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(Chest. 2006;129:1274-1281.)
© 2006 American College of Chest Physicians

Management of Pneumothorax in Lymphangioleiomyomatosis*

Effects on Recurrence and Lung Transplantation Complications

Khalid F. Almoosa, MD; Jay H. Ryu, MD; Jose Mendez, MD; J. Terrill Huggins, MD; Lisa R. Young, MD; Eugene J. Sullivan, MD; Janet Maurer, MD; Francis X. McCormack, MD and Steven A. Sahn, MD

* From the Division of Pulmonary and Critical Care Medicine (Drs. Almoosa, Young, and McCormack), University of Cincinnati, Cincinnati, OH; Division of Pulmonary and Critical Care Medicine (Drs. Ryu and Mendez), Mayo Clinic College of Medicine, Rochester, MN; Division of Pulmonary and Critical Care Medicine (Drs. Huggins and Sahn), Medical University of South Carolina, Charleston, SC; US Food and Drug Administration (Dr. Sullivan), Rockville, MD; and Cigna Health Care (Dr. Maurer), West Granby, CT.

Correspondence to: Khalid Almoosa, MD, Division of Pulmonary and Critical Care, University of Cincinnati, 231 Albert Sabin Way, 6053 MSB, Cincinnati, OH 45267-0564; e-mail: khalid.almoosa{at}uc.edu

Abstract

Study objectives: Pneumothorax is a common complication of lymphangioleiomyomatosis (LAM), and the optimal approach to its treatment and prevention is unknown. Chemical or surgical pleurodesis are often required to prevent recurrence. However, their efficacy in LAM is unclear, and whether they contribute to perioperative complications during lung transplantation is uncertain.

Setting: The LAM Foundation database of registered patients.

Design: A questionnaire was sent to all registered patients who had at least one pneumothorax to determine rates and patterns of recurrence and efficacy of interventions. A second questionnaire was sent to registered LAM patients who received a lung transplant.

Patients or participants: Of 395 registered patients, 260 patients (66%) reported at least one pneumothorax during their lifetime, 193 of whom (74%) completed the questionnaire. Of the 85 lung transplant patients who were sent a separate questionnaire, 80 patients (94%) responded.

Interventions: None.

Measurements and results: Of the 193 respondents to the pneumothorax questionnaire, data on 676 episodes of pneumothorax were collected. Eighty-two percent (158 of 193 patients) had their first pneumothorax prior to a diagnosis of LAM. One hundred forty patients (73%) had at least one additional pneumothorax, either an ipsilateral recurrence (99 of 140 patients, 71%) or a contralateral pneumothorax (104 of 140 patients, 74%). Recurrence rates were 66% after conservative therapy, 27% after chemical pleurodesis, and 32% after surgery. In patients who had undergone lung transplantation, prior chemical or surgical pleurodesis was performed in 45 of 80 patients (56%). Fourteen of 80 patients (18%) reported pleural-related postoperative bleeding, 13 of whom (93%) had prior pleurodesis.

Conclusions: Chemical pleurodesis or surgery are equally effective and better than conservative therapy in preventing recurrence of pneumothorax in LAM. Due to the high recurrence rate, either procedure should be considered for the initial pneumothorax in these patients. However, both contribute to increased perioperative bleeding following lung transplantation, with no effect on length of hospital stay.

Key Words: lung transplantation • lymphangioleiomyomatosis • pleurodesis • pneumothorax




This article has been cited by other articles:


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F. X. McCormack
Lymphangioleiomyomatosis: A Clinical Update
Chest, February 1, 2008; 133(2): 507 - 516.
[Abstract] [Full Text] [PDF]


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