Disorders of the Pleura |

Are Large Primary Spontaneous Pneumothoraces Always a Surgical Alternative? FREE TO VIEW

Evaldo Marchi*, MD; Tiago Ventureli, MD; Tiago Santos, MD; Marcus Carvalho, MD; Andre Fruchi, PT; Richard Light, MD
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Jundiai Medical College, Jundiai, Brazil

Chest. 2012;142(4_MeetingAbstracts):490A. doi:10.1378/chest.1389006
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SESSION TYPE: Pleural Disease

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: To describe the outcome of a series of patients with primary spontaneous pneumothorax (PSP) of large volume treated with clinical observation.

METHODS: Patients with PSP (n= 101) were treated either by clinical observation, chest drainage or surgery (thoracoscopy or open thoracotomy). Small size PSP were preferably treated by clinical observation and large size PSP with pleural drainage. However, a subgroup of patients with large PSP, non-smokers, with good clinical status and no previous episodes of pneumothorax were referred to non surgical treatment. Results of this subgroup were compared with patients with small size PSP treated clinically and with patients with large size PSP submitted to pleural drainage. Statistics: Anova (p< 0.05).

RESULTS: Clinical observation was the treatment of choice in 32 and pleural drainage in 35 patients. Twenty-one patients with clinical observation (66%) had small and 11 (34%) large size PSP. Age, degree of dyspnea and the side of PSP did not differ among groups. Non-smoker women with no previous episodes of PSP and large size PSP were more frequent referred for clinical treatment. In this particular subgroup of patients, complete remission time did not differ for small or larger size PSP. Sex (masc): Clin Small (81%), Clin Large (45%*) and Drainage (63%) (p< 0.05); Smoke hab (yes): Clin Small (19%), Clin Large (0%*) and Drainage (34%) (p< 0.05); PSP Prev. Epis. (yes): Clin Small (14%), Clin Large (0%*) and Drainage (11%) (p< 0.05); Remission time (days): Clin Small (11 ± 2.5), Clin Large (17 ± 4.0) and Drainage (3.2 ± 2.2*); (p< 0.05).

CONCLUSIONS: Remission time after treatment was shorter in patients with large PSP submitted to pleural drainage in comparison to clinically treated patients, as expected. However, no difference was found in remission time in clinical treated patients with small or large PSP.

CLINICAL IMPLICATIONS: Although large size PSP are preferably treated with thoracentesis or pleural drainage, a select group of clinically stable patients with large size PSP, non smoking habits and no previous episodes of PSP may benefit from clinical observation alone.

DISCLOSURE: The following authors have nothing to disclose: Evaldo Marchi, Tiago Ventureli, Tiago Santos, Marcus Carvalho, Andre Fruchi, Richard Light

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Jundiai Medical College, Jundiai, Brazil




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