Spontaneous Pneumothorax: Treatment and Mortality

Abstract

The records of 76 patients from the Hospital of the University of Pennsylvania and 77 patients from the Philadelphia General Hospital with spontaneous pneumothorax have been analyzed for etiology, recurrence, mortality and method of treatment. There were a total of 176 episodes. One-hundred and eighteen patients (72.3 per cent of the total group) had no demonstrable pulmonary disease or blebs, usually found at the apex of the lung. This group was the youngest (average age 35 years), predominantly men (92 per cent) and the mortality rate was 2.5 per cent. Twenty-three patients (14.1 per cent) had pulmonary tuberculosis: their average age was 51 years; 91 per cent were men and the mortality rate was 17 per cent. Twelve patients (7.4 per cent) had underlying pneumonia. One-half of the group averaged 11 months in age, and the remainder of the group averaged 61 years. Two-thirds of the group were men and the mortality rate was 50 per cent. The miscellaneous group was comprised of ten patients (6.2 per cent). The average age was 69 years, six were men and there were two deaths. The largest group of the patients were treated by closed tube thoracotomy (46 per cent of the episodes); 28.4 per cent of the pneumothoraces were treated by the expectant method; 13.1 per cent by either pleurectomy or wedge resection and 12.5 per cent by thoracentesis. Patients with recurrent episodes of pneumothorax, bilateral pneumothorax, massive hemopneumothorax, persistent air leak, or failure of lung to expand promptly with lesser procedures should be treated by open thoracotomy and pleurectomy.