Spontaneous pneumothorax: a 5-year experience (original) (raw)
Related papers
ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax
The European respiratory journal, 2015
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is ava...
Outcome of patients with spontaneous pneumothorax admitted in Abbasia Chest Hospital
Egyptian Journal of Bronchology, 2016
Conclusion PSP was more frequent compared with SSP in our study, with a higher incidence in younger and taller male population. Smoking is an important risk factor for spontaneous pneumothorax, and the most common lung disease found in our study to be associated with SSP was chronic obstructive pulmonary disease. We conclude that PSP carries a lesser risk for complications and better outcome compared with SSP. The risk for mortality or major complications from spontaneous pneumothorax in general was negligible in our study.
INDIAN JOURNAL OF APPLIED RESEARCH X 695 Clinical Study of Spontaneous Pneumothorax
Background: Pneumothorax is classified into traumatic and spontaneous. Spontaneous pneumothorax divided into primary spontaneouspneumothorax if there is no clinical evidence of lung disease and secondary spontaneous pneumothorax associated with lung disease. Method: Prospective observational study done at Pulmonary medicine department, Kurnool medical college. We studied the causes, presenting features, management and outcome of Spontaneous Pneumothorax in this study. Patients admitted in pulmonary medicine ward with a diagnosis of spontaneous pneumothorax were classified as primary spontaneous Pneumothorax (PSP) and Secondary spontaneous Pneumothorax (SSP). The diagnosis was made by chest radiograph, and computed Tomography if necessary. Necessary investigations done for confirmation of lung disease in SSP. Depending on clinical features, extent of pneumothorax and underlying lung disease management decided as observation with oxygen inhalation or aspiration or Intercostal ChestTube Drainage (ICTD) with under water seal. Supportive treatment given to all patients and Specific treatment for underlying lung disease given in SSP. Results : Total 69 patients were included in this studymales were more 48(69.6%). Mean age was 44.9 yrs(range 20 to 70 yrs). Out of 69 PSP were 10 (14.5%) and SSP were 59(85.5%). Lung diseases in SSP were Tuberculosis 33, Chronic obstructive pulmonary (COPD) disease 20, Asthma 2, interstial lung diseases 2 and pneumonia2. Treated with observation and oxygen inhalation 4 , with aspiration10 and with ICTD 55.In PSP cases lung expansion occurred-in 2 to 8 days. In SSP cases lung expansion occurred in 4-30 days.4 cases of SSP referred for surgery. Conclusion:Spontaneous Pneumothorax is more common in males.In majority of PSP dyspnoea is less, can be managed by observation with oxygen inhalation or by aspiration.Tuberculosis is the common cause for SSP in India and should be looked for in all spontaneous pneumothorax cases. Majority cases of SSP are managed by ICTD. Compared to SSP hospital stay in PSP is short Introduction : Pneumothorax is an emergency so early recognition and prompt treatment saves the patient. Pneu-mothorax classified into spontaneous and traumatic. Spontaneous pneumothorax divided into primary spontaneous Pneumothorax (PSP) if there is no clinical evidence of lung disease and secondary spontaneous pneumothorax (SSP) associated with underlying lung disease 1. This study is under taken to study the causes, clinical presentation, mode of management and response to treatment in spontaneous pneumothorax
Chest, 1994
The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumothorax (SP) after tetracycline pleurodesis (TCP), using that of observation, tube thoracostomy alone, and thoracotomy as references. From 1985 to the end of 1991, 78 patients were treated with tetracycline pleurodesis and 135 patients served as control subjects. Pleurodesis was induced by instillation of tetracycline and ascorbic acid through the pleural drain. The indication was any SP treated with tube thoracostomy, without active pulmonary infection. Follow-up period was from 13 to 95 months (mean, 45 months); follow-up rate was 94 percent. Post-therapy surgery was necessary for eight patients in whom pleurodesis failed due to presence of a persistent air leak. The ipsilateral recurrence rate of patients treated with TCP was 9 percent (6/66) and recurrence time ranged from 2 days to 9 months. The recurrence rate for patients treated with observation was 36 percent, 35 percent for those having chest tube alone,
Clinical profile and treatment outcome of patients with spontaneous pneumothorax
International Journal of Research in Medical Sciences, 2017
Background: The burden of Spontaneous Pneumothorax has been recorded as alarming health problem in medical sciences and is adversely influenced by environmental factors. Objectives of the study were to determine the incidence of spontaneous pneumothorax and to assess the clinical profile and outcome of patients of spontaneous pneumothorax admitted in Government tertiary health care centre.Methods: A hospital based cross-sectional study was conducted in year 2014-15 in the department of Pulmonary Medicine, Government Medical College, Miraj, Maharashtra, India. A total of 2142 patients were admitted with chest complaints during study period were enrolled as study subjects, of which 50 were diagnosed as spontaneous pneumothorax and treated as cases under study. The data were elicited by utilizing structured proforma includes clinical and outcome indicators of Spontaneous Pneumothorax. Qualitative information was computed in tabular and graphical form and analyzed into frequency percent...
Current aspects of spontaneous pneumothorax
European Respiratory Journal, 1997
Although spontaneous pneumothoraces have been recognized and treated for almost 180 yrs, new aspects have emerged concerning pathogenesis, diagnostic procedures and treatment modalities.
Management of spontaneous pneumothorax: state of the art
European Respiratory Journal, 2006
Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment. Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent. Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation. Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies. KEYWORDS: Spontaneous pneumothorax, state of the art S pontaneous pneumothorax (SP) is defined as the presence of air in the pleural cavity. It is divided into primary SP (PSP) and secondary SP (SSP). SSP is associated with underlying lung diseases such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), AIDS, etc. There are, therefore, two distinct epidemiological forms of SP, PSP, with a peak incidence in young people, and SSP, with a peak incidence in those aged .55 yrs [1]. Traumatic pneumothoraces (accidental or iatrogenic) [2, 3] are not discussed here. PSP remains a significant health problem, with an annual incidence of 18-28 per 100,000 population in males and 1.2-6.0 per 100,000 population in females [4]. The annual incidence of SSP is 6.3 per 100,000 population in males and 2.0 per 100,000 population in females [5], with incidences varying over time, e.g. during the AIDS-related Pneumocystis carinii pneumonia of the 1980s and
Guidelines for the diagnosis and treatment of spontaneous pneumothorax
Archivos de …, 2008
Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain.
Recurrence of primary spontaneous pneumothorax
Thorax, 1997
ondary to pulmonary tuberculosis up to 1932 when Kjaergard described primary spon-Background-Primary spontaneous pneumothorax (PSP) is a common clinical taneous pneumothorax (PSP) as a separate entity occurring in previously healthy adults. 3 problem and its incidence is thought to be increasing. The risk of recurrence is high Devilliers was the first to suggest the rupture of subpleural blebs as a cause for spontaneous and various studies quote rates of 20-60%. Factors which may or may not predispose pneumothorax and Hewson described thoracocentesis for its relief. 1 to recurrence have not yet been established. PSP is a common clinical problem occurring in apparently healthy subjects with a reported Methods-In a study period of four years 291 cases with a diagnosis of pneumo-incidence of 7.4-28/100 000 per year for men and 1.2/100 000 per year for women. 4 The thorax were reviewed; 153 patients with PSP were included in the study. Their risk incidence of PSP is believed to be increasing, and the recurrence rate has been variably re-of recurrence was analysed with particular reference to the following variables: age, ported as 20-60% 5 with few studies of predisposing risk factors. 6 7 sex, height and body mass index (BMI) of the patient, the initial size of pneumo-This retrospective study, which preceded publication of the BTS guidelines, 8 was con-thorax, the smoking status of the patient, and the primary form of treatment em-ducted to evaluate the recurrence rate of PSP with particular reference to the following vari-ployed. Univariate analysis was carried out by 2 testing and multivariate analysis ables: age, sex, height and BMI of the patient, initial size of the pneumothorax, smoking status was calculated by a logistic regression model. of the patient, and the primary form of treatment employed. Results-A retrospective study of 275 episodes of PSP in 153 patients over a four year period confirmed a high incidence of recurrence (54.2%). PSP was twice as Methods common in men as in women, though The study was carried out at a cardiothoracic women were significantly more likely to surgical centre (Castle Hill Hospital) for the develop a recurrence (2 =7.58, df=1, region of East Yorkshire. A total of 429 patients p<0.01). Male height was the second most with a diagnosis of pneumothorax were idenimportant factor, and smoking cessation tified from a computer-generated diagnostic the only other variable which significantly index for the period from February 1990 to influenced the risk of recurrence. March 1994. A proportion of patients (n= Conclusions-Analysis of several potential 104, 24%) were tertiary referrals for surgery risk factors revealed that recurrence was from neighbouring hospitals and were excluded not related to the BMI of the patient, the from the analysis to avoid selection bias. Miss-Medical Chest Unit, initial treatment of the pneumothorax, nor ing data (case notes or radiographs) for 34 Castle Hill Hospital, to its size. Recurrence was more common North Humberside, patients (8%) left 291 case records for detailed in taller men and in women. Smoking ces-UK study. R T Sadikot sation appeared to reduce the risk of re-Patients were entered into the study if they A G Arnold currence. These findings are discussed in were older than 15 years and if the initial index the context of the possible aetiology of Department of Public episode of pneumothorax occurred during the Health Medicine, spontaneous pneumothorax, recurrences, study period. The following data were col-University of Hull, and the management thereof. North Humberside, lected: (1) age and sex, (2) height and weight, (Thorax 1997;52:805-809) UK (3) smoking habits, (4) associated lung dis-T Greene eases, (5) side and size of pneumothorax, and
Spontaneous pneumothorax: A retrospective study of twenty-five patients and literature review
Annals of Saudi medicine, 1996
We present a retrospective study of 25 patients with spontaneous pneumothorax (three current), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only meth...