Simultaneous bilateral primary spontaneous pneumothorax

Abstract

While primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral PSP (SBPSP) is rare and can be life-threatening if it progresses to tension pneumothorax. This study reviewed cases of PSP to identify the clinical features of SBPSP. All patients with PSP diagnosed and treated between June 1996 and June 2006 were reviewed, and the clinicoradiological features and outcomes were evaluated. Of the 616 patients with 807 episodes of PSP, 13 had SBPSP (1.6%) at first presentation, and all were male (mean age 20.9 +/- 4.7 years, range 16-25 years). Compared with the non-SBPSP patients, SBPSP patients had significantly lower body weight and BMI (P = 0.018 and <0.001, respectively) and higher body height/body weight ratio (P = 0.004). There was no significant difference in their age, sex, smoking habits or body height. Patients with SBPSP had a significantly higher incidence of bleb/bullae seen in HRCT of the lung compared with non-SBPSP (88.5% vs 63.5%, P = 0.016). In multiple logistic regression analysis, BMI and presence of blebs/bullae were independent risk factors for SBPSP. All patients with SBPSP received bilateral video-assisted thoracoscopic surgery and recovered uneventfully. The mean follow-up period was 3.7 years (range 10 months-7 years). Patients with PSP having a lower BMI, and bilateral bleb/bullae formation are at higher risk for the development of SBPSP. SBPSP needs urgent assessment and management, and bilateral video-assisted thoracoscopic surgery is a safe and effective treatment.