Treatment of Non-Tuberculous Spontaneous Pneumothorax

We have had the opportunity of examining and treating about 100 cases of non-tuberculous spontaneous pneumothorax, of which approximately 40 were since 1945 and 11 in the year 1949 alone. This is usually a benign disease which requires only the simplest measures.

In some cases however the symptoms and course of the disease depart from this usual benign aspect and call for active treatment. One is then dealing with relapsing pneumothorax, chronic pneumothorax or pneumothorax with acute asphyxia.

The choice of the procedure to apply in each case depends on the responsible anatomical lesion.

With diffuse emphysematous vesicles, the commonest occurrence, we do not think it advisable to resort to thoracotomy. Pleuroscopy is enough to reveal the lesions, resect adhesions and bring about pleural symphysis by talc projection.

When dealing with a voluminous vesicle or an air cyst, either single, or few in number, they may be eliminated by removing them during thoracotomy.

Emphysematous or cystic lesions localized in a part of the lung call for a limited exeresis which usually consists of lobectomy.

Finally in some cases of chronic pneumothorax, with marked pleural thickening, one may sometimes be obliged to perform decortication.

In some cases one may have to complete these procedures by thoracoplasty, particularly in order to avoid hyperexpansion of the remaining lobe after exeresis.