Chest
Volume 108, Issue 2, August 1995, Pages 330-334
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Clinical Investigations; Articles; Thoracic Surgery
Videothoracoscopic Appearance of First and Recurrent Pneumothorax

https://doi.org/10.1378/chest.108.2.330Get rights and content

Study objective

Comparison of the videothoracoscopic appearance of first and recurrent pneumothorax, and assessment of a relation between endoscopic appearance and recurrence rate.

Setting

University hospital.

Patients

Eighty-two patients, 64 men (mean age, 32.7 years) and 18 women (mean age, 31.5 years), were included. Patients with known underlying pulmonary disease at the time of hospital admission were excluded. There were 61 patients (74%) with first pneumothorax, and 21 patients (26%) with recurrent pneumothorax.

Interventions

All patients underwent videothoracoscopy under general anesthesia, with double-lumen intubation.

Results

Blebs or bullae were found in 47 patients (77%) with first pneumothorax, and in 14 patients (67%) with recurrent pneumothorax. Bullae >2 cm were found in 34 patients (56%) with first pneumothorax and 10 patients (48%) with recurrent pneumothorax. Patients with blebs or bullae were significantly older than patients with normal videothoracoscopic appearance (mean age, 36.5±15.7 years vs 25.3±5.8 years, p<0.05). Adhesions were significantly more frequently found in patients with blebs or bullae compared with patients with normal thoracoscopic appearance of the lung (p<0.05). Seventeen of 21 patients (81%) with normal thoracoscopic appearance were smokers. Of nonsmoking patients (n=22), 82% had blebs and bullae.

Conclusions

No significant differences in videothoracoscopic appearance were found between first and recurrent pneumothorax. These results suggest that recurrence after the first event of spontaneous pneumothorax cannot be predicted by thoracoscopic findings. Smoking and blebs or bullae are independent risk factors for development of spontaneous pneumothorax.

(CHEST 1995; 108:330-34)

Section snippets

Materials and Methods

All patients presenting with SP between December 1991 and December 1993 were included in the study except patients with known underlying pulmonary disease at presentation. An SP was defined as recurrent if radiologic proof of a previous ipsilateral episode was available.

All patients underwent videothoracoscopy under general anesthesia with double-lumen intubation. The lung surface and the pleural cavity were thoroughly inspected. During the procedure, the lung was reinflated in order to detect

Age

A comparison of clinical results of patients with first and recurrent pneumothorax is summarized in Table 1. There were 82 patients included in the study. Of these, 61 presented with their first pneumothorax (74%) and 21 (26%) had suffered from recurrent pneumothorax. There were 64 men (mean [±SD] age, 32.7± 15.1 years) and 18 women (mean age, 31.6±13.7 years) included in the study. Mean age of all patients was 32.4±14.7 years. There was no significant difference in age between patients with

Discussion

The cause of SP is unknown. Mostly, SP is attributed to rupture of a subpleural bleb or bulla. The etiology of bulla and bleb formation is obscure. The high incidence of adhesions, in 25% (15 of 61) of patients with first SP, suggests that an inflammatory reaction has preceded the event of SP. Maybe in these patients a previous episode of SP has passed unnoticed.2 These adhesions were found significantly more frequently in patients with blebs or bullae (33%) than in patients with a

Conclusions

Smoking and bullous lesions are probably independent risk factors for developing an SP. There are no differences between the thoracoscopic findings in patients with first time and recurrent SP. Apparently, patients without macroscopic abnormalities are not less prone to recurrence of pneumothorax than patients with blebs and bullae. This implicates that thoracoscopy for diagnostic purposes is not necessary in patients with first time SP.

ACKNOWLEDGMENT

The authors would like to thank Wytze P. Oosterhuis, MD, PhD for his assistance with stastistical analyses.

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