How is the fluid in pneumothorax drained?

Written by Yuan Qing
Pulmonology
Updated on February 28, 2025
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Pneumothorax with effusion is mostly due to trauma or structural issues in the lungs themselves, leading to lung rupture, accompanied by intrathoracic hematomas, effusion, or pneumothorax. This condition is known as hydro-pneumothorax. Generally speaking, the treatment method depends on the severity of the hydro-pneumothorax. Usually, a mild case can be absorbed by the patient naturally. However, if the pneumothorax occupies more than 30% of the thoracic cavity, closed thoracic drainage should be implemented, along with the removal of pleural effusion for absorption to take place. Of course, the specific disease must be clearly identified, which might require repair, tumor resection, or anti-tuberculosis treatment to ultimately address the cause of the disease.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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The difference between tension pneumothorax and open pneumothorax

The main difference between a tension pneumothorax and an open pneumothorax lies in the difference in pressure. If the pressure inside the pleural cavity is approximately the same as the atmospheric pressure, it is referred to as an open pneumothorax. In this case, typically after an injury, the wound allows air to freely enter and exit during breathing. When inhaling, air can enter the pleural cavity, and the air can be expelled during exhalation. At this time, because the system opens and closes with each inhale and exhale, the pressure is roughly equal to atmospheric pressure. On the other hand, in a tension pneumothorax, under certain conditions, when air enters the pleural cavity and cannot escape during exhalation, such as when a sort of flap forms, for example after a trauma causing a rupture in the bronchus or trachea, this flap prevents the expulsion of air from the pleural cavity. Therefore, the pressure in the pleural cavity continues to increase, significantly higher than atmospheric pressure. This is the difference between a tension pneumothorax and an open pneumothorax.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pneumothorax recurrence symptoms

We know that normally there is no air in the pleural cavity, only a small amount of fluid or lubricant exists. However, in certain people, such as those who often smoke, tall and thin young people, and patients with chronic bronchitis, the alveoli in their lungs tend to be more fragile and can easily rupture. People experiencing a pneumothorax for the first time might feel this during certain situations like after a cold, coughing, sneezing, or playing sports, which can lead to a recurrence of the pneumothorax. Early symptoms of a recurrence, due to only a small amount of air compression, might not be very uncomfortable, just a slight sense of difficulty breathing. As the pneumothorax increases, symptoms like chest pain and difficulty breathing can develop. Therefore, the symptoms of a recurring pneumothorax are not identical each time, but there is a pattern; the severity can range from mild breathing difficulty to severe respiratory distress and chest pain.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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The difference between tension pneumothorax and open pneumothorax.

The main difference between a tension pneumothorax and an open pneumothorax lies in the relative pressures of the pleural cavity compared to the atmospheric pressure. An open pneumothorax occurs when the pleural cavity is in an open state due to some reason. During inhalation, gas can enter the pleural cavity, and during exhalation, the gas can be expelled through this opening or another opening, resulting in pleural cavity pressure that is roughly equal to the atmospheric pressure. In a tension pneumothorax, due to some reason, a one-way valve is formed. The gas enters the pleural cavity easily but encounters resistance during expulsion, causing the pressure in the patient's pleural cavity to increase progressively. The gas can only enter the pleural cavity and cannot be effectively expelled. Therefore, the main difference between a tension pneumothorax and an open pneumothorax is the level of pleural cavity pressure compared to atmospheric pressure; in a tension pneumothorax, the pressure in the pleural cavity is significantly higher than the atmospheric pressure, while in an open pneumothorax, the pressures are roughly equal.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How many days after pneumothorax can one smoke?

For patients with pneumothorax, it is advised to strictly quit smoking, as smoking greatly increases the recurrence of pneumothorax. Smoking leads to airway inflammation and respiratory bronchitis. Among male patients with pneumothorax, compared to non-smokers, smokers have a significantly higher incidence of pneumothorax, which is related to the degree of smoking. If the patient smokes less than half a pack, the recurrence rate of his pneumothorax is about 7 times higher. For moderate smokers, those who smoke between half a pack and one pack, the recurrence rate increases to 21 times. If one smokes a pack a day, the recurrence rate rises to 102 times, this is in males. In females, for those smoking less than half a pack, between half a pack and one pack, and more than one pack, the recurrence rates of pneumothorax become 4 times, 14 times, and 68 times respectively. Therefore, for both male and female patients with pneumothorax, smoking significantly increases the probability of recurrence. So, once pneumothorax is resolved, quit smoking as well, to prevent any future recurrences.

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Written by Xia Bao Jun
Pulmonology
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Pneumothorax is caused by what?

Pneumothorax is caused by the entry of air into the pleural cavity, leading to a series of changes. Pneumothorax can be divided into spontaneous and traumatic pneumothorax. Spontaneous pneumothorax occurs without trauma or other causes, while traumatic pneumothorax is caused by direct or indirect trauma to the pleura. Spontaneous pneumothorax can be further categorized into primary and secondary pneumothorax. Patients with primary spontaneous pneumothorax do not have underlying lung disease, whereas secondary pneumothorax is a complication of lung disease, commonly seen in chronic obstructive pulmonary disease. Traumatic pneumothorax includes iatrogenic pneumothorax, which occurs during diagnostic and therapeutic procedures.