Chest
Volume 96, Issue 6, December 1989, Pages 1302-1306
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Clinical Investigations
Civilian Spontaneous Pneumothorax: Treatment Options and Long-term Results

https://doi.org/10.1378/chest.96.6.1302Get rights and content

The treatment of spontaneous pneumothorax in the civilian population can be influenced by the age of the patient and the presence of associated pulmonary disease. The medical records of 130 patients who presented with 168 occurrences of SP were reviewed during an 11-year period (1973 to 1984). Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). The therapeutic options included observation alone (40 occurrences), thoracentesis (6 occurrences), chest tube thoracostomy (102 occurrences), and thoracotomy (20 occurrences). Treatment of SP should be prompt with the objective of complete re-expansion of the lung and prevention of recurrent pneumothorax. This should be accomplished by the use of chest tube thoracostomy with early addition of thoracotomy as necessary. Selected use of thoracentesis can be effective. The use of observation alone can be dangerous and is associated with a higher recurrence rate.

Section snippets

Methods

The medical records of 130 patients with 168 occurrences of SP were reviewed from May 1973 to May 1984. All of these patients, except the observation group, were treated by the thoracic surgical service of St. Joseph's Hospital, Milwaukee, Wisconsin. Patient information was obtained from the hospital chart and physician office records. Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). Patients excluded from the study were infants and neonates, those with a recent history

Results

All patients presented with the complaint of chest pain, dyspnea or both. There were 97 (74.6 percent) male and 33 (25.4 percent) female patients treated (p<0.001). Eighty-nine (68.5 percent) were less than 50 years of age and 41 (31.5 percent) were older than 50. As demonstrated in Figure 1, there is a bimodal age distribution representing two separate groups of patients. There is a younger group with a prevalence in the third decade and an older group with a cluster in the seventh to ninth

Discussion

During the past 30 years, most published reports on the treatment of SP have come from the military hospitals. Our data demonstrate marked demographic differences in civilian patients who present with spontaneous pneumothorax. These differences have made an impact on the therapeutic options used.

Although our data confirm that SP is a maledominant disease, the percentage of females (25.4 percent) is significantly higher than the 10 percent incidence reported previously by Mills et al.2 Smoking

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Presented in part at the 54th Annual Scientific Assembly, American College of Chest Physicians, Anaheim, October 3–7, 1988.

revision accepted April 7.

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