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CHEST: "Pneumothorax"

Authors:

Dov Weissberg, MD, FCCP and Yael Refaely, MD

* From the Department of Thoracic Surgery (Dr. Rafaely), Tel Aviv University Sackler School of Medicine, Tel Aviv; and E. Wolfson Medical Center (Dr. Weissberg), Holon, Israel.


Correspondence to: Dov Weissberg, MD, FCCP, E. Wolfson Medical Center, Holon 58100, Israel.

Objective:

To study the outcome of pneumothorax managed in a university-affiliated metropolitan medical center.

Design:

A retrospective review.

Setting:

Busy metropolitan medical center.

Patients and methods: Records of 1,199 patients with pneumothorax were reviewed and analyzed.

Results:

Primary spontaneous pneumothorax occurred in 218 patients, secondary spontaneous pneumothorax occurred in 505, traumatic in 403, and iatrogenic in 73. Ninety-six patients with small pneumothorax (8%) were managed by observation, and 1,103 patients (92%) were managed by tube thoracostomy. Drainage of the pleural cavity was continued for 1 to 7 days in 893 patients (81%), 8 to 10 days in 176 patients (16%), and >]]]] 10 days in 34 patients (3%). Drainage for >]]]] 10 days was classified as persistent pneumothorax. In these 34 patients and in 132 others with a second ipsilateral recurrence (a total of 166 patients), direct pleuroscopy was performed. The pleuroscopy findings and further management are outlined in the algorithm.

Conclusions:

Pneumothorax is a common condition affecting all age groups. If the volume of the pneumothorax is >]]]] 20% of the pleural space, pleural drainage is indicated. For management of persistent or recurrent pneumothorax, the use of pleuroscopy (direct or video-assisted) is of great value and should be part of routine management.

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