Simple Spontaneous Pneumothorax

¹ The Students' Health Service, the Department of Medicine and the School of Public Health, University of Minnesota Medical and Graduate Schools.

1. One hundred and fifteen cases of simple spontaneous pneumothorax are reported ranging in age from 15 to 64 years. Nearly one-half occurred between the ages 20 and 24 years. Eighty-five per cent of the entire group were males. The condition occurred on the left side only in 64, the right side only in 42 and bilaterally in nine.

2. In 78, initial symptoms were severe consisting mainly of pain and dyspnea. In the remainder the onset was gradual. Activities of the individuals when attacks occurred varied from strenuous work to sound sleep.

3. History of onset, physical signs and x-ray inspection were employed in diagnosis but fluoroscopy and x-ray films were most valuable.

4. Various degrees of collapse were observed. In 34 cases it was complete.

5. Approximately one third of these patients were treated ambulatorially while the remainder received bed rest, ranging from a few days to two months. Air was not aspirated except when positive intrapleural pressure developed. Thirty nine had small fluid accumulations which promptly disappeared without aspiration. Only one presented a large effusion which was removed. The nine cases of spontaneous hemopneumothorax were aspirated until all evidence of blood disappeared.

6. Serious tension pneumothorax occurred in only two cases. Air was removed promptly and as long as positive pressure continued to develop. From two other cases, air was removed with the first manifestation of positive pressure.

7. Among the 115, there were 41 who had tuberculosis as manifested by the tuberculin reaction but no evidence of clinical disease was found. Two developed clinical tuberculosis five years after pneumothorax occurred. Another who did not react at the time of the initial pneumothorax developed clinical pulmonary tuberculosis 18 years later.

8. Contact has been maintained or recently re-established in 104 of the 115 patients. Four have been observed for six months or less. The remaining 100 have been observed from one to 29 years.

9. Among the 100 cases, 71 have had no repetition and 17 have had one recurrence all on the original side except two. Twelve have had more than one recurrence, ranging from two to many. In five of these, all recurrences were on the original side.

10. Since 29 of this group of 100 traced cases have had one or more recurrences, everyone who has had an initial attack should be advised of the possibility of others and how to proceed in the event symptoms of tension pneumothorax begin to appear.

11. From these observations and the management of recurrent spontaneous pneumothorax, the procedure now recommended after two or more attacks consists of surgical closure of the rent, removal of blebs in evidence and producing slight irritation of the pleural surfaces by gentle sponge friction.

12. In all initial attacks as well as recurrences, accumulations of fluid, large or small, should be removed if they do not absorb within a few days to avoid deposits of fibrin on the pleural surfaces.

13. In all cases of spontaneous hemopneumothorax, blood should be removed as often as necessary, transfusions administered when indicated and ligation of the vessel and closing the rent if copious bleeding persists unduly long.

14. Apparently simple spontaneous pneumothorax occurs more frequently than the literature indicates since not all physicians report their cases and many persons whose symptoms are mild do not consult physicians.

15. No method has been devised for the prevention of simple spontaneous pneumothorax but some recurrences can probably be prevented by surgical removal of blebs or producing symphysis of the pleurae.

16. Persons who have blebs or bullae demonstrated by x-ray inspection as well as those who have had one or more attacks of simple spontaneous pneumothorax, should avoid high altitudes except in pressurized cabins and where oxygen can be administered or a needle can be introduced into the pleural cavity in the event of emergency.