Aetiology and clinical profile of spontaneous pneumothorax in adults.

BACKGROUND: Limited information is available on epidemiology of spontaneous pneumothorax (SP) from India. The present study was aimed at studying aetiology and clinical profile of patients with SP. METHODS: All patients admitted at a tertiary care hospital with the diagnosis of SP between January 2001 and March 2002 were prospectively studied. Detailed demographic and clinical data were recorded. Patients were divided into two groups-primary spontaneous pneumothorax (PSP), if no underlying aetiology for pneumothorax was found, and secondary spontaneous pneumothorax (SSP), when an underlying respiratory disorder could be identified. The clinical features were compared between the two groups. RESULTS: Sixty patients (12 with PSP and 48 with SSP) were included in the study. Annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Annual incidence figures for PSP and SSP were 20.0 and 80.0 per 100,000 hospital admissions respectively. Age distribution showed a biphasic pattern and the overall male to female ratio was 5 : 1. The most common cause of SSP was found to be pulmonary tuberculosis (41.7%). CONCLUSIONS: Pneumothorax is more common among men. In India, SSP is far more common than PSP, and the predominant underlying cause is pulmonary tuberculosis.

Role of simple needle aspiration in the management of pneumothorax.

OBJECTIVES: To determine the role of simple needle aspiration in the management of pneumothorax. DESIGN: All patients presenting with a pneumothorax requiring intervention were included in this prospective study. Patients who were very sick or had tension pneumothorax were treated with direct intercostal chest tube drainage (ICTD) and others were subjected to simple aspiration. The procedure was deemed successful, if after aspiration the lung expanded completely or symptoms were relieved with residual pneumothorax of less than 15% of hemithorax. In case of failed aspiration ICTD was carried out. RESULTS: Fifty-seven patients with 59 pneumothoraces were included in the study. Of these, 24 were treated with direct ICTD; 35 (12 spontaneous, 11 secondary and 12 iatrogenic pneumothoraces) were subjected to simple aspiration. Ten (83.3%) of the primary, 1 (9.6%) of the secondary and 11 (91.7%) of the iatrogenic pneumothoraces responded to simple aspiration. There were no significant complications. The pain perceived and the duration of hospital stay was significantly lesser in the simple aspiration group. CONCLUSIONS: Simple aspiration should be the initial modality of treatment for primary spontaneous and iatrogenic pneumothoraces. For secondary spontaneous pneumothorax and in conditions where pleurodesis is indicated, ICTD remains the treatment of choice.