Spontaneous pneumothorax still has controversial aspects. During the decade we observed in Romania a change in the proportion of etiological factors. The aim of our study is to establish how these changes and the modern diagnostic and surgical procedures affect the management of spontaneous pneumothorax.
We retrospectively analysed 245 consecutive patients with spontaneous pneumothorax treated in our clinic during the last 18 years. Data abstracted included patient′s demographics, medical history, clinical presentation, radiographic aspect, CT scans in some cases, surgical treatment and postoperative follow-up. We compared the results obtained between 1985 - 1994 with those obtained between 1995 - 2003.
The average age was 47 years with a female/male ratio of 2/9. Tube thoracostomy was used in 80% of cases and in 19,5% of cases we performed major surgical treatment (thoracotomy, resection of blebs or other lesions and parietal pleurectomy). In two cases of repeated episodes of pneumothorax due to generalized bullous emphysema, with respiratory failure, we performed two-stage bilateral lung volume reduction surgery associated with electrocoagulation of the pulmonary parenchyma and diaphragm and parietal pleurectomy (no possibility to perform lung transplantation in Romania). In 4 cases with residual cavities we performed thoracopleuroplasties, own procedure. In very few cases (0,5%) we performed only simple needle-aspiration.CONCLUSIONS: During the last years we observed an important increase of secondary pneumothorax, due to the growing number of patients with tuberculosis. The proportion of patients with spontaneous pneumothorax as first sign of tuberculosis raised from 4,5% between 1985-1994 to 30,2% between 1995-2003. There are some rare causes of spontaneous pneumothorax (ruptured aspergiloma, pleuro-pericardial cyst, sequestration, hydatid cyst etc.), which are usually not taken into consideration; even if each of these lesions is extremely rare, together they account for a significant proportion.
These results suggest the need of a more aggressive and differentiated treatment of spontaneous pneumothorax, with serious clinical, social and economic implications.
P.V. Botianu, None.