Current management of spontaneous pneumothorax.
Spontaneous pneumothorax is divided into primary, when there is no underlying lung disease, and secondary, mainly caused by chronic obstructive pulmonary disease. A variety of different non-invasive and invasive treatment options exist. Due to the lack of large randomised controlled trials no level A evidence is present. A first episode of a primary spontaneous pneumothorax is treated by observation if it is < 20% or by simple aspiration if it is > 20%, but recurrences are frequent. For recurrent or persisting pneumothorax a more invasive approach is indicated whereby video-assisted thoracic surgery provides a treatment of lung (resection of blebs or bullae) and pleura (pleurectomy or abrasion). In patients with a secondary spontaneous pneumothorax related to chronic obstructive pulmonary disease, there is an associated increased mortality and a more aggressive approach is warranted consisting of initial thoracic drainage followed by recurrence prevention by thoracoscopy or thoracotomy in patients with a low or moderate operative risk. Talc instillation by the thoracic drain is preferred for patients with a high operative risk.
Van Schil
P E
PE
Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem (Antwerp), Belgium. paul.van.schil@uza.be
Hendriks
J M
JM
De Maeseneer
M G
MG
Lauwers
P R
PR
D006801:Humans; D011030:Pneumothorax / Q000601:surgery*; D013396:Suction; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome