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Patient education, Surgical procedures

Blebs, Bullae and Spontaneous Pneumothorax

There are multiple classifications of pneumothoraces – primary, secondary, iatrogenic, traumatic, tension etc.  This article is a limited overview of the most common type(s) of pneumothorax, and methods of treatment.

What are blebs? 

The lung is made up of lung tissue itself (consisting of alveoli, bronchi and bronchioles) and a thin, membranous covering called the pleura.  This covering serves to prevent inhaled air from travelling from the lung to the area inside the thoracic cavity.  ‘Blebs’ are blister-like air pockets that form on the surface of the lung.  Bulla (or Bullae for pleural) is the term used for air-filled cavities within the lung tissue.

Who gets/ who has blebs and/or bullae?

Blebs and bullae may be related to an underlying disease process such as emphysema / chronic obstructive pulmonary disease, but they (blebs in particular) may also be found in young, healthy people with no other medical issues.  Indeed, the ‘classic’ scenario for a primary spontaneous pneumothorax is a young adult male (18 – 20’s), tall and thin in appearance and no other known medical history who presents with complaints of shortness of breath or dyspnea.

Smoking, and smoking cannabis have been implicated in the development of spontaneous pneumothorax in young (otherwise healthy) patients.

Bullae, or air pockets within the lung tissue are more commonly associated with chronic disease processes such as chronic obstructive pulmonary disease (emphysema).  It can be also part of the clinical picture in cystic fibrosis and other lung diseases.

How do blebs cause a pneumothorax?

When these blebs rupture or ‘pop’ inhaled air is able to travel from the airways to the thoracic cavity, creating a pneumothorax or lung collapse.

The symptoms of a pneumothorax depend on the amount of lung collapse and the baseline respiratory status of the patient.   In young, otherwise healthy patients, the symptoms may be more subtle even with a large pneumothorax.  In patients with limited reserve (chronic smokers, COPD, pulmonary fibrosis, sarcoidosis) patients may experience shortness of breath, dyspnea/ difficulty breathing, chest and chest wall pain.  With large pneumothoraces or complete collapse of a lung, patients may become cyanotic, or develop respiratory distress.

In cases of pneumothorax caused by external puncture of the lung, or other traumatic circumstances, a patient may develop a life-threatening condition from a tension pneumothorax.  This can happen with a simple, primary lung collapse from bleb rupture, but it is uncommon. 

How is this treated?

Simple (or first-time) pneumothorax

Oxygen therapy – traditional treatment for small pneumothorax in asymptomatic or minimally symptomatic patients was oxygen via a face mask or non-rebreather.  Much of the more recent literature has discredited this as an effective treatment.

Tube thoracostomy  (aka chest tube placement) – a chest tube is placed to evacuate air from the thoracic cavity, to allow the lung to re-expand.  The chest tube is initially placed to suction until the lung surface heals, and the lung is fully expanded.  After a waterseal trial, the chest tube is removed.

Recurrent pneumothorax / other circumstances;

Blebectomy via:

  1. VATS (video-assisted thoracoscopy)
  2. Open thoracotomy or mini-thoracotomy

As we have discussed previously, the VATS procedure / open thoracotomy and mini-thoracotomy are not really stand alone procedures but are the surgical approaches or techniques used to gain entry into the chest.  Using a VATS technique involves the creation of one or more ‘ports’ or opening for the use of thoracoscopic surgical tools, and a thoracoscope (or camera.)  There are rigid and flexible scopes available; but most thoracic surgeons prefer the rigid scopes for better visibility and control of tissue during the operation[1].

blebs seen during VATS procedure

Open thoracotomy or mini-thoracotomy incisions may be used to gain access to the lung, particularly for resection of bullae (lung volume reduction) surgeries for the treatment of chronic disease.

During this procedure, fibrin sealants may be used.  Investigational use of both radio-frequency and other ablative therapies have also been used (Linchevskyy, Makarov & Getman, 2010, Funai, Suzuki, Shimizu & Shiiya 2011**).

Treatment Guidelines

British Thoracic Surgeons 2010 treatment guidelines

American College of Chest Physicians – a bit dated (2001)

Linchevskyy, Makarov & Getman, 2010.  Lung sealing using the tissue-welding technology in spontaneous pneumothorax.  Eur J Cardiothorac Surg (2010) 37(5): 1126-1128.

Funai, Suzuki, Shimizu & Shiiya (2011).  Ablation of weak emphysematous visceral pleura by an ultrasonically activated device for spontaneous pneumothorax. Interact CardioVasc Thorac Surg (2011) 12(6): 908-911. 

Pleurodesis may also be used – in combination with either tube thoracostomy or surgical resection.  Pleurodesis can be performed either mechanically, chemically or both.  Mechanical pleurodesis is accomplished by irritated the pleura by physical means (such as scratching or rubbing the pleura with the bovie scratch pad or surgical brushes.  A chest tube also produces a small amount of mechanical pleurodesis as the tube rubs on the chest wall during patient movement.

Chemical pleurodesis is the instillation of either sterile talc or erythromycin to produce irritation or inflammation of the pleura.  With bedside pleurodesis or tube thoracostomy pleurodesis, sterile talc is mixed with lidocaine and sterile water to create a talc slurry.  (If you like your patient, carry it in your pocket for 10 – 20 minutes to allow the solution to warm to at least room temperature.  This will help reduce the discomfort during instillation.)  The mixture should be in a 60cc syringe or similar delivery device – shake briskly before use.  The mixture is then instilled via the existing thoracostomy tube.  The chest tube is clamped for 30 – 60 minutes (dwell time) and the patient is re-positioned every 10 to 20 minutes. Despite the lidocaine, the talc will produce a burning sensation, so pre-medication is desirable.  This procedure has largely fallen out of fashion in many facilities.  Post-pleurodesis, pleural inflammation may cause a brief temperature elevation.  This is best treated with incentive spirometry, and pulmonary toileting.

Chemical pleurodesis can also be performed in the operating room.  Loose sterile talc can be insufflated, or instilled using multiple delivery devices including aerosolized talc.  As discussed in previous articles, pleurodesis can also be used for the treatment of pleural effusions.

Sepehripour, Nasir and Shah (2011).  Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax?  Interact CardioVasc Thorac Surg ivr094 first published online December 18, 2011 doi:10.1093/icvts/ivr094

Alayouty, Hasan,  Alhadad Omar Barabba (2011).  Mechanical versus chemical pleurodesis for management of primary spontaneous pneumothorax evaluated with thoracic echography.                     Interact CardioVasc Thorac Surg (2011) 13(5): 475-479 

Special conditions and circumstances related to Pneumothorax:

Catamenial pneumothorax – this a pneumothorax that occurs in menstruating women.  It usually occurs on the right-side and is associated with endometriosis, and defects in the diaphragm. A related case study can be viewed here.  Several recent studies suggest catamenial pneumothorax may be more common that previously believed and should be suspected in all women presenting with right-sided pneumothorax, particularly if pneumothorax occurs within 48 – 72 hours of menstrual cycle.  This may be the first indication of underlying endometrial disease.

Additional References

For more reference citations and articles about the less common causes  – see More Blebs, Bullae and Spontaneous Pneumothorax

Pneumothorax: an update – gives a nice overview of the different types of pneumothorax, and causes of each.

Medscape overview of pneumothorax – this is a good article with radiographs with basic information about pneumothoraces.

More on the difference between blebs and bullae – from learning radiology.com

Lung resection for bullous emphysema

Japanese study suggesting Fibulin-5 protein deficiency in young people with pneumothoraces.

VATS versus tube thoracostomy for spontaneous pneumothorax

What’s worse than a spontaneous pneumothorax?  Bilateral pneumothoraces – a case report.

Early article suggesting VATS for treatment of spontaneous pneumothorax (1997)

Blebs, Pneumothorax and chest drains

[1] Flexible scopes are usually preferred for GI procedures such as colonoscopy, where the camera is inserted into a soft tissue orifice.  By comparison, the thoracic cavity with the bony rib cage is more easily navigated with the use of a firm instrument.

** I have contacted the primary authors on both of these papers for more information.

Like all materials presented on this site, this paper is presented for information only.  It should not be considered medical advice or treatment.  Also, all information provided is generalized information and (outside of clinical case presentations) is not intended to treat of diagnose any disease or condition.  If you have questions about the content, please contact us.  If you have medical questions, please consult your thoracic surgeon or pulmonologist.

About Kristin Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.


109 thoughts on “Blebs, Bullae and Spontaneous Pneumothorax

  1. After a primary spontaneous pneumothorax with chest tube used for drainage, does the presence of blebs in the CT images (made a month after) imply the need for blebectomy, despite the number and sizes of the blebs found?

    Posted by Carlos | November 1, 2012, 9:43 pm
  2. I am delighted to “discover” this site! I have severe bullous emphysema (congenital as I never smoked) and am searching for experimental non-invasive surgical options as my right lung is very occluded with a huge bullae (20 x 10 cm.) Had surgery in 1979 (pleurodesis and pneumothorax repair) and again in 1997 (resection.) Traditional invasive surgery is out according to my doctors, so I am hoping for the radiofrequency, thermal or other ablation therapies being experimentally used on lung cancer tumors. Noticed from the article above that the Japanese seem to be using a similar therapy on blebs for emphysema patients!

    Posted by jay s. gertz | December 10, 2012, 12:39 pm
    • there is also an eastern european surgeon using these techniques but he was pretty cagey when I wrote to him about it.

      Posted by CartagenaSurgery | December 11, 2012, 7:38 pm
    • I would like to know where to find these articals on the above non-invasive surgery. I have had several lung collapses. For 2 years ran to the doctor I hurt I cant breath . They wrote me off as a drug seeker. So I went to the ER over and over till some one listened… I had to have emergency surgery the next day. I have a L.V.R.S. vats.. I still have a issue things have got worse. The surgeon said that was it for surgery’s. I am a 32 year old man today I had the LVRS in 2010. I am In a lot of pain and still called a drug seeker cause I look fine and I am not to have what I have at my age. I am looking for answers besides I smoked cause the doctors said there’s no way this is possible for my age. I have had test for several things and all wrote off clear but I have medical insurance from the state due I had to stop work again and doctors that wont work for me. I need any help >>>>Thanks

      Posted by Jeremy Pieper | June 26, 2013, 12:56 am
      • Jeremy,

        All of the research articles are available on pubmed – and I usually post links to the original articles to help readers like yourself. The interviews with the surgeons themselves, and the case reports are based on cases I have participated in/ or observed during my work and are thus, only published here.

        Many conditions cause blebs on the lungs – and some people are predisposed to form them more easily than other people. Many of these cases are in young individuals.

        You may need to see another pulmonologist. Prolonged neuropathic pain can occur after surgery (and usually responds better to neuropathic medications than narcotics (but take several weeks to months for appreciable results), so that may be something to discuss with your physicians.

        I hope this information helps.

        Posted by CartagenaSurgery | June 26, 2013, 3:08 pm
      • Jeremy- You really need another Dr. I am 50 years old & had my first pneumothorax at 25. The first one was bad enough I almost died & was fortunate enough to get not only to the hospital in time, but also had a wonderful surgeon. I recently on August 5th had my most current pneumo & had VATS thoracotomy to fix it due to numerous blebs on my right lung. This was the 4th time I had to be hospitalized. VATS was less invasive since the surgery was done on Tuesday & I was discharged after my tubes were removed on Saturday. Good Luck.

        Posted by Pegi Campbell | September 15, 2013, 7:50 pm
  3. Is there anything I can be doing to prevent a bleb? I had a spontaneous pneumothorax in 2oo9, they said was due to the rupture of a bleb. I have been having some pains, that lead me to believe I have a bleb or blebs. Are their dietary changes I can make? Supplements I can take? Exercises I can do?? Any advise is appreciated. Thanks

    Posted by Brittney | January 18, 2013, 5:16 am
    • If you smoke, quitting smoking will help prevent further blebs. There has been some literature suggesting stimulants may worsen this condition (but the data is far from conclusive.) Otherwise, there is not much you can do. However, if you do have another collapsed lung, talk to your doctor about pleurodesis. also, read our related article on catamenial pneumothorax.

      If you think you have symptoms similar to your previous pneumothorax, see your doctor right away.

      Posted by CartagenaSurgery | January 18, 2013, 11:26 am
    • Are their dietary changes I can make? Supplements I can take? Exercises I can do?? Any advise is appreciated. Thanks

      Posted by ai | August 28, 2013, 6:06 pm
      • Unfortunately, other than smoking cessation (for current smokers), there is no known diet, medication or other lifestyle changes that can prevent bleb rupture. The biggest predictor of a recurrent pneumothorax is the size and number of blebs. (People with numerous large blebs have a much bigger risk).

        Posted by CartagenaSurgery | August 29, 2013, 3:25 am
    • yes agressive chestphysiotherapy like blowing a whistle and if persists you can go for a procedure cald thoractomy

      Posted by maggie | January 24, 2014, 8:34 pm
  4. My doctor gave me a cortisone injection in my shoulder, he went in to far and hit my lung with the needle. I instantly was unable to take a deep breath, it became very painful. He then asked me to go to ER where I got a CT scan and they found I had a pneumothorax/ collapsed left lung due to this. I was admitted and stayed for 3 days. The last xray showed that its still the same no more air has entered, I am still very uncomfortable. Has anyone ever had this happen or heard of this? Please help me, I’m very scared that this may cause more problems down the road. Thank you

    Posted by Haley80 | March 25, 2013, 3:50 am
    • Sorry for the late reply. If you have no underlying lung disease (like COPD), then it is fairly unlikely that this will occur again, once you have fully recovered from this injury. I hope that eases your mind.

      If you had a CT scan during your hospital admission, ask your doctor to review the images with you (in lung window) so you can see the condition of your lungs for yourself.

      Posted by CartagenaSurgery | March 29, 2013, 9:13 pm
  5. I am following a young patient with MDR TB (he is 26 years old) and he had a bulla in the RT apex with a fibrotic scar and upward hilar retraction (25 Sept 2012). but on a repeat CXR taken on 19 Feb 2013, the bulla has disapeared and other finding remain. Do patients with pulmonary TB present with bullae, do these bullae disapear spntaneously over time?

    Posted by ni | April 10, 2013, 9:45 am
  6. I had my blebs stapled and an abrasive rub to attach my lung to my chest wall 2 years ago. I’m always worried that lifting or straining will “pop” the staples out or rip my lung from my chest wall. Is that even possible?

    Posted by Lora McGinnis | April 21, 2013, 2:33 pm
    • While I can not offer specific medical advice, in general patients after blebectomies can resume all activities without limitations within weeks of surgery. After the immediate post operative period (days), the risk of staple line disruption is minimal since the tissue itself will heal.. Now, any patients with other serious medical conditions or extensive lung disease (such as new blebs or blebs on the other lung should use caution as advised by their physicians regarding physical activities but even then, the risk is fairly small.

      Hope this information is helpful.

      Posted by CartagenaSurgery | April 24, 2013, 6:50 am
  7. I am waiting for the Doctors but got my CT result ..“extensive subpleural blebs in right apex and medial right upper lobe ..and an intraparenchymal Bullae in upper right . On the bright side it said left clear and no no leasons effusion ect.. ” I had the scan due to an x ray following a long bout of what they thought was pnemonia. Now not sure.. also 2 years ago in October i was seen for what was thought to be a heart attack and kept four days with tons of test that all said heart was fine.. they thought I breathed in something or had a contact allergy. Now I think ok I had a pneumothorax . Would this make sense..? and while I wait can I exercise ..slowing when need be .. or am I banned form the weight room .. not sure how surgical decisions are made and no sizes were reflected on report. I just want to start educating myself and there is not alot that I have found 52 quit smoking 15 years ago
    thank you

    Posted by markey Stubbs | May 8, 2013, 7:50 pm
    • Quitting smoking was the best thing you could have done – and congratulations on your lasting achievement! It is difficult to know with any certainty what caused your symptoms during a previous hospitalization. However, any plain radiograph (chest x-ray) would have shown a pneumothorax during your previous admission.
      Exercise, particularly weight lifting are not associated with rupture of blebs. Talk to your doctor to be sure, but in most cases, there are no exercise limitations.
      If there are no documented pneumothoraces, (with lung collapse on chest xray or CT scan) and blebs are of a small size (not impairing lung function) – then surgery is not usually indicated. For more specific answers based on your films – please see a board certified thoracic surgeon. You can find a surgeon near you by going to CTnet.org and clicking under the community tab – then surgeons – Advanced Member Search – to ‘find a surgeon’.

      Posted by CartagenaSurgery | May 15, 2013, 6:53 am
  8. How quickly do bulla grow. My husband had surgery, but has been told he has another. They have ruled out any lung diseases and these happened after a spontaneous neumothorax

    Posted by Tracy lister | June 6, 2013, 7:11 pm
  9. Thanku for this wonderful information!
    Actually, my wife had a pneumothorax surgery exactly 15 days ago. Her right lung was collapsing and when chest tubes didn’t work docs finally declared surgery. Her incision is healing but the part where the lung was operated was paining few days before. And today she is complaining she has burns on the same place where surgery had taken place. I mean burning inside,on the lungs. Is it some sort of complication? Or is it a part of healing process?

    Posted by Roger | June 19, 2013, 3:11 pm
    • While I can not give medical advice –

      Since it has just been two weeks since her surgery – a follow-up visit with the surgeon wouldn’t be a bad idea, just in case she has developed a small pneumothorax (which can sometimes happen).

      After thoracic surgery, many patients due experience a kind of ‘tingly,’ burning, or ‘pins and needles’ sensations on their chest wall during the recovery process, as nerves that were stretched surgery heal. If this becomes problematic, her surgeon can prescribe medications to lessen the sensations.

      Posted by CartagenaSurgery | June 19, 2013, 6:42 pm
      • I had a pneumothorax in Jan. I’m very thin and I also had burning under the skin where the tubes were placed. It feels like a rug burn. It took about 2 months for that feeling to go away. I’m also in the hospital right now recovering from another surgery.

        Posted by Sandy | April 14, 2015, 10:39 am
  10. I am overall a healthy tall, skinny male in the 20’s as I’ve read being at risk for bulla. Now when saying healthy I have been also what I would consider a chronic smoker of cannabis starting at 16 years old (only tobacco for say 6 cartons of cigarettes in my teenage years). Surprisingly for being a smoker am very active in exercising as well til this day. 5 years ago I started having chest pains on the left lung thinking it was a heart condition along with shortness of breathe. After going to a thoracic doctor he issued my first CT scan. Heart was well but saw a golf ball size bulla in the lower lung. He explained how they usually see in the upper lung but not my case. They did show me the image at that time. Right away he calmly recommended surgery to remove that lung section which shocked me in the moment (Also mind said well not the heart so relief mentally and I have two lungs so not as bad as a heart condition!, stupid I know….). I did hide the fact I was smoking cannabis from the doctor evaluating me (Mainly fear insurance companies if I tell a doctor). In my own mind and he agreed we waited 6 months to see what would happen when I returned for a followup CT scan since I knew at that moment smoking is a major factor with my lung problem. I started smoking a bit less and stopped 3 weeks before the followup CT scan. Those results came back and he said the bulla disappeared. I didn’t have him show that 2nd CT image to me to know he was being honest to me. This got me all happy and continued back on the path of smoking thinking all was well. As months continued I began to feel the pressure build on and off of the bulla. It’s been over 3-4 years since that last CT scan and the pain/pressure is becoming regular again. Shortness of breathe hasn’t been a problem but might be from me being more active in cycling/strength training/running. I’ve convinced myself to quit smoking for good.

    My question comes as what happens to an individual that is now in late 20s if they quit smoking that has a bulla. Haven’t found any reading on people that is just disappears and no problems later in life. I’d expect the pain and size will go down, but will it exist through my later years in life to become a problem? After 2 CT scans at a young age I don’t know if I should have another to check my condition. It’s concerning to read that surgery can be used but if the bulla is so large then it’s out of the option. I always feel some doctors jump to surgery to quick. Just trying to find answers on after I’ve stopped smoking if I should still get a followup with a doctor to address a problem later in life or risk letting it be as is after no more smoking.

    Any input is much appreciated. Understand if you can’t advise in some of these concerns.

    P.S. I’m also concerned if I should go request they save me the old CT scan images to hold personally for the future. If I recall the health system in the US won’t hold onto those records forever and it is approaching that 5 year mark.

    Posted by Cody | June 27, 2013, 2:45 am
    • Forgot to add as recent as 5 months ago while feeling the bulla returning earlier on I did get sick this winter and family doctor thought I should get a chest xray to see if any pneumonia or just a bronchitis infection. While he had those Xrays I mentioned what the specialist found for a bulla years back on the CT scan. I requested while he had those to look for any other oddities in my left lung. He called back and said everything looked normal. Gave a good mentally good sign again that it was not as bad as I have been feeling during that time. Odd…but maybe they are harder to see in chest xrays vs. CT scans detailed images.

      Posted by Cody | June 27, 2013, 2:51 am
  11. My son has 2 recurring spontaneous pneumothorax within 2 months. His last surgery was about 2 weeks ago. He is still having some pain after the operation, mostly at the back. Sometime on upper back, other times at lower back. He also described his lung feel bubbly sometimes. Is this normal and how long this pain will last before it becomes a concern?

    Posted by Janet Siu | July 7, 2013, 3:53 am
    • Janet –

      If his pain is worsening instead of getting better bring his back to his physician. Otherwise, if the pain is gradually improving, it make take several more weeks, depending on the surgical technique. Has he had a follow up visit with his surgeon yet?

      Posted by CartagenaSurgery | July 7, 2013, 6:32 am
      • Yes, he had his follow up a few days after the surgery. When mentioned about the pain then, the surgeon commented that the pain is normal although he didn’t say how long the pain is expected to last. The surgery my son had this time is the type that the lining is being striped away – I think it is called pleuro tommy.

        Posted by Janet Siu | July 7, 2013, 4:42 pm
      • In general, recovering from pleurectomy make take several weeks (4-6) for the pain to subside since the surgery causes fairly extensive inflammation. Over-the-counter low dose anti-inflammatories may help with the discomfort, but people should use these medications sparingly and only with adequate hydration since these medications can injury the kidneys and liver in large or repeated doses. He may not feel like doing much but encourage him to stay active, use the affected arm frequently and walk several times a day to help speed his recovery.

        Posted by CartagenaSurgery | July 8, 2013, 1:51 am
  12. My son was scheduled to have Pectus Excavatum repair last week. 1/2 hour prior to surgery CXR done and showed 4cm spontaneous pneumo. Needless to say surgery was cancelled. Since he was asymptomatic, we were sent home. 4 days later spontaneous pneumo now 6cm. Admitted to hospital and chest tube put in without complications. My son was the classic patient type: young (15y/o), tall, & thin. Chest CT today showed two blebs (1.5cm & 0.5cm) right lung apex. Two questions: Would doing the blebectomy and the Pectus bar placement for his Pectus Excavatum at the same time be advisable? Argument on the Pro side would be single surgery and single recovery period. Are there any significant cons to doing both surgeries at same time? Second question: (OK third question)- how long should we wait to do these surgeries? I would like to get his Pectus Excavatum surgery done before school starts in 4 weeks. He just got the chest tube out today. We are home and he is feeling fine. P.S. I am a Physician Assistant so I have a little more medical understanding than the layperson.

    Posted by Christine Hunter PA-C, MPAS | July 27, 2013, 1:20 am
  13. If smoking exacerbates primary pneumothorax could it possibly make sense that high allergen and mold content in the air could as well. Just wondering if there have been any studies on “seasonal” pneumos. I had one last week, I am exceptionally healthy 56 year old female with no history of smoking, cardiovascular exercise 3x weekly, all blood work great. By best guess I had probably had the pneumo ( 50%) about 6 weeks – 2 months. I had recently moved ( 3 years ago) to an area with increased rain and thus increased molds and pollens… is this a possible irritant??? Just wondering.

    Posted by sue Shannon | August 22, 2013, 2:16 am
  14. Hey
    I am a 21 male and have now had 4 collapsed lungs in my lifetime and two surgeries . The 1st being March 09, the 2nd being April 09 at which time i had my first surgery, the third being January 2011, and then the 4th being February 2011 in which i had my 2nd surgery. I am a fit individual with no prior history of smoking and play many sports. However, i will every now and then have bubbling sensations in my lung, accompanied by a burning feeling when i breathe in, and at these times i am often that worried that i will stop exercise all together, in which case these sensations will eventually pass.

    I was just wondering is this normal for someone with a previous history like myself?
    What is the explanation of the bubbling and burning feelings?
    are these possibly small collapses of lung? and if it is, is it possible that the lung is healing on its own at times when i do cease exercise?
    Sorry for all the questions, but it is something that completely puzzles me, i hope you have time to best answer them for me.

    Posted by James | August 22, 2013, 2:41 pm
    • I never smoked, played 3 types of sport and went to gym. I was fairly fit and in my twenties. I had a pneumothorax due to a burst bleb in 2013. This was due to secondhand smoke and also toxic gases from severe pollution. I have recovered, started playing sports again and lived my life. Problem is, I have been plagued by pains in my torso eversince. A few days back I moved my arm a bit too much and it felt as if I could have another pneumothorax. This I found out was due to the sensitivity of the nerves that they cut through in the operation. So not to say it is another bleb. I had the bubbling sensations and still have difficulty yawning. I amnow evev playing cricket again, and bowling as fast as I can. It depends on the cause of bleb. Consult your surgeon rather. In my case the doctor said i must continue with cardio sports. If I don’t practise for a while, I get short of breath, another normal after effect.

      Posted by Shawn | January 4, 2015, 8:43 pm
    • James this is old but we have the same history. I am older but had 5. I had a wedge resection and a talc pleurodesis. After 5 years I have constant burning. Did you ever find an answer for the burning pain?

      Posted by Mark | December 7, 2014, 2:41 am
  15. I have been having this sensation of bubbling in my left rear chest for a few weeks. Mainly notice it when I first get up in the morning or at night. Seems to go away with a couple of deep breaths or when I’m upright. A little shortness of breath but not major. After a recent singing lesson, I had some pain when breathing deep & a couple days of heaviness on my left side like there was a weight on my chest. Am still having the occasional bubbling/gurgling sensation now. I’ve been to my doctor, had a couple chest x-rays done, and they were normal. I went again and had a CT-scan today, and they said it was normal. No sign of pneumothorax. I had a penumothorax on the same side many years ago when I was 18 but it healed itself so I wanted to make sure this wasn’t that. I do have the body type for a risk of pneumothroax, tall and slim, but not THAT tall (I’m 5’11 170). After the CT scan came back negative, the ER doc told me that even the smallest pneumothorax would show up on it. So what’s causing my gurgling sensations & shortness of breath on that side? He thought it was lung secretions or allergies of some kind. Guess I should trust the CT scan results since they are foolproof. Just wanted your thoughts.

    Thanks, Rob.

    Posted by Rob | September 1, 2013, 11:59 pm
  16. Hi, my son had 2 surgery in the past months for spontaneous pneumothorax. After his last surgery which is in June 2013, he is feeling pain in his chest areas. The doctor said this is nerve pain. Now is 3 months after the surgery, and the pain hasn’t subsided completely yet. The pain can be at different spots on the lungs each day. I heard that Vitamin B can help with nerve pain. Would you recommend it?


    Posted by Janet | September 17, 2013, 2:18 am
    • Janet –

      Multiple studies including meta-analyses and reviews have provided mixed results with vitamin B providing modest or no benefit to patients.
      If you suspect a vitamin B deficiency due to dietary or lifestyle habits (alcoholism), a modest (not megadose) supplement may help. Do not use in people with a history of liver, kidney disease or blood clotting disorders without talking to your healthcare provider.
      Unfortunately, in some cases, neuropathies may persist up to six months or more – and since your sonhad multiple surgeries- he is at increased chance of having neuropathic pain (from nerves being stretched during surgery).

      Posted by CartagenaSurgery | September 24, 2013, 12:38 pm
    • Have his provider/surgeon put him on Lyrica or Neurontin for the nerve pain he is still having.

      Posted by Christine Hunter PA-C, MPAS | September 24, 2013, 2:49 pm
    • I had only one, a year and a half earlier. I still have nerve pains , although much less. It will lessen, but not quickly. It was also all over my torso.

      Posted by Shawn | January 4, 2015, 8:47 pm
  17. First of all thank you everyone for the information so far. since Nov. 2012 i had thought my asthma was acting up after about 15 yrs of being “docile?” then it just kicked in again. so after a cpl trips to the ER and the usual prednisone rx and albuterol inhaler regiment, thinking the whole time it was just asthma acting up,.. i was taken from one hospital to a more capable one. since i cant have the IVP Dye i was taken to the bigger hospital to the nuclear medicine dept. so they could do more intense chest xrays . which they did gave me the usual Rx and sent me home with no explaination about the chest xrays or cat scan. I went to my PcP yesterday( i have molina so it took a cpl weeks to get one) he looked up my records from the hosp. that did my nuclear medicine mri. My doc ask me if i knew what a Emphysematous Blep is… i told him no, he stated that when i had the the chest xray at the bigger hosptial that the Emphysematous Blep was obvious. i told my Dr that it was never mentioned that i was just sent home. My question is to all of you is, can the Emphysematous Blep do more damage in the two months prior to me being told on 10/7/2013. im just learning about all of this

    Posted by Dru | October 8, 2013, 3:14 pm
    • Emphysematous blebs are a chronic disease process that occurs over time, so these blebs have probably been forming in your lungs for some time. So, most likely, the preceding two months before your formal diagnosis haven’t changed your treatment/ prognosis/ outcome.

      Posted by CartagenaSurgery | October 9, 2013, 4:03 pm
      • tyvm for your response. i have some more testing to do in the next couple weeks to see how advanced this is. and have to get tested for alpha-1 antitrypsin also. if i test positive my 3 yr old daughter will have to get tested also. again, Thank you for your response

        Posted by Dru | October 9, 2013, 9:07 pm
      • Dru –

        Best of luck to you and your daughter.

        Posted by CartagenaSurgery | October 10, 2013, 2:19 am
  18. thank you

    Posted by Dru | October 10, 2013, 1:26 pm
    • Here are my PFT results from 10/14/2013: spirometry shows an fvc of 3.41 liters (71% predicted ) FEV1 of 1.36 liters ( 36%) predicted. And an FEV1/FEV ratio of 40%. There is a significant bronchodilator response. Lung volumes show a total lung capacity of 7.74 liters (122% predicted ) with a residual volume of 4.17 liters 205% predicted. The DLCO is 22.7% (96%) predicted. Not so good

      Posted by Dru | October 25, 2013, 9:45 pm
      • Dru –

        Have you discussed the results with your pulmonologist? (If you don’t have one – you really should, at this point.) Do you understand all of the results and what it means? (Please don’t be offended by the question – we are not always the world’s best communicators). Has s/he explained the treatment plan to you fully?

        Posted by CartagenaSurgery | October 27, 2013, 7:58 pm
  19. I was the classic young slim tall male pneumothorax patient back in my late 20’s. Mine, I have been told was interesting because it was spontaneous and bilateral. I had the old style cut open the sternum surgery much like having open heart surgery. As a matter of fact the open heart patient next to me went home faster than I did. Now 30 years later I have developed a serious emphysemic condition with several large blebs in both lungs. When I applied for surgery at UW medical center for another surgery, they declined to do it, saying because of the old surgery I was possibly too scarred to benefit from another resection. Is this for real ? They are talking like my only option is to wait till I get bad enough for a lung transplant and then hope a suitable donor shows up when I need them….. Man I really don’t want to let it go that long and that far before something gets done. Are there any options ?

    Posted by Terry Mingus | October 24, 2013, 4:23 am
    • Mr. Mingus –

      Have you had a second opinion? Without reviewing your entire medical history/ films with a surgeon, it is impossible for me to say with any certainty what your current options are. Are you under the care of a pulmonologist for your emphysema? (If not, consider it – along with a pulmonary rehabilitation program to maximize your lung function, improve symptoms (like breathlessness) and improve your quality of life). Also, this step (pulmonary rehab) is very helpful for surgeons in determining whether surgery would benefit you. If you need help in finding another qualified thoracic surgeon – I am happy to help you locate a board certified surgeon near you.

      Posted by CartagenaSurgery | October 27, 2013, 7:54 pm
  20. My son is 17… He had three fairly minor pneumothorax over the course of 15 months… He plays basketball seriously. Had surgery 6 months ago (pleural scarification).. They couldn’t find bleb but stapled off most likely area and he has been back to full action for three months of intense physical activity.
    Yesterday he developed another one… Very Minor… Doc told us if it happens again it likely something he will have to live with… Is it really ok for him to heal for a week or so, resume full activity and have another a few weeks later? Again these are minor never keeping him out for more then two weeks then being fine for a couple months at a time. He just got a scholarship and we want to make sure playing is fine.

    Posted by Tim | November 10, 2013, 4:30 pm
    • For the majority of people with this condition, exercise and activity, (even strenuous activity) should not interfere with their daily lives or adversely affect their health. In fact, exercise is actually recommended for rapid healing and prevention of complications after spontaneous pneumothorax.

      Should he continue to experience pnuemothoraces (after this most recent occurrance), he should return to his pulmonologist for evaluation for additional testing (for other health conditions that may be contributing to the development of repeated pneumonthoraces).

      Posted by CartagenaSurgery | November 17, 2013, 10:36 pm
      • Thank you for all the information here! My son, 15 year old, 192 m, plays HS varsity basketball, had also an episode similar to Tim’s son end of Nov last year. CT Scan did not reveal any blebs and his diagnosis was spontaneous pneumothorax. He continued to play in a tournament middle of Jan this year and all went well. After a week, he had a mild episode again (<10%) and this time, his X-ray showed a 'healing' rib fracture — which added a new element — we are still at the stage of trying to re-investigate his initial episode. My question is similar or Tim's: Is it possible for intensively active athletes (he is also aiming to play college ball) to continue their sports-centric life with this condition?

        Posted by Bee Duran | February 1, 2014, 4:32 am
      • Ok so my son had 3 episodes that… First two sidelined him for 3 weeks each and the 3rd for one week. He never felt like he couldn’t breathe so the lung was collapsed minorly but it hurt like a bitch. We discussed possible surgery with a thoracic surgeon. He said no need to do anything but since My boy was an athlete it may make sense and left it to us. My son decided he needed surgery for peace of mind.
        Now just because no bleb is seen in the ct scan doesn’t mean there isn’t one there. They put chest tubes and a camera in his chest during surgery. They couldn’t find a bleb so they stapled off the area where 90% of them occur and said there was a 95% chance of no further episodes. Also they performed pleural scarification which in essence adheres the lung to the chest wall so if there is a pneumothorax the lung does drop or collapse (or does so only minorly) and thus future episodes are VERY minor and recovery times are typically 5-7 days. Doc said even if a future event happens there is nothing else they can do and go live your life. If it happens again you heal and get back to activity ASAP.
        Well, 6 months after surgery there was another episode. There was really no pain but my son could feel it had happened again. He knew for 2 days and still played basketball making it worse but only marginally. Crushed and defeated he came home and told us about it. Though it was disappointing that the problem was still around I was able to bolster his spirits because the scarification really worked. The episode was ultra minor and he was playing again 8 days after it occurred (this inculed the 2 days he played). Down time should have been 5 days but playing for two probably made it longer.
        There has not been another episode in the 4 months following. Senior year of high school basketball is done because of a broken wrist while dunking, but the college deal is signed and we disclosed this to the coach.
        The short answer is if properly handled and treated there is no reason a young athletic career needs to end over this. If surgery is performed it is a tough road. Chest tubes are invasive but the young recover remarkably fast.

        Hope this helps. I wasn’t going to post anything except seeing the recent posts made me think how much I would liked to have read something like this.

        Regards, and see ya on the hardwood….


        Posted by Tim | February 2, 2014, 9:05 pm
      • Thanks Tim for sharing your family’s experiences!

        Posted by CartagenaSurgery | February 2, 2014, 11:22 pm
  21. My 17-y.o. son just had a blebectomy and pleurodesis procedure done 5 days ago. This was his second pneumothorax in 7 months with no prior history of them (he is tall and skinny and does have very slight asthma). This was his first time for a chest tube. When the chest tube was removed after 3 days and they were ready to discharge him, the same lung collapsed again, so they put another chest tube in. After a water seal, they will clamp it for 24 hours (the last time it was only for 8 hours before they removed the tube). If the lung collapses again, they are considering sealing the lung with talc but they’d prefer not to do that because they say he’s too young for that procedure. Questions: what is it about the talc treatment that makes it questionable for an adolescent, and are there other safer options?

    Posted by Shonna | January 23, 2014, 7:22 pm
    • Since it’s only been five days since the initial surgery – your son mainly needs time to heal. The pleurodesis procedure (that he had in the operating room) takes time to be effective – as the pleural surface heals, it forms adhesions that hold the lung firm to the chest wall.

      Talc is safe for most patients regardless of age, and is just one of several different chemical agents that can be used for chemical pleurodesis. (Talc is the most popular but other options include chemicals like betadine). Their hesitancy may be related to subjecting him to multiple procedures, as well as the discomfort related to talc pleurodesis – which is usually tempered by, but not eliminated by the addition of lidocaine to the solution.
      There has been concern in the past related to the inspiration/ inhalation of talc but the literature does not cite this as a risk with talc pleurodesis where the talc is instilled directly into the chest cavity.

      Since he has a chest tube currently in place – his best option may just be more time. Continue pulmonary toileting (frequent incentive spirometry, coughing, deep breathing, respiratory treatments) and ambulation (as allowed) and talk to his surgeon. I hope that this information helps.

      Posted by CartagenaSurgery | January 23, 2014, 10:21 pm
    • Shonna! I have had a long history of asthma and as I grew into young adulthood, it was discovered I had bullous emphysema. This has a genetic component as I was not a smoker. I had this same type (talc) pleurodesis done at about the same age (19) as the result of a lung collapse. The surgeons said this would help prevent further collapses. When I was about 48, the lung collapsed again! I had a partial resection of the same lung and some of the larger bullae and blebs were removed. I am now 64 years old with the same lung compromised again with new bullae. As I remain, and wish to remain, a fairly active individual with this severe emphysema, I am going to Duke Hospital to see if there are any current therapies on the horizon that might restore some of that right lung.

      The problem with further surgical procedures is the scar tissue in that right lung. Evidently the pleurodesis helps prevent other collapses, but it also causes problems with future surgeries on that lung. The second surgery added scar tissue as well, but the pleurodesis evidently creates scarring all along the pleura.

      As someone who has lived with this disease for decades, I wish your son well and hope he returns to good health very soon. Let me tell you that the most important thing for him to do is to get plenty of aerobic and other active exercise. The only reason I survived my second operation is that I was a very active person despite my asthma and emphysema. Although I have less than 40% lung capacity, I am not on oxygen and still lead a normal life with dancing, yoga and exercise in the gym.

      Posted by jay s. gertz | January 24, 2014, 3:51 pm
      • Dear Jay,

        Thank you for your information and advice above.
        I have a similar story. You may be able to shed some light on some questions I have.
        Recently, I had surgery some weeks ago for a pneumothorax on my right side.
        Surgeon said I have bullae emphysema.
        I am 44 year of age, never smoked and live an active lifestyle with a healthy diet.
        What may have caused this illness to come about?
        I am concerned for my future and need some guidance as to how to move forward?
        Is there a way to stop this disease from progressing?

        Your story is an inspiration and I hope to be as impressive in later years.



        Posted by Yolanda | September 18, 2014, 6:49 am
      • Thank you for your comments Jay.I too have had asthma since a child,then emphsema,COPD,and have just found out that I have a Giant Bulla on my left lung.Fortunately I have always exercised,and have done 2x5k runs and 1×10 k run for chariteis in the last 4 years.That’s why it came as a hell of a shock to be told what I have.Have spent the last 8 months going to the GP telling them that I didnt feel ill,just couldn’t breathe and it was painful.6X COURSE OF STEROIDS ANTIBIOTICS later and prob a hyperchondriac stamp on my head,I was diagnosed by a Consultant friend !!!!! Please people,don’t give up,keep going again and again to your surgery when you know there is something wrong…..after all we pay for it!!

        Posted by Maggie Litherland | June 11, 2014, 3:15 pm
      • Yolanda, I am not an expert on lung diseases, but I do not believe there is any “cure” for emphysema, bullous or otherwise. There are a number of medications that help slow the progressive nature of this disease, such as Spiriva and Advair and others. There are surgical procedures that can remove the bullae. Once the bullae are removed, the lung often re-expands and restores some of the lung volume. But these operations have their risks and are complicated. There are currently some procedures that are less invasive then the resection surgeons used to do, but I believe the type of operation depends on the individual, the seriousness of their condition, location of bullae, previous operations…etc. etc.

        My personal suggestion is to do lots of research online with quality electronic resources, such as Medline and websites sponsored by various lung associations. Find GOOD pulmonary specialists…if you live in a big city perhaps at a university medical center that does research on pulmonary diseases.

        Most importantly STAY ACTIVE! Even if it is hard to breath, do some sort of aerobic exercise: walk, run, dance, stationery bike, yoga is great (not only physically, but mentally and spirituality).

        Take care, all my best, jay

        Posted by Jay S. Gertz | October 6, 2014, 11:18 pm
  22. I have recently diagnosed with a Giant Bulla in the left lung.Have been dyspnoeic and in some pain for the last 8 months or so before diagnosis.Do I carry on as normal with my usual activities,or should I be doing anything different to help minimise the symptoms?

    Posted by Maggie Litherland | June 9, 2014, 7:17 am
  23. I am a 42 year old woman and otherwise healthy. I have recently had a spontaneous pneumathorax and was submitted to hospital. At first they inserted a small chest tube, but after three days, this had not changed my condition. A larger chest tube was inserted and this was a much more painful procedure. The lung expanded almost immediately, though the tube was kept for another 5 days. A CT scan shows I have a bulla of 2 cm, Because the doctor reckons the chances of a relapse are slim, surgery has not been an option. I sometimes get twinges in my chest and back although they disappear again. My question is, is this normal and when will the twinges stop occurring? Also, I was told not to do any physical activity or fly for 2 months what sort of exercise can I begin with to get back into shape, without the risk go reoccurrence?

    Posted by Linn Groth | July 28, 2014, 5:35 pm
    • Linn, I know it’s easy for me to say and less easy for you to do, but try not to worry about the twinges. My husband still gets occasional twinges and certainly knows when he has overdone it. His spontaneous pneumothorax was 18 months ago now and his twinges are getting less frequent. My father also had occasional discomfort for a couple of years afterwards. As for flying, due to the pressure I would tell you to follow medical advice. We first flew 8 months afterwards and my husband felt tightening in his chest on the outward journey, but was fine returning and has been fine since. Having said all this, don’t be afraid to go back if you feel anything different or are simply worried. Trust your instincts as no-one knows your body better than you do. Good luck. Tracy x

      Posted by Tracy Lister | July 28, 2014, 7:21 pm
      • Thanks so much, Tracy! Hearing from others that have experienced similar symptoms really means so much, as people naturally enough know very little about spontaneous pneumothorax and the trauma of going trough treatment and recovery. Best wishes to you and your husband. Linn x

        Posted by Linn Groth | July 28, 2014, 8:18 pm
    • I’ll let some of our loyal readers answer some of your questions.. As to flying: http://latinamericansurgery.com/2014/05/27/is-it-safe-to-fly-after-surgery/

      Posted by CartagenaSurgery | July 28, 2014, 6:14 pm
      • Thank you so much for your quick response! I am happy to read the article regarding the new research indicating that it is safe to fly. I am sure this is comforting news to many, as the advice as to how long one should wait is very inconsistent. I have been told from 2 weeks to 2 months by different doctors. will be looking forward to hearing from others regarding pain and twinges every now and then. Also any advice concerning exercise would be great. This is a great site, thanks again!

        Posted by Linn Groth | July 28, 2014, 8:13 pm
  24. My son had 2 pneumothoraces, 2 weeks apart, followed by pleurodesis, one year ago. He still gets pain, almost daily, of varying degrees, sometimes severe, and I wonder if this is normal?

    Posted by Jennifer | August 6, 2014, 2:40 am
    • No not normal. He likely has pneumothorax that hasn’t healed if it is the same pain. My son had a few then had pleural scarification which adheres the lung to the chest wall thus either eliminating or significantly reducing the severity of future pneumothorax.
      He had it done a year ago, had one minor event that caused four days of down time. He has been ultra active during the year and will play basketball in college.
      It was tough deciding to go through with it but worth it.

      Posted by Tim | August 13, 2014, 1:33 pm
  25. My 16 year old daughter has been having chest pain since she was 9. They told us she has asthma and put her on inhalers. As the years went by, the inhalers would stop working and they would increase the dose. This past year has been the worst. We went on a quest to find out what is causing her chest pain. She has seen a cardio-thoracic surgeon, Rheumatologist, Neurologist, Pulmologist, even Chiropractic and massage therapist. After extensive testing they told us she has blebs her upper right lung and a 9cm channel of air trapped under her sternum.. Treatment: continue asthma inhalers (even though they no longer think she has asthma) steroid pack, muscle relaxers, narcotics for pain, and time. Three months later and she continues to be in pain, taking pills everyday, not able to make it up a flight of stairs, not able to play her clarinet in band anymore, do karate, and was even back in the emergency room for another guess of “ruptured bleb”I have been calling and researching hospitals all over the country but keep getting dead ends. Does anyone have some advise or does this sound familiar to anyone? I can’t settle for her to live this way the rest of her life. There has to be a cause and treatment?!

    Posted by Lauren Velez | October 29, 2014, 4:23 pm
    • The air trapped in the lung is probably due to a bleb that has burst and caused a pneumothorax. She has to get an operation if it does not heal. Some will heal, some will not. Are you smoking around her? Secondhand smoke gave me a bleb, which burst and collapsed my lung. In case of smoking caused blebs, it will not heal self. I cannot be sure in your case what is going on, I just want to try and help.

      Posted by Shawn | January 4, 2015, 9:01 pm
  26. What are the chances that pulmonary blebs or nodules would rupture due to pressure changes? I have recently been considered for hyperbaric oxygen therapy, and I understand that the chamber decompresses gradually. How common is this?

    Posted by Drew | November 13, 2014, 7:30 pm
    • Drew,

      Have you had spontaneous pneumothorax in the past? How many times? Each episode increases the risk of future episodes..

      There is some amount of research on blebs and diving which suggests that the pressure will / may cause significant barotrauma.



      There is also limited research suggesting that patients with blebs are at increased risk of cerebral embolism (stroke) due to blebs during hyperbaric treatment.


      So, if you have been diagnosed with blebs or have a history of pneumothorax – the potential risks may outweigh the benefits of treatment. Unfortunately, there is not enough published literature to be able to delineate or determine the extent of the risk (or how often this occurs).

      I recommend speaking with your pulmonologist, who is more familiar with your past medical history.

      Posted by CartagenaSurgery | November 14, 2014, 2:15 pm
      • thanks for posting this information. I am 28 and in Oct 2012 I was in a car accident and I was thrown backwards and the middle of my back hit a metal tool box. I didn’t go to the hospital because I could breath fine at the time and didn’t have insurance. Fast forward to now and I have had four chest tubes over the course of 2013 to 2014 and last August a VAT to remove a proton that had bulbous formation . I kept going to walk in clinics because I finally got medicaid, but was not treated very well and brushed off constantly and told it was just asthma. I have developed shortness of breath again and get winded walking.

        Posted by Krystian | March 30, 2015, 3:41 am
      • Sorry to hear that you are feeling badly, and upset to hear that you were treated poorly! Anyone with your history (of thoracic surgery) and symptoms of breathlessness should see a specialist. Urgent care centers and walk in clinics are great for cuts, and colds but not specialty care. Now that you have medicaid, it may make it easier – unfortunately our healthcare payor system is a mess- but maybe one of our other readers can give advice about insurance issues. Please see a pulmonologist or respiratory specialist ASAP, and make sure providers know your surgical history.

        Posted by Thoracic Surgery | March 30, 2015, 3:00 pm
  27. I am a 35 year old woman, I do not smoke. I had my first partial collapse in 2008, and continued to have them every ~4 months until I had surgery in summer 2009 where they removed the top part of my lung to “cut away the blebs”. Everything has been fine since, for 5.5 years, Until 2 days ago. It happened again, a small collapse of about 4-5 cm. (I am guessing, I did not see a doctor, as I fear they want to put a chest-tube in me, when I know it will sort itself out again after a few days, it always does, I do NOT like chest tubes). My doctor has never mentioned or (as far as I know) ever investigated any underlying causes of theese blebs, they have all just said they dont know why they are there. I notice I am not at all in the statistics of who gets this, other than being tall and thin, I am female and I do not smoke. I exercize little though. My question however is, does the blebs re-appear ? was the cutting out of my lung only a temporary thing and now I have developed/ will continue to develop blebs on my “new” top part of the lung ?!?

    Posted by Veronica | January 4, 2015, 10:34 am
  28. I had a spontaneous pneumothorax nearly 10years ago I was 35, I have noticed pain on and off ever since. Just wondered if it will collapse again. My travel insurance has double due to it. I am female small athletic build.

    Posted by Gabby | January 28, 2015, 11:09 pm
    • Try a different insurer. I have travel insurance free with my bank account, but they insisted that until 6 months had lapsed since my husbands operation the risk was increased which resulted in an additional premium. I went through an online insurer who specialise in medical conditions and they did not consider him at risk to fly etc once 3 months had lapsed after his bullectomy.

      Posted by Tracy Lister | February 2, 2015, 7:58 pm
  29. Hello, I had secondary spontaneous pneumothorax SSP 15 days ago. doctor inserted chest tube 15 days ago but air leakage still here. i m patient of brochieactesis .. i have poor functional lungs.. doctors refuse for VATS . doctor said wait and it will be recover naturally.

    Posted by SHAZAD | February 7, 2015, 2:05 pm
  30. Hello I Am A 55 yr old tall slim male ex smoker started @ 20yrs old quit @ 40yrs old I had collapsed on 1/5/15 got a small pigtail tube put on wall suction for 4 days then on water seal for 2 days still leaking ah little air doc sends me home with one way valve for 1 week still small leak doc says I need surgery, Injection of Anesthetic Into Peripheral Nerve for Analgesia, Plication of Emphysematous Bleb, Scarification of Pleura, with larger straight chest tube. After this my air leak was a big on , on wall suction I had a lot of bubbles, in hosp for 16 day bubbles got to the point they were originally sent home with one way valve again for one week went to xray then to dr office he removed the tube and the next morning xray shows its coming back down, I get re admitted another pigtail chest tube on wall suction after a few days started to show progress very few bubbles then no bubbles then to water seal , had ah few bubbles when baring down, then I go CLAMPED for 24 hrs xray show slite drop, go back on suction to water seal to clamped for another 24 hr test xray shows GOOD dr takes tube out 24 hrs next xray shows it came down ah little and made me stay another day xray this AM 2/26/15,, the thing is I feel good small pain from having tubes for 50 days hurts when I cough hard but not short of breath. so now I got a new special doc that’s pushing a 3rd more invasive surgery But im not ready to abandon this yet am I out of line?, if I don’t is this AMA? will see what todays xray shows.

    Posted by Jeff Anderson | February 26, 2015, 7:06 am
    • Mr. Anderson,

      You are not out-of-line by any means. It’s your body, and you are asking very reasonable questions. I am confused on one point – did you have the first (suggested) surgery and then develop a prolonged airleak – or have you had it since the first pnuemothorax? I couldn’t quite tell from your comment.. (My answer pertains only if you didn’t have the surgery)

      Have you reviewed your films with the doctors? Have you reviewed the CT scan? (I would be very interested to see the CT scan – because it may give you a lot more answers. A pleurodesis procedure may be your best bet at this point, but that’s a decision for you o make – based on your personal feelings (symptoms, etc) as well as risk stratification.
      How severe were your initial symptoms? Were you tolerating it (i.e pain but no breathlessness?) Or were you hypoxic and gasping for air? (If you were hypoxic/ very SOB – I would be way less tolerant to any ideas of not pursuing surgery for reasons mentioned below.)

      (For example, if your CT scan shows a lot of blebs – (which is sounds like it might) surgery is your best bet, particularly because your pneumothorax had such a prolonged air leak. I know that’s not what you really wanted to hear – but the risk of repeated pneumothorax increases based on your underlying lung function.

      If you do decide for surgery – ask about the surgery. Are they planning to do a VATS procedure? Will they perform pleurodesis/ scarification at that time? If the answer is an open thoracotomy – I would definitely seek another surgeon. (Usually thoracotomy is a last resort for a thoracic surgeon for this type of procedure). Who is leading your treatment team? a pulmonologist, a hospitalist or a thoracic surgeon?

      How far do you live from the hospital? Ultimately, (if your CT scan shows minimal blebs) if you aren’t SOB, and you weren’t SOB when you came in – and you live near the doctor – it may be okay to go home – if your pneumothorax is resolved on today’s and tomorrow’s chest x-ray (and just keep the doctors on speed dial) – as long as you know that yes, this will probably re-occur..

      Let me caveat all of the above, by reminding you – I am not your healthcare provider (and don’t have access to your films) but that this information should be used to encourage discussion with your physicians. I hope this helps.

      Posted by CartagenaSurgery | February 26, 2015, 2:51 pm
  31. I am an attorney whose client had a very successful surgical treatment for spontaneous pneumothorax several years ago. She agreed to surgical intervention because of repeated (possibly 20) repeated episodes. My client describes the procedure as a “bleb stapling” procedure. She believes that as a result of the successful surgery her lung capacity was measurably (although not substantially) diminished. Here’s my question, which is related to a very “borderline” DWI arrest: Would the diminished lung capacity caused by the stapling procedure have the result of skewing a “Breathalyzer” result higher? Breathalyzer-type tests do not, of course, directly measure the subject’s blood-alcohol content, but calculate the presumed perdentage of alcohol in one’s blood by measuring the alcohol exhaled in one’s breath. Thank you.

    Posted by Glenn Pincus | March 24, 2015, 5:27 pm
    • Mr. Pincus,

      My honest answer: I don’t know. it certainly seems to be a topic worthy of study – so Pubmed may be your best bet. We know that other medical procedures (such as gastric bypass) do play a role in the metabolism of alcohol so its not an unreasonable assumption. What about a follow up serum study? I am (obviously) not a legal consultant – but serum studies would provide a more definitive answer, so maybe you can steer the case that way. (especially since she had a borderline result). However, since we are on the topic of your client – I would recommend pulmonary rehabilitation to decrease the sensations of breathlessness, to improve her pulmonary capacity, and overall quality of life. (I know that’s not your primary concern – but the stapling should have improved, not worsened her symptoms so she may have a lot of underlying disease).

      Posted by Thoracic Surgery | March 30, 2015, 3:13 pm
  32. Hello,

    Thank you so much for putting this blog together and keeping it going I would be lost without this. My younger brother fits the bill physically he has always been able to eat whatever he wants and stay skinny he is about an inch taller than me but he looks like a real tall lanky guy. 6’1 – I guess that’s above the average right.

    So we first found out about pnuemothorax back in mid 2000’s when he complained of chest pains and collapsed at work one day he was 18 I think. After taking him in to the local hospital they found multiple small bleps and did surgery that week. 3 years later he had moved away from the area and was living in another state and the same thing happened he collapsed at work, it was the same thing bleps and surgery was preformed. Both times he had the reduction surgery and they removed the bleps and part of his lungs.

    Fast forward to today about 3 weeks ago he started to cough up surgical staples. He is now living back home with his family he just had a son and is getting married next year. The same surgeon who preformed his surgery the first time said he has no idea where the staples are coming from that they never used staples in his surgery according to their records there was never a staple used in any of his surgeries. Obviously this is wrong and they found out after a couple of days that they did use staples in the surgery and that he has bleps, blood, and an infection in his lungs. I immediately told him to seek a second opinion but when he did the surgeon said that he didn’t think that the hospital he was going to get the 2nd opinion from would be the right thing. He has surgery scheduled for tomorrow to remove the infection and bleps (his 3rd lung reduction surgery in the last 6 years). I am very concerned, he has much going on and the last couple of years have not been easy for him he used to smoke cannabis daily and smoked cigs until he had his first collapse according to him he does neither of them now and has not for quite awhile.

    He is looking to me for advice and help since I am the big brother. I honestly want to tell him he needs to find a new pulmonary doctor and get that second opinion but obviously I am not a doctor and I want to trust that this doctor knows what he is doing. I guess I am looking for any advice. I am afraid this is a chronic disease and one day he might need a lung transplant – with him being 26 years old and having a newborn son should we just go for that now instead of him waiting another 6 years or longer for this to just come back? This would be a preventive move and I don’t even think it would be allowed or an option. I don’t know I am just looking for any feedback you might have.

    Posted by Nicholas | March 26, 2015, 3:27 pm
    • I wish I could have responded sooner but I was travelling. I hope that your brother is doing better. With his complicated history, I think it is very reasonable (and wise!) to seek another opinion. Are you near a major medical center? It would be a good idea to find a high volume thoracic surgery center and seek consultation with both a pulmonologist and thoracic surgeon. They can review his history, do some additional testing (which sounds warranted at this point) and lay out a long-term treatment plan which will address both his current symptoms and future healthcare needs. Without knowing his history, I can not say whether he will eventually need transplantation, but this is a concern that should be addressed sooner rather than later. You sound like a wonderful, caring and supportive brother, which is something he needs right now. Best of luck to you both.

      Posted by Thoracic Surgery | March 30, 2015, 3:06 pm
  33. I had a pneumothorax in 1994. I also had a chemical pleurodesis. my long kept collapsing and I really didn’t know why. I’m now 43 years old I eventually had VATS surgery and haven’t had any problems since. I was out of town when I head my surgery and the hospital who performed my surgery lost my medical records. I have staples in the apex of my left lung. my doctor wants me to have an MRI for my back I have a back problem now and I’m not sure if it’s ok to have an MRI with staples in the lung. I really need some advice.

    Posted by Toni | May 20, 2015, 8:40 pm
    • Surgical staples should be fine, especially since it’s been 10 -20 years. The staples are quite tiny, and in the intervening time, tissue has formed over the staples, decreasing the potential magnetic properties. But if you need additional assurance, call a diagnostic center – they usually have a fairly in-depth questions for patients prior to undergoing MRI as well as a detailed list of safe implants (versus devices that are incompatible with MRI). Hope this info helps – and hope you get some relief with your back..

      Posted by Thoracic Surgery | May 22, 2015, 9:43 pm
  34. Hi, I just received a CT scan back with a result of large bullae in my right lower lung and a note to investigate whether I have Alpha-1. Are bullae of concern? I do get shortness of breath when walking up a lot of stairs and have pain often in my right upper to mid back. Is this something I should investigate further?

    Posted by Genevieve | June 23, 2015, 6:42 am
  35. Thank you for your reply. Would you be able to explain why my General Practice Doctor would tell me that it is nothing to worry about, and then when I pushed him, he said “there’s nothing you can do about Bullae anyway, so what’s the point!”. I even had to push him to do the Alpha-1 test, even though it’s a simple blood test. It’s a little upsetting!! Thanks

    Posted by Genevieve | June 25, 2015, 6:01 am
    • It the absence of major symptomology, (like as a declining functional status due to major impairments such as increasing shortness of breath, increasing dyspnea on exertion, or dyspnea at rest (or that arises you from sleep) your doctor may not see the utility of further evaluating an incidental finding on a CT scan. But from a patient perspective, I would want to establish baseline pulmonary function tests – and to at least speak with a pulmonologist. The lung doctor could then determine, when and if you need additional surveillence. It would also be helpful in case you do develop symptoms in the future. Bullae can and do develop problems in some people, and (if they do cause problems) they can be treated (in some cases) with surgery. Without knowing more about your scan – it is hard to predict (and that in my opinion) warrants an appointment with a specialist in this area .

      Posted by Thoracic Surgery | June 25, 2015, 11:31 pm
  36. my husband had a collapsed lung many years ago and a few times since so he got a Pleurodesis surgery but now his blebs keep popping once in a while, and usually heal on their own, if he goes to the hospital for it, is there anything they will do?

    Posted by Judy Smith | September 19, 2015, 2:10 am
    • Ms. Smith,
      Does your husband get symptomatic when this happens? Any chest pain, shortness of breath or difficulty breathing? Does he have a regular pulmonologist that knows his history? S/he would be better able to advise you with a greater degree of certainty.
      Without knowing much more about him or the severity of his blebs, it’s hard to say. (If he were to become very short of breath after bleb rupture, he might need oxygen therapy, or even another chest tube placement). While a large pneumothorax is uncommon after pleurodesis, it can sometimes happen.

      As long as he remains asymptomatic, it is probably safe to stay at home (and continue return follow up with your pulmonologist.)

      Posted by Kristin Eckland | September 19, 2015, 6:46 pm
  37. Just came upon a massive mold growth in my workplace. The room is roughly 14×20. The brown splotches covering the commercial stick on tiles was confirmed as mold. It is coming from underneath the tiles. There is also mold spots on the wall that they keep bleaching but the mold comes back a few weeks later. The room had flooded several years ago and they cut out the walls but did not replace the floor. I am a 32 year old male, 145lbs 5’11”, and have had 5 or 6 spontaneous pneumothoraxes ALL after the flood several years ago.

    Any chance there is a connection? I have been unable to find anything with mold and pneumothoraxes through extensive searching.

    Posted by Daniel | October 3, 2015, 2:46 pm
    • Daniel,
      there is no literature to support a connection to mold and spontaneous pneumothorax but there is well-known and documented connections between specific fungi (like apergillous and other agriculture-related organisms) and lung disease. There have been reports of isolated cavitary lesion ruptures causing pneumothoraces in patients with fungal infections. However, this should have been picked up on a standard chest x-ray (and may take many many years to develop). However, not all household molds are toxic ones. With a history of multiple pneumothoraces, you should have undergone a complete physical and diagnostic evaluation including CT scan and a clinical history. Talk to your pulmonologist and mention this possible exposure history. He can decide (since he knows the results of your scans, and other information) whether this warrants closer inspection. Hope this information helps.

      Posted by Kristin Eckland | October 3, 2015, 5:31 pm
  38. My son is 15 and had two spontaneous pneumothoraces on this right lung about a year ago. The first was dealt with simply via a pigtail and aspiration. The second one led to a blebectomy and abrasive pleurodesis. He is the classic case: adolescent, grew quickly over the past 2 years, thin chest cavity and involved in many cardio sports (cross country, lacrosse and soccer). These two incidents were preceded by 30 – 120 minutes of pain in the chest and he knows what to look out for in this regard.

    Recently, following heavy work outs of cross country, he has felt a very similar pain, also on the right side, but for a much shorter period of time – more like 30 – 120 seconds. He has also experienced nausea.

    I have performed the crude “99 test” to confirm that the lung is expanding and believe that it is.

    – Have others had experienced this and what they have found out
    – Could this be another bleb rupture and the nausea is caused by the body’s reaction?
    – Should I be concerned?
    – At what point do I need to have him examined?

    Thank you for any of your experiences or advice.


    Posted by cHRIS | October 13, 2015, 1:02 am
    • I would advise him to seek immediate medical attention:
      – If at any point he becomes short of breath, has difficulty breathing or the pain does not resolve quickly/ persists.
      – If he has any symptoms that mimic the first two episodes.

      – For some people, nausea occurs along with pain. This is more common in cardiac syndromes but can happen with several different pain triggers particularly thoracic/ abdominal pain.

      Posted by Kristin Eckland | October 14, 2015, 12:55 am
  39. My son has a history of asthma, bronchitis and pneumonia from birth until he was about 5. He had his first pneumothorax on the left side May 2013 when he was 15. They decided to just take xrays and watch to see if it would inflate. After 2 weeks he was cleared to return to baseball and normal activities. He felt like he had another collapse during the summer but the ER doctor said they couldn’t see anything. He had his second one on the left side Oct 2013. The surgeon performed VATS/chemical/mechanical pluerodesis. When they removed the chest tube his lung had a small collapse. He was on bed rest for a week after returning home. He continued to have pain and would feel like blisters were rubbing and popping. Every time I took him in they couldn’t find anything. Then he started having pain in his right lung and again they couldn’t find anything. His right lung collapsed in Nov 2014. He was admitted with a chest tube to reinflate the lung. When they removed the tube his lung collapsed again. So he had the same surgery on his right lung. It has now been 2 years since surgery on the left lung and almost a year for the right lung. He continues to suffer with pain. Sometimes it is excruciating, and sometimes he says it is just aggravating. We have been back to the ER and they say he has had another blister pop. He just recently had a CT scan and it shows that he still has blebs. He had a pulmonary function test done that shows he has 73% lung volume. He has exercise induced asthma and is getting bronchitis more often. Sometimes coughing up blood with the bronchitis. The doctors can’t figure out why he is in so much pain. The biopsy from his right lung showed bleb with associated scar and chronic inflammation reactive pleural surface mesothelial changes. What does this mean? He is just so frustrated now with all the doctor appointments and they can’t seem to do anything to give him any relief. Could he have an underlying disease that has caused this?

    Posted by Kim Smith | October 15, 2015, 5:46 pm
    • Ms. Smith,

      With his history of asthma, frequent bronchitis and multiple pneumothoraces, I would suspect he has a serious underlying lung disease but his pulmonologist should have sorted that out for you by now. I don’t blame him for being frustrated – but the most important thing is to find him some symptom relief and maintain his functional status. Pulmonary rehab would be a good option – and it’s a therapy session instead of a doctor’s appointment. Neurontin, Lyrica or another medication for neuropathies may help with the pain.

      Chronic inflammation and scarification is part of pleurodesis process, and can be quite painful – but the pain is (usually) not long-lasting.

      Posted by Kristin Eckland | October 17, 2015, 6:33 am
      • Kristin,

        Thanks for the reply. We have only seen a pulmonologist twice. On the first visit he looked at a CT scan from June 2014 and saw some cysts in the lungs and mentioned that Hunter could possibly have PLCH. We recently had another scan done and he didn’t see any changes so he said the chances of him having that are slim. So we haven’t been back and I don’t really know what to do from here. I am having him tested for CF because it runs in my family. When I got a copy of his records to request a CF test I found that on the CT scan from 2014 the ER found that he has bilateral renal cysts. I don’t know if this would have any connection to his lung issues. We were never told so it hasn’t been explored any further. Hunter is skinny but not very tall. He’s 127 and 5’7″ and can’t gain any weight. He has been the same size all four years of high school. Can you give a recommendation on what I should do and or look for.


        Posted by Kim Smith | October 19, 2015, 5:03 pm
      • Dear Ms. Smith, I apologize for the late reply, but I didn’t see your message. I am not sure where to direct you next – without possible sending you down a dead end or wasting you time. Are you near a large academic institution? Your son might benefit from a university setting, where he could be referred to a pulmonology who specializes in either asthmatic disease or more difficult to diagnose cases, or possibly a rheumatologist or geneticist. I am sorry I can not give more concrete advice.

        Posted by Kristin Eckland | October 31, 2015, 3:17 am
  40. I previously have had 3 collapsed lungs on the left hand side and on the third time that it happened i had a Mechanical Pleurodesis where the lung is stuck to the chest wall, This was around 9 years ago and last week my lung had collapsed again on the left hand side after those long 9 years which i found very strange after being fine for all that time. I even did not believe it was my lung at first after being fine for so long and slept on it over night which was probably a bad idea as it was collapsed 25-30% on the x-ray.

    My Cardiothoracic surgeon decided to do a Talc pleurodesis this time after removing some scar tissue from the Mechanical Pleurodesis i had last time hopefully this will keep it together.

    Posted by Peter Nelson (@pj_nelson_) | November 4, 2015, 3:33 am

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