Clinical and Pathological Characteristics of Spontaneous Pneumothorax in Women: A 25-Year Single-Institutional Experience

Abstract

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Accumulating evidences suggest that spontaneous pneumothorax (SP) in women is relatively rare but postoperative recurrence is more common compared to men, which may partly be attributed to catamenial/ endometriosis-related pneumothorax. However, detailed clinical-pathological background of female SP is yet to be fully elucidated. Our aim is to further delineate clinical and pathological characteristics of female spontaneous pneumothorax. METHODS: We retrospectively reviewed women with SP undergoing surgery at Kansai Medical University Hospital from January 1990 to December 2015. Female patients with SP with no underlying lung disease were divided into those with age greater than or equal to 50 years (‘Age≥ 50yr’) and those younger than 50 years, latter of which was further subdivided into two categories: patients with catamenial pneumothorax (CP) and those with non-CP. RESULTS: A total of 705 operations were performed for male or female SP during the study period. 71 women underwent 74 operations for their SP. Among these, 12 patients had known underlying lung disease (i.e. secondary SP). 59 patients had SP with no known underlying lung disease: 11 (18.6%) had CP, 40 (67.8%) had non-CP and 8 (13.6%) were Age≥ 50yr. Pathological diagnosis of CP was diaphragmatic endometriosis in 4 cases, emphysematous bullae in 4 cases, pulmonary hemangiomatosis-like foci in 2 cases and hematoma in one case. On the other hand, emphysematous blebs/bullae accounted for all but one case with non-CP and all the SP in Age≥ 50yr, most of which were located in the right or left upper lobe of the lung. The 2-year cumulative ipsilateral recurrence rate of CP, non-CP, and SP in Age≥ 50yr group was 42.0%, 13.8%, and 14.2%, respectively. CP showed significantly higher recurrence rate compared to non-CP (p = 0.006). CONCLUSIONS: This study showed that surgery for female SP accounted for approximately 10% of all surgeries for SP. CP affected approximately 20% of female SP with no underlying lung disease, resulting in a significantly higher postoperative recurrence rate compared to non-CP based on the heterogenous pathology including thoracic endometriosis, emphysematous bullae and pulmonary capillary hemangiomatosis-like foci. CLINICAL IMPLICATIONS: When treating female patients with SP, clinicians may need to consider their age and the presentation of their pneumothoraces (i.e. CP or non-CP). Surgical treatment may not be as effective for CP as for non-CP to prevent the recurrent pneumothorax. DISCLOSURE: The following authors have nothing to disclose: Tomohito Saito, Yukihito Saito, Kento Fukumoto, Hiroshi Matsui, Takahito Nakano, Yohei Taniguchi, Hiroyuki Kaneda, Akiharu Okamura, Yoshiko Uemura, Koji Tsuta, Tomohiro Murakawa No Product/Research Disclosure Information