FAQ’s

When three or more ribs in a row have multiple fractures within each rib, part of the chest wall can separate and move out of sync with the rest. It is an emergency — there may be severe associated lung injury, and immediate treatment is essential.

Flail chest is uncommon after chest trauma, but when it occurs it can severely affect breathing and cause considerable health concerns.

The ideal age for intervention in symptomatic pectus excavatum is from 8 years old through pre-pubescence, typically 12–14 years (adolescents prior to the growth spurt). It is advisable to operate before the age of 20 so that consequential pathologies — such as scoliosis or rib deformities — neither appear nor worsen.

Pectus excavatum (funnel chest) is a congenital defect that causes the chest wall to appear sunken. It often results in lack of confidence and shortness of breath. In most people it presents before the age of one; in some it becomes apparent only at puberty. It is seen about four times more frequently in boys than in girls.

Mild symptoms may improve with physical therapy. For moderate to severe deformity with physical symptoms and significant cosmetic effect, surgery is often recommended. Most patients are candidates for the Nuss procedure, which takes 30–60 minutes. Two to three (sometimes more) ~5 cm incisions are made. A camera is inserted through one of the openings so the surgeon can monitor the field and avoid injury to the heart. Through another incision, one to three steel bars are placed under the sternum to press it into a more normal position. Local anaesthetic is applied to the wounds; they are closed with absorbable sutures and dressed.

A chest tube can drain air, blood, or fluid from the pleural space around the lungs. Insertion — chest tube thoracostomy — is typically an emergency procedure, and may also follow surgery on organs or tissues in the chest cavity.

A hollow plastic tube is placed between the ribs into the pleural space and may be connected to a drainage system. It remains until the air, blood, or fluid has been cleared.

A pneumothorax is a collapsed lung: air leaks into the space between lung and chest wall, pushes on the lung, and causes collapse — often only of a portion. Causes include blunt or penetrating chest injury, certain medical procedures, underlying lung disease, or no obvious reason.

Symptoms usually include sudden chest pain and shortness of breath. Treatment typically involves a flexible tube or needle between the ribs to remove excess air; a small pneumothorax may heal on its own. On some occasions it can be life-threatening.

Emphysema (pulmonary emphysema) involves widespread destruction of the gas-exchanging tissues of the lungs, leaving abnormally large air spaces. Loss of alveolar walls and capillaries reduces the surface available for oxygen and carbon dioxide exchange.

Loss of elastic tissue also lets the lungs expand within the chest, compressing small bronchi and increasing airflow resistance — especially on expiration, when chest and abdominal muscle contraction further raises intrathoracic pressure. Bullectomy removes large bullae that contribute to this impairment.

Mediastinoscopy with biopsy is a minor surgical procedure that gathers samples of lymph nodes — clusters of cells that help the body fight viruses and bacteria. Under general anaesthesia, a lighted mediastinoscope is inserted through an incision at the base of the neck, passed under the sternum into the space between the lungs, and used to inspect the area and take one or more small biopsies. Laboratory assessment commonly looks for cancer or other disease.

Your doctor may order mediastinoscopy with biopsy to:

• See whether lung cancer has spread to the lymph nodes
• Check for other lymphatic cancers, including Hodgkin lymphoma
• Identify infections such as tuberculosis

It is often used to stage how far lung or other cancers have advanced, which helps select the most appropriate treatment.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique used to diagnose and treat problems in the chest. A tiny camera (thoracoscope) and instruments are inserted through small incisions in the chest wall. Images on a video monitor guide the surgeon through the procedure.

A lobectomy can stop or slow the spread of cancer, infections, and other disease. It may also remove a portion of an organ that impairs other structures — for example a benign tumour pressing on blood vessels. Removing the affected lobe addresses that mechanical problem at its source.

Endoscopic thoracic sympathectomy (ETS) is a surgical option for certain forms of hyperhidrosis, in which a portion of the thoracic sympathetic nerve trunk is interrupted under general anaesthesia. It has a high success rate for palmar hyperhidrosis but carries a significant risk of compensatory (“rebound”) sweating on the back or lower limbs weeks to months later — often lasting for life and difficult to treat. A thorough discussion with the treating surgeon is essential before considering ETS.

A chest drain is placed in the pleural space for drainage of:

• Air in pneumothorax
• Blood in haemothorax
• Fluid in pleural effusion, particularly malignant effusion
• Pus in empyema
• Postoperatively after thoracotomy or cardiac surgery

A lobectomy is surgical removal of a lobe of an organ — most often a section of lung, though the term can apply to liver, brain, thyroid, and others. The right lung has three lobes (upper, middle, lower); the left has two (upper, lower).

In most cases surgeons remove a cancerous portion to limit spread. It is the most common operation for lung cancer. Lobectomy may also treat fungal infections, benign tumours, emphysema, lung abscesses, and tuberculosis.