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Spontaneous Pneumothorax Experiences: 33 Year-Old Male

My first pneumothorax (right side) occured on my way to lunch. It felt mostly like bad heartburn, and I simply assumed that's what it was. Off and on, I had additional pain in my right shoulder and elbow. The pain continued overnight, and was still present in the morning, at which time I decided it would be wise to visit my doctor.

As part of the exam, my doctor listened to my breath sounds, and identified reduced sounds on my right side. At that point he ordered a chest x-ray, which revealed that my right lung had partially collapsed. He sent me to the hospital ER for treatment.

Treatment at the ER involved the insertion of a catheter into my chest, and then the removal of the air from the pleural space using a syringe and a three-way valve. After the air was removed, the valve was closed and I was sent home with the tube still inserted. An x-ray the next morning confirmed that the lung was still leaking, so a Heimlich valve was attached to the tube and I was sent home again.

After five days, I returned to the hospital for follow-up, having closed the valve again six hours in advance. An x-ray confirmed that the leak had stopped, and a thoracic surgeon removed the catheter (no actual surgery was involved...he simply removed the sutures, and then the catheter itself).

Six months later, I suffered another spontanteous pneumothorax. This time I was pretty sure I knew what it was, and had a friend call for an ambulance, since the pain was somewhat more intense than the last time. After sitting and relaxing a bit, the intensity of the pain was reduced, but the emergency staff insisted that the paramedics still come to meet me and take me to the hospital. As it happened, I'm sure I would have been okay being driven by my friend, but at the same time, one never knows and I feel that the emergency staff made the right decision.

Treatment was similar to the first time, except that the Heimlich valve was used right away, and the air was expelled simply through coughing and breathing normally, rather than the use of a syringe. As with the last time, the tube was closed off prior to my return for follow-up, an x-ray done to confirm that the lung had healed, and the catheter was removed by the thoracic surgeon.

I am currently researching the surgical options available to me to prevent a third recurrence. I have tenatively scheduled thoracoscopic surgery to remove the very top 1% of the right lung, using staples to close the lung. Assuming my research supports this decision, the surgery will be performed as scheduled.

Some notes concerning my case...

The catheter insertion during my first SP was VERY painful. It was right at the edge of my limits to endure pain. Once the catheter was in, the pain was managed quite well using Advil and oxycodone (Percocet). The same ER doctor handled my second SP, and I explained how bad the pain was the first time. He made three changes to my treatment the second time -- I was given Percocet prior to the catheter insertion, he used more local anethsetic, and he used a slightly larger catheter -- and I found the procedure MUCH more bearable the second time around.

The reason for using the larger catheter was to allow for a more flexible tube, one that conforms better to the body and causes less pain. I don't really know which of these three changes made the most difference, but not only was the procedure less painful, I had less fatigue and pain during the time the catheter was in my chest.

While x-rays were used to verify that the lung had healed, because the Heimlich valve makes a very distinctive noise when air passes through it, and because I noticed no such noise after the third day, it was readily apparent to me even with x-rays when the lung had healed.