Spontaneous pneumothorax

Background: Spontaneous pneumothorax is classified into primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP). PSP occurs without any cause, usually as a result of the rupture of subpleural blebs. SSP is related to the presence of underlying lung disease. The pathological consequences depend primarily on the site of pneumothorax and the condition of the underlying lung.
Material and Methods: Data related to 84 patients with 126 episodes of pneumothorax presenting from January 1998 to December 2000 were retrospectively reviewed to assess the clinical manifestations and therapy of spontaneous pneumothorax.
Results: There were 52 patients with 80 episodes of PSP and 32 patients with 46 episodes of SSP. The common causes for SSP were tuberculosis (18 patients with 29 episodes) and emphysema (7 patients with 10 episodes). The age of presentation was 27±11 years for PSP and 58.8±15.2 years for SSP (p<0.01). The commonest clinical manifestation with PSP was chest pain (86.25 %)whereas dyspnoea was the commonest manifestation with SSP (84.78%). Seventy-three (91.25%) episodes of PSP and 37 (80.43%) episodes of SSP were managed with non-operative treatment. Thoracotomy was done in 7 (8.7%) and 9 (19.5%) episodes of PSP and SSP respectively. The overall recurrence rate of PSP was 31.25% and 26.08% in SSP. No recurrence was seen with open thoracotomy in both groups of patients.
Conclusions: We conclude that patients with both PSP and SSP should be managed initially with nonoperative treatment. Thoracostomy tube drainage is the mainstay of treatment. Patients with SSP are generally debilitated from the respiratory standpoint and may have other significant comorbid diseases. Effective treatment must be individualized.