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What is the cause and treatment for recurrent spontaneous pneumothorax?

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Posted on Thu, 20 Mar 2014
Question: My daughter, 39 years of age, has been in the hospital for the last 26 days for spontaneous pneumothorax. The first week, she had a suction tube inserted, and, towards the end of the week, it seemed that maybe the condition had resolved itself. The tube was pulled, and, within 24 hours, she was back in (a different) hospital in another city with the same condition. A tube was inserted, withdrawn after a few days, lung collapsed, and another tube was inserted. After a day or two, it was decided to go in robotically and repair all the blebs. That done, the tube was again pulled, the lung collapsed, and then the surgeon went in laparoscopically and checked her previous work, which looked OK. While in there, she "roughed up" wall of the thorax to make it heal to the lung (plural lining?). Then inserted two suction tubes. After several days, she pulled one of the tubes, and again, air had entered the thoracic space to some small degree. She is waiting until tomorrow to pull the second tube . My question is, is there any other avenue by which air may be infiltrating the thorax other than blebs, leaky tube wounds (all of which have been gone over with a fine-toothed come--even clipped and stitched)? Could air be getting into the thorax via a small break or crack in the trachea or bronchial tubes where they join/branch, etc.? 26 days to fix a pneumothorax is a long time, don't you agree? We're very concerned. thanks
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Answered by Dr. Gyanshankar Mishra (5 hours later)
Brief Answer: Plurodesis is required. Detailed Answer: Hi, Thanks for posting the query on HCM. After going through your query, I would like to comment the following: 1. Your daughter seems to be having recurrent spontaneous pneumothorax. 2. Ideally a HRCT scan of thorax needs to be done to rule out ant underlying lung disease. 3. The cause of recurrence could be rupture of subpleural bleb or persistence/ opening of a small bronchopleural fistula. 4. Pleurodesis is required in such instances. Already a thoracoscopic pleurodesis has been done in your case. If recurrence is seen despite mechanical pleurodesis, then chemical pleurodesis may be an option. 5. A detailed clinical evaluation with Pulmonologist need to be done and management as outlined above can be done. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Gyanshankar Mishra

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Practicing since :2003

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What is the cause and treatment for recurrent spontaneous pneumothorax?

Brief Answer: Plurodesis is required. Detailed Answer: Hi, Thanks for posting the query on HCM. After going through your query, I would like to comment the following: 1. Your daughter seems to be having recurrent spontaneous pneumothorax. 2. Ideally a HRCT scan of thorax needs to be done to rule out ant underlying lung disease. 3. The cause of recurrence could be rupture of subpleural bleb or persistence/ opening of a small bronchopleural fistula. 4. Pleurodesis is required in such instances. Already a thoracoscopic pleurodesis has been done in your case. If recurrence is seen despite mechanical pleurodesis, then chemical pleurodesis may be an option. 5. A detailed clinical evaluation with Pulmonologist need to be done and management as outlined above can be done. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist