Surgical Management of Pneumothorax and Pleural Space Disease

Pneumothorax and pleural-based disease are ancient maladies with a rich history of management strategies, but the basic tenets of surgical goals and objectives have been consistent for centuries. Pneumothorax presents in both the outpatient and inpatient setting with escalating levels of intervention from simple observation to surgical exploration with 2 surgical goals: pleural symphysis and prevention of recurrence. Empyema, typically seen in the inpatient setting, requires an understanding of the patients' immune status, virulence of the organism, and timeliness of treatment to determine what management tools (tube thoracostomy, fibrinolytics, surgical exploration) are needed to achieve the surgical goals of removal of infected fluid/tissue and reexpansion of the lung.