Spontaneous Pneumothorax: Lung Lesions

There is disagreement in the literature on management of primary spontaneous pneumothorax, with no clear evidence supporting any particular approach.

Most patients with spontaneous pneumothorax are adolescents (around 18 years old).

The majority of children at their institution elect to undergo general anesthesia rather than bedside chest tube placement under local anesthesia.

50% of patients who undergo chest tube placement or observation for pneumothorax will have recurrence and need additional intervention.

Among patients with bleb disease who undergo simple chest tube placement for symptomatic pneumothorax, upwards of 50% will recur.

Second recurrence rate is approximately 75%.

No study has separated patients on first event into those with blebs versus no blebs and examined risk of second event recurrence.

A CT scan is not very effective for visualizing blebs when the lung is partially collapsed.

In Argentina, for stable patients with pneumothorax, they place a thin double pigtail catheter percutaneously with local anesthesia, attached to a Heimlich valve.

Almost all patients with spontaneous pneumothorax have bleb disease whether it is defined early or not.

Bleb disease does not necessarily mean recurrence will occur.

Patients with spontaneous pneumothorax usually recur when at home, not in remote locations or extremis.

After unilateral treatment of symptomatic pneumothorax, recurrence can occur on the contralateral side during the immediate postoperative period.

There is still a pretty high recurrence rate even after VATS with blebectomy and mechanical or chemical pleurodesis.

Apical pleurectomy causes more postoperative pain than talc pleurodesis.

Aerosolized talc can be administered through a chest tube, creating a 'snow' effect inside the chest for pleurodesis.

Hydrostatic pleurectomy technique involves making a small pleural incision, inserting a suction irrigator, sealing around it, and irrigating to dissect the entire pleura, which can then be rolled up and removed.

Hydrostatic pleurectomy can achieve hemi-thorax pleural removal, more extensive than apical pleurectomy alone.