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Contralateral Recurrence of Primary Spontaneous Pneumothorax^*

^* From the Division of Thoracic Surgery, Department of Surgery (Drs. Huang, Lee, Cheng, Tzao, Chang, and Chen), Department of Radiology (Dr. Hsu), Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

Correspondence to: Yeung-Leung Cheng, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, 325, Section 2, Cheng-Kung Rd, Taipei 114, Taiwan, ROC; e-mail: ndmc0928{at}yahoo.com.tw

Abstract

Background: Primary spontaneous pneumothorax (PSP) is a common disease in young adults. With advances in its surgical treatment, ipsilateral recurrence is < 5%. However, contralateral recurrence remains a significant problem. The purpose of this retrospective study was to identify the factors associated with contralateral recurrence of PSP.

Methods: From January 1997 to December 1999, 231 patients with PSP were reviewed and evaluated after an average of 92-months of follow-up. The clinical features and treatment of these patients were analyzed retrospectively.

Results: Thirty-three of these patients had contralateral recurrence (14.3%). The average time of contralateral recurrence was 22.94 months. In the univariate analysis (after Bonferroni correction), patients with contralateral recurrence of PSP had lower a body mass index (BMI) [p < 0.001], and higher frequency of contralateral blebs/bullae on high-resolution CT (HRCT) of the lung (p < 0.001). Multiple logistic regression was performed on 128 patients with contralateral blebs/bullae on HRCT of the lung, and the results indicate that being underweight (BMI < 18.5 kg/m²) is an independent risk factor for contralateral recurrence (odds ratio, 5.327). All patients with contralateral recurrence of PSP received surgical treatment. Two patients had unilateral recurrences of pneumothorax during follow-up (2 of 64 video-assisted thoracoscopic surgeries, 3%).

Conclusions: Contralateral recurrence of PSP is significantly more common in patients with underweight and blebs/bullae in the contralateral lung. Single-stage bilateral surgery may be considered for these patients to circumvent the need for subsequent anesthetic and operative procedures, and additional hospitalization.

Key Words: bleb • bulla • contralateral recurrence • primary spontaneous pneumothorax • video-assisted thoracoscopic surgery

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				A. I. Hatzitolios, G. Ntaios, M. L. Sion, and Y.-L. Cheng Both Spontaneous Pneumothorax and Spontaneous Pneumomediastinum May Constitute a Complication in Underweight Patients Chest, July 1, 2008; 134(1): 216 - 217. [Full Text] [PDF]

				M. H. Baumann To Bleb or Not To Bleb? Chest, October 1, 2007; 132(4): 1110 - 1112. [Full Text] [PDF]