Contralateral bulla neogenesis associated with postoperative recurrences of primary spontaneous pneumothorax in young patients

ObjectivesThe incidence of primary spontaneous pneumothorax is partly unknown. Commonly quoted estimates were published decades ago and recent large-scale epidemiological publications lack validation. We validated the pneumothorax diagnosis in a national registry and estimated the incidence of primary spontaneous pneumothorax in young patients.MethodsComplete data on patients with an assigned pneumothorax diagnosis was retrieved from the National Danish Patient Registry. Initially, we validated the diagnosis in a selected population: all patient charts with an assigned pneumothorax diagnosis from one cardiothoracic department over a 25-year period (1984–2008) were reviewed. Subsequently, the national incidence of primary spontaneous pneumothorax in young, healthy individuals was estimated by restricting our population to patients ≤40 years of age admitted during a 5-year period (2009–2014). We performed a systematic read-though of patient charts in 50% of the complete national cohort to ensure that we only included patients with their first episode of primary spontaneous pneumothorax.ResultsValidation revealed a poor inter-rater agreement (κ=0.08). Therefore, we abstained from further analysis on directly retrieved data from the national database. Subsequently, a systematic re-evaluation of 7022 patients revealed an incidence rate of 12.3 cases per 100 000 (95% CI 11.5–13.1) in males and 2.2 cases per 100 000 (95% CI 1.9–2.6) in females (male/female ratio 5.9). Compared with the general Danish population, pneumothorax patients had a lower body mass index (p<0.001) and smoked more than the Danish population in general (p<0.001).ConclusionsThe incidence of primary spontaneous pneumothorax in a validated national study was lower than previously reported.

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A novel finding related to bulla and bleb formation in patients with primary spontaneous pneumothorax

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01402-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Akira Iyoda ◽

Yoko Azuma ◽

Takashi Sakai ◽

Satoshi Koezuka ◽

Hajime Otsuka ◽

...

Keyword(s):

Clinical Finding ◽

Spontaneous Pneumothorax ◽

Smoking Status ◽

Young Patients ◽

Primary Spontaneous Pneumothorax ◽

Control Group ◽

The Novel ◽

Clinical Factors ◽

Bleb Formation ◽

And Control

Abstract Background Spontaneous pneumothorax is a common problem globally. Bullas and blebs have been implicated in this problem, but the etiology of their formation is unknown. We aim to show the relation between a novel clinical finding, the pulmonary delayed inflation (PDI) sign, and the etiology of bulla and bleb formation in young patients. Methods We retrospectively analyzed data from 111 patients with pneumothorax and a control group of 27 patients. We evaluated the relation between the PDI sign and other clinical factors. Results The PDI sign was observed in 78 patients. Of these, 75 exhibited the PDI sign in only the upper lobe. Regardless of smoking status, patients 34 years of age or younger had a significantly higher incidence of the PDI sign than, patients 55 years of age or older and control patients. The inflation time in patients 34 years of age or younger, regardless of smoking status, was significantly longer than in patients 55 years of age or older and patients in the control group. There was no significant association between inflation time and the presence of asthma. Conclusions The novel PDI sign is seen in patients 34 years of age or younger. Because this sign may indicate a peripheral bronchial abnormality and may be related to the formation of blebs and bullae in young patients with spontaneous pneumothorax, it is possible that it can be used to develop effective treatments for pneumothorax in young patients.

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Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2006.147546 ◽

2006 ◽

Vol 6 (1) ◽

pp. 117-120 ◽

Cited By ~ 32

Author(s):

I. Hunt ◽

B. Barber ◽

R. Southon ◽

T. Treasure

Keyword(s):

Spontaneous Pneumothorax ◽

Young Patients ◽

Primary Spontaneous Pneumothorax ◽

Talc Pleurodesis

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Epidemiology and management of primary spontaneous pneumothorax: a systematic review

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz290 ◽

2019 ◽

Vol 30 (3) ◽

pp. 337-345

Author(s):

Paolo Mendogni ◽

Jacopo Vannucci ◽

Marco Ghisalberti ◽

Marco Anile ◽

Beatrice Aramini ◽

...

Keyword(s):

Systematic Review ◽

Thoracic Surgery ◽

Surgical Approach ◽

Spontaneous Pneumothorax ◽

Young Patients ◽

Primary Spontaneous Pneumothorax ◽

First Episode ◽

Inert Material ◽

Chest Drainage ◽

Clinical Trial Registration

Abstract Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients. Clinical trial registration number International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.

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