Pneumothorax - Experience with 1,199 patients

Objective: To study the outcome of pneumothorax managed in a university-aff iliated metropolitan medical center. Design: A retrospective review. Setting: Busy metropolitan medical center. Patients and Methods: Records of 1,199 patients with pneumothorax were reviewed and analyzed. Results: Primary spontaneous pneumothorax occurred in 218 patients, seconda ry spontaneous pneumothorax: occurred in 505, traumatic in 403, and iatroge nic in 73, Ninety-six patients with small pneumothorax; (8%) were managed b y observation, and 1,103 patients (92%) were managed by tube thoracostomy. Drainage of the pleural cavity was continued for 1 to 7 days in 893 patient s (81%), 8 to 10 days in 176 patients (16%), and > 10 days in 34 patients ( 3%). Drainage for > 10 days was classified as persistent pneumothorax. In t hese 34 patients and in 132 others,vith a second ipsilateral recurrence (a total of 166 patients), direct pleuroscopy was performed, The pleuroscopy f indings and further management are outlined in the algorithm. Conclusions: Pneumothorax is a common condition affecting all age groups. I f the volume of the pneumothorax is > 20% of the pleural space, pleural dra inage is indicated. For management of persistent or recurrent pneumothorax, the use of pleuroscopy (direct or video-assisted) is of great value and sh ould be part of routine management.