Collapsed lung (pneumothorax) Information | Mount Sinai

Air around the lung; Air outside the lung; Pneumothorax dropped lung; Spontaneous pneumothorax

A collapsed lung occurs when air escapes from the lung. The air then fills the space outside of the lung between the lung and chest wall. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath.

The medical name of this condition is pneumothorax.

The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.

Pneumothorax occurs when air leaks from inside of the lung to the space between the lung and the chest wall. The lung then collapses. The dark side of the chest (right side of the picture) is filled with air that is outside of the lung tissue.

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

The pleural cavity is the space between the layers of the membrane lining the lung (pleura) and the chest cavity.

The lungs are paired organs that lie in the thoracic cavity. The lungs extract oxygen from inhaled air and transport the oxygen to the blood. Surrounding the lungs is a very thin space called the pleural space. The pleural space is usually extremely thin, and filled with a small amount of fluid.

Causes

Collapsed lung can be caused by an injury to the lung. Injuries can include a gunshot or knife wound to the chest, rib fracture, or certain medical procedures.

In some cases, a collapsed lung is caused by air blisters of the lung (blebs) that break open, sending air into the space around the lung. This can result from air pressure changes such as when scuba diving or traveling to a high altitude.

Tall, thin people and smokers are more at risk for a collapsed lung.

Lung diseases can also increase the chance of getting a collapsed lung. These include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• Tuberculosis
• Whooping cough

In some cases, a collapsed lung occurs without any cause. This is called a spontaneous collapsed lung or spontaneous pneumothorax.

Symptoms

Common symptoms of a collapsed lung include:

• Sharp chest or shoulder pain, made worse by a deep breath or a cough
• Shortness of breath
• Nasal flaring (from shortness of breath)

A larger pneumothorax causes more severe symptoms, including:

• Bluish color of the skin due to lack of oxygen
• Chest tightness
• Lightheadedness and near fainting
• Easy fatigue
• Abnormal breathing patterns or increased effort of breathing
• Rapid heart rate
• Shock and collapse

Exams and Tests

The health care provider will listen to your breathing with a stethoscope. If you have a collapsed lung, there are decreased breath sounds or no breath sounds on the affected side. You may also have low blood pressure.

Tests that may be ordered include:

• Chest x-ray
• Arterial blood gases and other blood tests
• CT scan if other injuries or conditions are suspected
• Electrocardiogram (ECG)

Treatment

A small pneumothorax may go away on its own over time. You may only need oxygen treatment and rest.

The provider may use a needle to allow the air to escape from around the lung so it can expand more fully. You may be allowed to go home if you live near the hospital.

If you have a large pneumothorax, a chest tube will be placed between the ribs into the space around the lungs to help drain the air and allow the lung to re-expand. The chest tube may be left in place for several days and you may need to stay in the hospital. If a small chest tube or flutter valve is used, you may be able to go home. You will need to return to the hospital to have the tube or valve removed.

Some people with a collapsed lung need extra oxygen.

Lung surgery may be needed to treat collapsed lung or to prevent future episodes. The area where the leak occurred may be repaired. Sometimes, a special chemical is placed into the area of the collapsed lung. This chemical causes a scar to form. This procedure is called pleurodesis.

Outlook (Prognosis)

If you have a spontaneous collapsed lung, you are more likely to have another one in the future if you:

• Are tall and thin
• Continue to smoke
• Have had two collapsed lung episodes in the past

How well you do after having a collapsed lung depends on what caused it.

Possible Complications

Complications may include any of the following:

• Another collapsed lung in the future
• Shock, if there are serious injuries or infection, severe inflammation, or fluid in the lung develops

When to Contact a Medical Professional

Contact your provider if you have symptoms of a collapsed lung, especially if you have had one before.

Prevention

There is no known way to prevent a collapsed lung. Following standard procedure can reduce the risk of a pneumothorax when scuba diving. You can decrease your risk by not smoking.

Hallifax R, Rahman NM. Pneumothorax. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 110.

Peak DA. Scuba diving and dysbarism. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 131.

Raja AS. Thoracic trauma. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 37.

Last reviewed on: 1/2/2023

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Collapsed Lung: Care Instructions | Kaiser Permanente

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Overview

A collapsed lung (pneumothorax) is a buildup of air in the space between the lung and the chest wall. The pressure of the air against the lung makes the lung collapse. Your lung cannot fully expand when you inhale. This causes shortness of breath and chest pain.

A collapsed lung is usually caused by an injury to the chest. It may also occur suddenly because of a lung illness, such as emphysema or lung fibrosis. A lung may collapse after lung surgery or another medical procedure. Sometimes it happens for no known reason.

Treatment can depend on the cause and severity of the collapsed lung. Treatment can also depend on whether the problem has returned. Some people stay in the hospital for treatment. In some cases, oxygen may be given (through a mask). It may heal with rest, but your doctor will need to check you. It can take several days for the lung to expand again. Your doctor may have drained the excess air from your chest with a needle or tube. Sometimes surgery is done to help keep the lung inflated.

The doctor will want to keep track of your progress. So you will need a follow-up exam to check your lungs. You may need further treatment if you are not getting better.

A collapsed lung may happen again. Watch for symptoms. If you have shortness of breath or chest pain, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Get plenty of rest and sleep. You may feel weak and tired for a while, but your energy level will improve with time.
• Be safe with medicines. Read and follow all instructions on the label.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you have a bandage over your chest tube, or the place where the chest tube was inserted, keep it clean and dry. Follow your doctor’s instructions on bandage care.
• If you go home with a tube in place, follow the doctor’s directions. Do not adjust the tube in any way. This could break the seal or cause other problems. Keep the tube dry.
• Avoid exercise until your doctor says it’s okay.
• Do not fly in an airplane or scuba dive until your doctor tells you it is okay.
• Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You have severe trouble breathing.
• You have severe chest pain.
• You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

• You have new or worse trouble breathing.
• You have new pain or your pain gets worse.
• You cough up blood.
• Your chest tube comes out or is bent or blocked.
• You are bleeding through the bandage where the tube was put in.
• You have symptoms of infection where the tube was put in, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• The skin around the place where the chest tube was put in is red or irritated.
• You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter Q132 in the search box to learn more about “Collapsed Lung: Care Instructions”.

Mistakes, dangers, complications in the first episode of spontaneous pneumothorax

the first episode of the disease [1-4]. It has been noted that the probability of recurrence of the disease after its first episode in the first 6 months averages 30%, reaching 62% after the second and 83% after the third recurrence of the disease [5–7]. The National Clinical Guidelines for the Treatment of Spontaneous Pneumothorax (2014) [8] formulated a unified doctrine of providing care to this category of patients at various stages, but insufficient attention was paid to the treatment of the first episode of the disease, so surgeons are often guided by personal experience, which gives rise to diagnostic and medical errors and complications.

The study of the most typical mistakes made in general surgical hospitals at various territorial levels will improve the results of treatment, reduce the frequency of complications and reduce the treatment time for this category of patients.

Material and methods

From 2005 to 2015, 317 patients with the first episode of spontaneous pneumothorax (PESP) were treated in the thoracic department of the general surgery clinic of the Volgograd State Medical University. There were 314 men (99%), women — 3 (1%). The age of patients is from 17 to 77 years, and able-bodied persons accounted for 97.3% ( n = 308). The causes of PESP were bullous lung disease — 302 (95.2%) patients, lung cysts — 5 (1.5%), COPD — 2 (0.6%), histiocytosis X — 1 (0.3%), pulmonary endometriosis — 2 (0.3%), the cause was not identified — 5 (1.5%) patients.

To determine the location of pneumothorax and the degree of lung collapse, patients underwent a chest x-ray in two projections. In the first episode of the disease, pneumothorax was more often localized on the right — 76% ( n \u003d 241) observations, the degree of lung collapse in most observations – 114 (36%) reached ½ of the volume.

The epidemiology of SP in the Volgograd region was studied. We are talking about the “Primary hospitalized morbidity (by referral)”, which is a set of new cases of hospitalization for a disease that were not previously recorded anywhere and for the first time this year (meaning PESP). The incidence of S.P. in 2015 it was 7.5 per 100,000 population for men and 1.3 per 100,000 population for women.

All numerical data were processed by the method of variation statistics with the calculation of the relative indicator, the error for the relative indicator and the Student’s coefficient for the relative indicator. The difference in the mean was considered significant at p

Results

Treatment of PESP usually begins in general surgical hospitals, where doctors often do not have sufficient experience in providing care for this disease, which leads to delayed or erroneous diagnosis and treatment tactics.

In order to identify differences in treatment outcomes, all patients were divided into two groups or two periods: before and after the introduction of minimally invasive technologies.

During the first period (2005-2008), 79 patients (25% of the total number of observations – group 1) with PESP were hospitalized in the thoracic department of the clinic. In 90% ( n =71) of patients, the pleural cavity had already been drained in the general surgical hospital, in 8 patients this was done in the thoracic department of the clinic, and the puncture method was used at the place of initial treatment.

Drainage of the pleural cavity according to Bulau led to persistent aerostasis in 4 (5%) patients. The remaining 75 patients retained air discharge through the drainage of the pleural cavity, and they were connected to an active aspiration apparatus with a discharge mode of 20 mm of water. with simultaneous chemical induction of pleurodesis with 4% sodium bicarbonate solution. This wait-and-see policy was followed for 1 week. Stable lung expansion was achieved in 15 patients (4.7% of the total number of observations), in 60 (76%) patients, despite individual selection of the degree of vacuum of active aspiration and repeated pleurodesis of aerostasis, it was not possible to achieve stable elimination of lung collapse, they were operated.

As a method of surgical treatment, thoracotomy and atypical resection of bullous lung areas were used, which were most often localized in S _I , S _II , S _III and S _VI . In 15 (25.9%) patients, pleurodesis with talc (4 g) was additionally performed.

After the operation, 2 (3.3%) patients with severe comorbidities died, recurrence of pneumothorax on the side of the operation was observed in 1 (1.6%) patient. The average preoperative bed-day was 7 days, the postoperative bed-day was 15.6 days.

Despite the good results of “traditional” surgical treatment, there is a clear contradiction between the relatively small amount of intervention on the lung and the traumatic nature of thoracotomy.

In the period from 2009 to 2015 (2nd group of patients), video-assisted thoracoscopic lung resection (VATS resection) and thoracoscopic interventions became the main methods of surgical treatment of PESP. This group of observations included 238 patients, 232 were operated on, in 6 patients persistent aerostasis was achieved by draining the pleural cavity with chemical pleurodesis.

The operation was considered indicated for lung collapse by 1/3 of the volume and ineffective passive drainage of the pleural cavity within 48 hours, with collapse of the lung by ½ volume or total SP – within 24 hours. Thus, the time before surgery did not exceed 48 hours, the average the postoperative period was 6 days. The recurrence rate is 1.6%, the mortality rate is 1.2%. Comparative analysis of the results of treatment of patients with PESP before and after the use of minimally invasive technologies is presented in Table. 1. Table 1. Results of surgical treatment of patients with PESP before and after the use of minimally invasive technologies Note. * — Drainage of the pleural cavity in the 1st group was used 2.67 times more often than in the 2nd (t=3.82; p>99.9%, p99.9%, p

Before talking about errors in the diagnosis and treatment of PESP, a definition of “error” should be given. The Clinical Guidelines for the Treatment of Spontaneous Pneumothorax (2014) [8] refer only to errors in drainage of the pleural cavity.

In our opinion, an action (or inaction) of a physician that conflicts with generally accepted recommendations at all stages and under all conditions of providing medical care to patients with PESP should be considered an error, i.e. the degree of contradiction of actions (or inaction) of the doctor in the section “Tactics of examination and treatment of patients with spontaneous pneumothorax depending on the category of medical institution” in the “Clinical guidelines for the treatment of spontaneous pneumothorax” (2014) [8].

In other words, it is necessary to find out the consequences of an error in the form of dangers for the patient or postoperative complications that are associated with previously made errors.

When analyzing errors in treatment tactics in patients with PESP, several groups of typical technical and organizational violations of the basic principles of modern thoracic surgery were identified in 133 (42%) patients at the prehospital stage and in general surgical hospitals.

Prehospital stage. Among the 317 patients with PESP included in the study, 98 (31%) were residents of Volgograd, 219 (69%) lived in the regions of the Volgograd region. In this group of observations, the patients were most often late in seeking medical help in the presence of trouble from the respiratory system. This fact cannot formally be considered an error in medical tactics, however, in the regional center there were 10.2% of such patients ( n = 10), in rural areas – 19.6% ( n = 43), which amounted to 16, 7% of the total number of observations.

In 46 (14.5%) cases, in the presence of chest pain, patients were referred for X-ray examination of the lungs only 3-4 days after its onset, which is a diagnostic error, since during this time an increase in the volume of pneumothorax and the development of dangerous respiratory and hemodynamic disorders.

Errors in the general surgical hospital. The next group of shortcomings in the provision of medical care to patients with PESP refers to violations of diagnostic and therapeutic tactics in non-specialized surgical hospitals.

The first group of errors is the excessive length of the intrapleural part of the drainage, which leads to kinks in the drainage tube and partial or complete loss of its function.

The second group of errors is passive monitoring of the continued flow of air from the drainage tube (up to 5-7 days). In this case, the lung is in a collapsed state, the formation of pleuropulmonary adhesions, the appearance of effusion in the pleural cavity and the development of a rigid lung occur. In other words, one of the main requirements of the “Clinical guidelines for the treatment of spontaneous pneumothorax” (2014) is not fulfilled, which states that the collapsed lung should be expanded as soon as possible, and if this cannot be achieved, then the patient should be operated on.

The third group of errors is the late transfer of patients with PESP to a specialized hospital with continued air discharge through the drainage of the pleural cavity. First of all, this concerns patients who were treated in the surgical departments of the central district hospitals (CRH), almost 1/3 of them after 10 days or more were hospitalized in the thoracic department, where they were finally able to receive adequate treatment.

The fourth group of errors is the wrong choice of the point for introducing drainage into the pleural cavity. Despite the long-existing detailed description of the technique of this manipulation, it is during its implementation that a rather large number of errors are made, and, according to our data, all of them were made in the surgical departments of the Central District Hospital – 16 (5%) patients.

We consider the drainage of the pleural cavity in the first intercostal space in 7 (2.2%) patients to be a gross technical error, since there is a significant risk of injury to the subclavian vessels and damage to the structures of the upper mediastinum. In 9 (2.8%) cases, drains were inserted in a wide variety of places and could not provide adequate air outflow from the pleural cavity.

The fifth group of errors is the wrong choice of the type of drainage tube: they used either too thin (usually it was a subclavian catheter), or the material from which they were made (tubes from disposable systems for intravenous infusion), at body temperature it became very soft, so the drains easily kinked or stuck together.

The sixth group of errors is the blocking of the drainage with a clamp during the patient’s transportation to the thoracic department of the clinic, which creates conditions for the development of tension pneumothorax and subcutaneous emphysema. This is a fairly common mistake made by general surgery staff and appears to be similar when using abdominal drains.

We have six such observations, and 4 of them belong to large medical institutions in Volgograd. Since some areas are located at a distance of more than 400 km from the regional center, this cannot be ignored. Fortunately, such a mistake was made in 1.9% of the total number of patients included in the study.

In 1 (0.3%) patient, who was treated in one of the surgical departments of Volgograd, a complication occurred in the form of a penetrating lung injury during drainage of the pleural cavity. The drainage passed through the lung parenchyma in such a way that its distal end was in the free pleural cavity and a false impression was created about the normal functioning of the drainage. The patient was operated on, the wounds of the lung were sutured, the altered part of the organ with the bulla was resected, recovery occurred.

We did not observe prolapse of the pleural cavity drainage, cited as an error in the Clinical Guidelines for the Treatment of Spontaneous Pneumothorax (2014) [8].

Analyzing errors in the provision of medical care to patients with PESP in general surgical hospitals in Volgograd and the Central Regional Hospital of the Volgograd Region, we can conclude that they are of the same type. There is only a quantitative difference in the incorrect actions of surgeons in these groups, which we were able to identify. A more detailed description of errors and complications in the treatment of patients with PESP in general surgical hospitals in Volgograd and in the Central District Hospital of the region is presented in Table. 2. Table 2. Types and frequency of errors and complications in the treatment of patients with PESP in general surgical hospitals in Volgograd and the Central District Hospital of the Volgograd Region Note. * – inefficiency of drainage of the pleural cavity in the Central District Hospital is noted in 1.9times more often than in Volgograd (t=3.83; p>99.9%, p99.9%, p99.9%, p

PESP was usually accompanied by a typical clinical picture, which is described in sufficient detail in the specialized literature. The diagnosis of pneumothorax, including its first episode, was finally established by X-ray examination of the chest organs in two projections.

Only in 11 (3.4%) cases in the presence of severe subcutaneous emphysema, computed tomography was required after lung expansion. Unfortunately, some practical limitations make it difficult to use this method as an initial diagnostic step.

The main tasks of surgical care for patients with PESP after diagnosis are decompression of the pleural cavity, the fastest expansion of the collapsed lung and the rationale for further treatment tactics. Methods of treatment of patients with PESP and their results are presented in table. 3. Table 3. The results of treatment of patients with PESP, depending on the treatment performed

Taking into account the obtained results, the indications for performing surgery for PESP are as follows: 1) ineffective drainage of the pleural cavity for 48 hours with lung collapse by 1/3 of the volume; 2) in case of pneumothorax of a larger volume or total collapse of the lung, it is necessary to operate the patient within 24 hours.

We did not observe pleural empyema in any patient with PESP, despite the fact that particles of bronchial mucus with representatives of the microbiota vegetating in the respiratory tract inevitably enter the pleural cavity. The results of a bacteriological study of the contents of the pleural cavity and resected areas of the lung, performed in 26 cases, did not confirm this point of view. Only 2 patients had yeast-like fungi Candida albicans , which are carriers of 80% of the population, in 24 cases in the resected areas of the lung tissue, the human herpes virus type VI was detected, but the determination of the local immunobiological reactivity of the organism and the count of the main population of lymphocytes did not reveal abnormalities. Obviously, PESP is not characterized by the participation of the infectious component and the development of the inflammatory process. The probability of developing pleural empyema in patients with PESP is most likely exaggerated, and the applied tactics of early surgical treatment is also correct from this point of view.

Thus, strict adherence to the rules and techniques of therapeutic manipulations makes it possible to avoid errors that adversely affect the quality of treatment of patients with the first episode of spontaneous pneumothorax.

When providing surgical care to this category of patients in general surgical hospitals of any level, the same type of violations of treatment tactics occur, which indicates the need for the fastest possible referral of such patients to a specialized department.

Early intervention (within 24-48 hours) using minimally invasive techniques gives the best results.

The likelihood of developing infectious complications from the pleural cavity in patients with a first episode of spontaneous pneumothorax is low, especially with active surgical tactics.

The authors declare no conflict of interest.

*e-mail: [email protected]

Atypical lung resection in St. Petersburg

Article verified by Euromed Clinic thoracic surgeon Nechiporuk Vasily Mikhailovich.

What is pneumothorax?

Pneumothorax is an accumulation of air in the pleural cavity, resulting in a complete or partial collapse (collapse) of the lung with a violation of its function. This leads to hypoxia and respiratory failure. Open pneumothorax occurs, as a rule, with injuries of the chest, closed – with various diseases, such as bullous lung disease, tuberculosis, tumors.

The Euromed clinic treats spontaneous recurrent pneumothorax in bullous lung disease.

Why Euromed?

• Euromed thoracic surgeons have extensive experience in the treatment of chest diseases, they are proficient in modern methods of performing operations, which contributes to the high effectiveness of the intervention and comfortable quick rehabilitation.
• Euromed is a full cycle clinic. Before the operation, we will arrange for you, if necessary, consultations with a therapist, cardiologist and any other specialist, here you can quickly take tests in our laboratory and immediately get the result. The process is organized clearly and takes much less time than in other clinics.

Treatment of pneumothorax

Atypical lung resection with costal pleurectomy
The operation is performed mainly in young patients (under 50, preferably under 40) with recurrent pneumothorax.

Atypical (marginal) resection is the excision of a part of the lung located on its edge. After the operation, as a rule, it is possible to restore lung function.

Costal pleurectomy is an operation that creates adhesions between the chest wall and the lung to prevent recurrence of pneumothorax. In this case, the lung, as it were, is soldered to the inner surface of the chest wall, which prevents recurrence of pneumothorax and collapse of the lung. The modern version of the operation eliminates large incisions on the surface of the chest: the operation is performed thoracoscopically – through three small incisions about 1 cm long.

Contraindications for surgery:

• Severe respiratory failure.
• Severe concomitant diseases with severe organ failure (renal, hepatic, cardiac).
• Coagulopathy (blood clotting disorder).
• Pronounced adhesive process in the pleural cavity.
• Hypertension (high blood pressure) of the pulmonary circulation.

Postoperative period

In the postoperative period after any atypical lung resection, a cough is possible, associated not with the operation itself, but with anesthesia. Some blood may come out during coughing – this is a common postoperative phenomenon and is not a complication. In case of heavy bleeding, you should immediately contact your doctor.

The drains are removed after 3-5 days, after their removal the patient can leave the hospital. A month later, it is necessary to perform a control computed tomography of the chest.
The proportion of relapses after surgery in spontaneous pneumothorax does not exceed 1%.

Operation cost: Atypical lung resection with costal pleurectomy* — from 82,000 rubles.

*Basic cost of operation does not include : preoperative examination, anesthesia allowance, histological examination of the surgical material and hospital stay.

Patient testimonials Euromed Clinic

Natalia July 14, 2023

The clinic staff is very attentive and friendly. The environment is comfortable, the hospital is clean, you don’t feel like you are in a hospital. I turned to Dr. Ivanov Alexander Vladimirovich on the recommendation and did not regret it. A professional in his field, very easy and pleasant to communicate with, he is very accommodating, answers questions in great detail, you feel in safe hands. I sincerely recommend this doctor to everyone! The clinic staff is very attentive and friendly. The environment is comfortable, the hospital is clean, you don’t feel like you are in a hospital. I turned to Dr. Ivanov Alexander Vladimirovich on the recommendation and did not regret it. A professional in his field, very easy and pleasant to communicate with, he is very accommodating, answers questions in great detail, you feel in safe hands. I sincerely recommend this doctor to everyone!

Clinic answer: Good afternoon! Thank you for your choice and feedback. It is very valuable for us to receive such feedback. We are sincerely glad that you appreciated the conditions created in the clinic for our patients, as well as the professionalism of the doctor and the sensitive attitude of the staff. Be healthy! With care for you, Euromed In Vitro

Igor Ivanov for a while he lived with unpleasant symptoms in terms of digestion, at times he even tried to be treated, but somehow everything was to no avail.