Spontaneous Pneumothorax

Western Toronto Thoracic Associates

A pneumothorax is a partial or complete collapse of the lung. Air collects in the membranes between the chest wall and the lung, called the pleura. Normally, the chest wall pleura and the lung pleura are in close proximity to each other, but in pneumothorax, they become separated.

A spontaneous pneumothorax occurs when the lung collapses with minimal or no trauma. A non spontaneous pneumothorax occurs after trauma to the chest (for instance a punctured lung from a rib fracture).

A Primary Spontaneous pneumothorax occurs when there is no apparent underlying lung disease. A secondary Spotaneous pneumothorax occurs when there is an underlying problem with the lung itself.

Age Tends to be younger (13-30) Tends to be older
Chronic Lung
No Yes: Emphysema, Cystic Fibrosis, Obstructive pulmonary disease
Cause of
Tiny blisters (bullae) on lung surface Fragile lungs, large blisters

A primary spontaneous pneumothorax tends to occur in young, otherwise healthy individuals. Patients are usually tall and thin. The bullae can be regarded as "stretch marks" on the lung- caused by local weakness/stretching caused during the adolescent growth phase.

Symptoms of a Pneumothorax

Most spontaneous pneumothoracies occur during minimal exertion. It is heralded by a sudden, sharp chest pain on the side of the pneumothorax that is pleuritic in nature (gets worse upon taking a deep breath). It is accompanied by a feeling of shortness of breath. A chest x-ray is usually diagnostic of a collapsed lung.

Western Toronto Thoracic Associates Collapsed left lung



Pneumothoracies are categorized based on size. A small pneumothorax may be treated with oxygen therapy and observed, as they will often spontaneously resolve. Moderate or large pneumothoracies are usually treated with a chest tube. This is a tube inserted into the chest cavity that will drain the air, allowing the lung to heal.

The risk of recurrence after 1 pneumothorax ranges from 10-15%. The risk of recurrence from 2 or more pneumothoracies is around 50% or greater. Therefore after 2 spontaneous pneumothoracies, surgery is usually recommended.

Surgery for Spontaneous Pneumothorax

This minimally invasive therapy involves the removal of all visible bullae via endoscopic stapler. The operation is performed through keyhole surgery, 3 incisions that are around 1 cm in size.

Western Toronto Thoracic Associates

Bullae of spontaneous pneumothorax

Western Toronto Thoracic Associates

Removal of a lung bullae

After all lung bullae are removed, the inner lining (pleura) of the chest cavity is abraded or removed to allow the lung to adhere to the chest wall. This prevents another pneumothorax from occurring, even if microscopic bullae are left behind.

The combination of removal and pleurodesis results in a recurrence rate of around 4-8%, significantly better than 50%+ otherwise.

Indications for surgery

  • Recurrent pneumothorax (same side)
  • Recurrent pneumothorax (after surgery on opposite side)
  • Blood and air in the chest cavity
  • Complete collapse of the lung
  • Airline personel (flight attendant, pilot, co-pilot)

Frequently Asked Questions

1.How much lung is removed?

The total amount of lung removed is less than 2% and should not affect your lung function

2.What is the length of stay and recovery time after surgery?

Around 3 days in hospital

Around 2 weeks at home before significant recovery occurs

3.I have just had a successfully treated pneumothorax. Are there any restrictions?


You cannot fly in an airplane for 2 months after the pneumothorax has been successfully treated

You cannot scuba dive (lifetime restriction)

You must refrain from strenuous activity, including contact sports for 2 months

4.What are the potential complications from surgery?

1% bleeding requiring a transfusion

1% infection

1% ongoing air leak after surgery