Pneumothorax (lung collapse), pleural effusion & chest tubes

The basics

What is the pleural space?

The pleura is a thin lining over the lung and inside the chest wall. A small amount of fluid normally helps these surfaces slide as you breathe. The pleural space refers to a space between the rib cage and the lung (blue area in the picture). When air or excess fluid collects in this pleural space, the lung may not expand normally. This can lead to shortness of breath or pain.

Enlarge illustration

A chest X-ray, ultrasound, or CT scan helps show what is present. The best next step depends on symptoms, oxygen level, the imaging findings, and your overall health—not the scan alone.

Lung collapse

Pneumothorax: why it happens and how it is treated

A pneumothorax may happen without an injury, after a procedure, or following chest trauma. A primary spontaneous pneumothorax occurs without known underlying lung disease; small air-filled areas on the lung surface, called blebs, may be involved. A secondary spontaneous pneumothorax occurs in someone with lung disease, such as emphysema. It may be harder to tolerate because breathing reserve is already limited.

Symptoms often begin suddenly with one-sided chest pain and shortness of breath. Some people have few symptoms. Rarely, pressure builds enough to affect breathing and circulation—a tension pneumothorax, which requires emergency treatment.

Not every pneumothorax requires an operation

• Observation: selected stable patients with minimal symptoms can be monitored with a clear follow-up and repeat-imaging plan. This decision must be made by the treating team.
• Removing the air: aspiration through a needle or small catheter, or drainage through a chest tube, may allow the lung to expand as the leak heals.
• Surgery: may be recommended for a leak that does not stop, a lung that does not re-expand, repeated episodes, or circumstances in which another collapse would be particularly dangerous.

Oxygen is given when needed for a low oxygen level. Patients with significant underlying lung disease may need a different treatment plan from otherwise healthy patients.

Tell the team if episodes occur around menstrual periods, if relatives have had pneumothorax, or if you have a condition associated with lung cysts. These details may change the evaluation.[1][4]

Fluid around the lung

Pleural effusion: finding and treating the cause

Common causes include heart failure, infection, cancer, and other medical conditions. An effusion does not necessarily mean cancer. Symptoms can include shortness of breath, cough, chest discomfort, or fever; some effusions are found incidentally.

What tests might I need?

Ultrasound helps locate the fluid and guide drainage. During thoracentesis, a clinician removes fluid through a needle or small catheter, usually with local numbing medicine. This may improve breathing and provide a sample for tests for infection, cancer cells, and other clues. CT imaging or a biopsy of the pleura may be needed if the cause remains unclear.

Treatment depends on why the fluid is there

Heart failure or another medical cause

Treating the underlying condition may reduce the fluid. Not every effusion needs a drain or surgery.

Infection or empyema

Antibiotics and drainage may be needed. Empyema means infected fluid or pus around the lung. If drainage is incomplete, medicines through the tube or surgery may be considered.

Fluid that keeps returning

An indwelling pleural catheter allows repeated drainage at home after training. Another option is pleurodesis, which helps the lung lining adhere to the chest wall to limit further fluid buildup.

If the lung cannot fully expand after drainage, pleurodesis may not work well. An indwelling catheter can be especially useful in this setting. The choice depends on symptoms, the cause of the effusion, lung expansion, and your preferences.[4]

What to expect

Chest tubes and smaller drainage catheters

A chest tube sits between the ribs in the space around the lung—not inside the airway. It drains air, fluid, or blood. Some drains are narrow, flexible catheters, sometimes called pigtails; others are larger tubes. The team chooses the type for the problem being treated. A drain may also be placed during chest surgery.

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Placement and comfort

Placement usually involves numbing medicine; sedation may also be used. A tube placed during surgery is inserted while you are under anesthesia. Imaging may guide positioning. The drain is secured and covered with a dressing, then connected to a collection device or one-way valve. Some systems use suction.

Pressure or soreness can occur. Let the team know if pain prevents deep breathing, coughing, or walking so your pain-control plan can be adjusted. Risks include bleeding, infection, tube blockage or movement, injury to nearby structures, and rarely fluid buildup within the lung as it re-expands.

How long does it stay in?

There is no fixed number of days. The team checks the air leak, the amount and type of drainage, imaging, and how you feel. Removal is usually a brief bedside procedure followed by a dressing; a chest X-ray may be obtained. A longer-term pleural catheter has a different purpose and may remain for weeks or longer.[2][3]

Minimally invasive thoracic surgery

When can robotic surgery help?

Dr. Servais uses robotic minimally invasive surgery to treat pneumothorax and pleural conditions when an operation is appropriate. Through small incisions, he controls the camera and instruments to examine the lung and pleural space and perform the planned treatment. The robot does not operate independently.

Surgery is one part of care. At Lahey Clinic, the plan may involve thoracic surgery, pulmonary medicine, interventional radiology, and other specialists according to the underlying condition.

Repairing an air leak

A bleb or damaged area of lung may be removed with a small wedge resection. Pleurodesis is often added to reduce the chance of another collapse; in selected cases, part of the pleural lining is removed (pleurectomy).

Draining infection

Surgery can clear infected fluid and divide pockets that a tube cannot drain. If a thick layer restricts the lung, removing it—a decortication—may help the lung expand.

Diagnosing or controlling an effusion

A pleural biopsy can help establish the cause. Depending on the findings, pleurodesis or placement of a long-term drainage catheter may also be considered.

Robotic surgery and video-assisted thoracoscopic surgery (VATS) are both minimally invasive approaches. The safest choice depends on your health, the cause of the problem, and findings inside the chest. An open operation is sometimes necessary.

The goals are to address the underlying problem, improve breathing, and—where possible—reduce recurrence. Surgery still carries risks, including bleeding, infection, prolonged air leak, pain, and anesthesia-related complications. Your consultation should cover these risks and nonsurgical alternatives.[4]

After treatment

Recovery, drain care, and warning signs

Follow your own discharge instructions: different drainage systems require different care. Walking, breathing exercises, wound care, and pain control are commonly part of recovery. Ask when you can drive, lift, exercise, and return to work.

• Protect the tube from pulling or kinking. Follow instructions for keeping the dressing clean and dry and positioning the drainage device.
• Do not clamp, disconnect, flush, or change suction settings unless your care team has specifically trained and instructed you to do so.
• If you have a home pleural catheter, drain only as taught, using the prescribed schedule and limits. Do not try to drain extra fluid to speed recovery.
• Know who to contact after hours and when your next examination or chest X-ray is due.

After a pneumothorax

Stopping smoking helps lower the chance of another episode. Do not fly with an unresolved pneumothorax; obtain clearance from your treating clinician before air travel. Scuba diving generally needs to be avoided after a spontaneous pneumothorax unless a specialist determines that strict safety criteria have been met. Ask about these activities even if you feel fully recovered.

New chest pain or shortness of breath after treatment needs prompt assessment because a pneumothorax can recur, including after surgery.[2][3]

Questions to bring to your visit

1. What caused the air or fluid around my lung?
2. Do I need observation, drainage, a biopsy, or surgery—and why?
3. If surgery is recommended, what will you do and can it be robotic?
4. What is my risk of recurrence, and how can we reduce it?
5. Could I go home with a drain? Who will teach me and help with supplies?
6. When can I return to work, exercise, and travel?

Sources and further reading

Patient education based on the references below. Treatment is individualized; this guide does not replace your discharge instructions or an assessment by your care team.

Updated October 4, 2026. General education for adults; your care team will tailor recommendations to your condition.