Evaluation of aetiology and treatment outcome of spontaneous pneumothorax

Introduction: Pneumothorax is defined as accumulation of air in the pleural space with secondary lung collapse. They can either be spontaneous, traumatic, or iatrogenic. A PSP occurs in individuals with no known underlying pulmonary disease, while a Secondary Spontaneous Pneumothorax (SSP) develops in patients with underlying lung disease. Material and Methods: All the patients above 18 years and admitted to the hospital with a diagnosis of SP were included. All cases of spontaneous pneumothorax with pregnancy, significant heart diseases, coagulopathies, diabetes mellitus were not included. Any case without consent or chest CT were excluded. A total of 62 patients(Male patients-55), with 70 episodes of SP were enrolled in the study. Results: There was smoking history in majority of patients and their details are given in. PSP was diagnosed in 72.72% of patients aged less than 30 years where as SSP was diagnosed in those over 40 years. Dyspnoea was the commonest symptom at presentation in 58 (93.54%) patients followed by pleuritic chest pain in 49 (79.03%) patients. The commonest risk factor of SSP was COPD 38.7% (n:24) followed by pulmonary tuberculosis 30.6%( n=19), Bronchiectasis in 6.45% (n:4) and pyogenic infections in 4.83%(n=3) and interstitial lung disease in1.61%(n=1). In our study, pulmonary tuberculosis was the second most frequent casuse of SSP. The treatment options available for spontaneous pneumothorax are observation, supple-mentary oxygen, simple aspira-tion, tube thoracos-tomy, tube thoracostomy with instillation of sclero-sant, thoracoscopy, and open thoractomy. 15 This study revealed that most of the patients had resolution of pneumothorax within 2-3 weeks of chest intubation. It can be concluded that if the pneumothorax does not resolve within this period, then surgical intervention is advisable. Conclusion: PSP is primarily a disease of young people and is predominant in males. PSP is usually caused by the rupture of the subpleural bleb which are usually multiple and mostly occur at lung apices. It is well established that smoking increases the risk of contracting first pneumothorax. SSP is most often associated COPD. In our country, Pulmonary tuberculosis is a common cause of secondary pneumothorax. Rupture of subpleural tuberculous lesion or cavities are believed to be responsible for development of pneumothorax but the exact mechanism of SSP in pulmonary TB is unclear.