Spontaneous Pneumothorax

¹ Chief, Pulmonary Disease Service, Veterans Administration Hospital, Long Beach, and Assistant Clinical Professor of Medicine, U.C.L.A. School of Medicine, Los Angeles

Two hundred consecutive cases of benign, nontraumatic, nontuberculous spontaneous pneumothorax, unassociated with other pulmonary disease as pneumonia, tumor, etc., are presented. Nearly all were men, and 80 per cent were under 40 years of age. Right and left sides were affected equally. The median time for re-expansion of the collapsed lung was four weeks in the nonsurgical group, three weeks in the repeated needle aspiration group, and two weeks in a small group treated with intrapleural catheter.

Most of the patients under 40 years of age were thin. Those older usually had pulmonary emphysema. Only 1.5 per cent had asthmatic attacks just prior to the pneumothorax, and only 3 per cent were engaged in significant physical exertion shortly before. Chest pain was present in 98.5 per cent, and 82 per cent had dyspnea.

Gross intrapleural bleeding occurred in 4.5 per cent. Erythrocyte sedimentation rate, white blood count and body temperature were usually normal. One patient with severe emphysema and spontaneous hemopneumothorax and one with severe emphysema and congestive heart failure died shortly after admission.

Recurrence occurred usually on the same side in 27 per cent of these patients. More than one recurrence was observed in 9.5 per cent. Almost all were treated conservatively with modified bed rest until the collapsed lung had re-expanded to about 80 per cent of its volume. Full ambulation was then permitted. With complete re-expansion, the patients returned to normal activities.