothorax the same as emphysema? Pneumothorax and emphysema are two different diseases. Simply put, pneumothorax is a pleural disease caused by a rupture of the pleura, while emphysema is a disease of the airways. When a lung is imaged for pneumothorax, the film shows lung compression. It is possible to see the external boundary of the compressed lung where pneumothorax is present, with no lung markings. In the case of emphysema, imaging shows that the thoracic cage is expanded, with widened intercostal spaces, and increased translucency in both lung lobes. Therefore, the differences between pneumothorax and emphysema are significant, and they are not the same disease.

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Written by Han Shun Li
Pulmonology
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Can you smoke with pneumothorax?

After suffering from pneumothorax, patients often experience symptoms such as chest pain, chest tightness, and coughing. Can patients smoke after suffering from pneumothorax? It is advised against smoking after suffering from pneumothorax, as smoke and harmful substances directly irritate the respiratory tract, worsening the patient's symptoms. Additionally, smoking produces a large amount of carbon monoxide, which, when absorbed by the body, can cause hypoxia, thereby exacerbating symptoms of breathing difficulty. Therefore, patients with pneumothorax should not smoke, and it is also recommended to quit smoking even after recovery from pneumothorax, as smoking is harmful in many ways and particularly damaging to the respiratory system.

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Written by Han Shun Li
Pulmonology
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Can pneumothorax heal by itself?

Pneumothorax is caused by a rupture of the pleura, allowing air to enter the pleural cavity, and it is relatively common clinically. Can pneumothorax be cured after it occurs? It depends on the specific circumstances. If it is a closed pneumothorax with a small amount of air accumulation, conservative treatments like rest and oxygen therapy can allow for self-healing of the pneumothorax. However, in most cases, the accumulation of air is generally significant, and often it is a tension pneumothorax. In these instances, treatments generally involve pleural cavity puncture, or closed pleural drainage to drain the air, making it difficult to heal spontaneously and requiring medical treatment. Moreover, some patients may not recover fully despite aggressive treatment and may require surgical intervention.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to check for hemothorax and pneumothorax?

Actually, the examination methods for hemothorax and pneumothorax are quite simple. From their definitions, we know that hemothorax means the abnormal presence of blood in the pleural cavity, and pneumothorax means the presence of gas in the pleural cavity where it shouldn't be. Therefore, the simplest examination is an X-ray, a standard frontal and lateral chest X-ray, which usually costs about 52 yuan, can detect whether a patient has pneumothorax. As for hemothorax, of course, it involves the use of a syringe. After injecting some lidocaine local anesthesia into the patient, if blood is withdrawn from the pleural cavity, then it indicates a hemothorax. Thus, the first step in examining for hemothorax and pneumothorax is to perform an X-ray to check for the presence of gas. If gas is detected, then it is pneumothorax. If liquid is found, a syringe under ultrasound guidance can be used to withdraw it. If the withdrawal yields fluid, it indicates pleural effusion; if blood is drawn, then it indicates hemothorax.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Foods to avoid with pneumothorax

We know that the lung tissue of a normal person is like a balloon. When breathing, this balloon expands and contracts, and there are about hundreds of millions of small structures in the lungs like balloons, which we call alveolar tissue. This structure also continuously expands and contracts, expelling carbon dioxide and inhaling oxygen. For certain reasons, such as infection or due to the body shape of tall, thin young people, or chronic obstructive pulmonary disease (COPD) and bronchitis in elderly people, this alveolar structure can rupture, causing some alveoli to merge into a large bulla. Of course, if the large bulla eventually ruptures, the break in this balloon-like surface will leak air into the pleural cavity, causing a pneumothorax. As for the nutrition from food, we believe that patients should not refrain from certain foods, but should instead increase their intake of protein, such as eating three to four egg whites daily. If worried about high cholesterol, discard the yolk, consuming only one yolk per day, but ensuring adequate protein intake. Therefore, for patients with pneumothorax, it is not about avoiding certain foods, but about eating more of those foods to which they are not allergic, such as shrimp and beef, rather than restricting their diet.