Current aspects of spontaneous pneumothorax

Abstract

In spite of the fact that blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they seldom seem to be the actual cause of the pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the pneumothorax during transpulmonary pressure changes.The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary spontaneous pneumothorax. Eur Respir J 1997; 10: 1372-1379 Pneumothorax is defined as the presence of air in the pleural cavity [1]. As early as 1819, LAENNEC [2] described the symptoms and signs of a patient with a pneumothorax. Although most pneumothoraces were then caused by tuberculosis, he also found pneumothoraces during autopsies of patients with apparently healthy lungs; he named these "pneumothorax simple". Aetiology and pathogenesisToday, pneumothoraces are divided into spontaneous pneumothorax, occurring without a preceding event, and traumatic pneumothorax, due to direct or indirect trauma. Iatrogenic pneumothoraces, resulting from diagnostic or therapeutic medical procedures, are also categorized as traumatic pneumothoraces.Spontaneous pneumothoraces are divided into primary and secondary spontaneous pneumothoraces. Secondary spontaneous pneumothoraces are associated with underlying pulmonary pathology, usually chronic obstructive pulmonary disease (COPD). Acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii infections appear to play an increasing role in the aetiology of secondary spontaneous pneumothoraces [3].No underlying pulmonary disease is present in patients with primary spontaneous pneumothorax. However, blebs and bullae seem to play a role in the pathogenesis, since they are frequently found during thoracoscopy, thoracotomy or sternotomy (table 1). Thoracoscopic studies have shown the presence of blebs and bullae in 48-79% of patients with unilateral primary spontaneous pneumo-thorax [4][5][6][7][8]. With the development of video-assisted techniques, the recognition of blebs and bullae during thoracoscopy has improved. In more than 76% of patients,

Size of Pneumothorax can be a New Indication for Surgical Treatment in Primary Spontaneous Pneumothorax: A Prospective Study

“…16) Although emphysema-like changes were seen in 81% of patients with PSP, no association with PAL or recurrence could be demonstrated. 17) In a publication of the British Thoracic Society in 2003 and 2010, smoking, height and age over 60 years have been reported as an independent risk factors for the recurrences in PSP. 1,18) Potential ipsilateral recurrences or PAL might be thought to be more frequent in patients with total lung collapse since the defect has been reported to be larger in such patients.…”

Incidence of primary spontaneous pneumothorax is not associated with microclimatic variations. Results of a seven-year survey in a temperate climate area

“…Epidemiologic data are mainly based on a small number of studies, which seemingly show an incidence of 18-28/100.000 cases yearly in men and 1.2-6/100.000 cases yearly in women, respectively [5,6]. No other large-scale studies are available to date, so that a significant part of the epidemiologic knowledge is derived from case series, often showing contradictory figures [7][8][9][10]. Regardless of the still partially undefined epidemiology, SP apparently displays a bimodal peak frequency.…”

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

“…In two case-control studies, the CT scans of persons with recent PSP (including nonsmokers) were found to have significantly more emphysema-like changes in both studies as well as a lower mean radiographic density of the lungs in one of the studies (9,10). A CT study and multiple surgical studies have consistently identified blebs and bullae in patients suffering a spontaneous pneumothorax (11)(12)(13)(14)(15)(16). Secondary spontaneous pneumothorax occurs in patients with clinically apparent lung disease, which is most commonly COPD (2,17,18).…”