A young man with a spontaneous pneumothorax

A "pneumothorax" is air escaping from the lung and filling the space inside the chest cavity outside the lung. The lung collapses and can't function properly. This can be caused by trauma (stab wound), hospital procedures, or be "spontaneous". In doctor-speak "spontaneous" means "happened by itself".

Spontaneous pneumothorax most commonly occurs in young thin males. Initial treatment is decompression of the air by a tube inserted through the ribs, allowing the lung to re-expand. In most cases, the lung air leak will stop because the expanded lung will stick to the chest lining. Sometimes the leak is too large or the lung won't fully expand or there is some abnormality in the lung structure so the leak won't stop. If the air leak persists for more than a week, surgical repair is usually indicated.

Bryan is a 16 year old who came to the emergency room short of breath. His right lung was completely collapsed. A tube was inserted between his ribs to evacuate the air outside his lung. His lung expanded. We were hopefull that the air leak would seal and we could take the tube out and send him home. We gave it a week, but the air leak persisted. So I took him to the operating room and, through an minimally-invasive incision, removed the abnormal lung that was causing the problem. 

Here is the abnormal part resected from the top of his right lung:

These grape-like things are "bullae". We see them in young thin males and in heavy smokers. 

Here is the incision (black arrow) and the chest tube inserted in the emergency room (red arrow) and a little blood on his skin that we washed off (yellow arrow).

We did the operation through a two-inch incision without spreading the ribs.

This will most iikely be the last pneumothorax Bryan has. His right lung is fixed. He can go back to school and sports right away. He may have bullae on the left lung, but chances are that will never trouble him. If it does, the treatment will be the same.