Fifty hospitalized patients with spontaneous pneumothorax have been reviewed during the past five years and six months. In view of the increasing incidence of this disease, we have realized its gradually growing importance to the examination and treatment of chest disease.
According to our data, spontaneous rupture of pleural blebs or bullae constitutes the most important cause of spontaneous pneumothorax.
As etiologic factors of spontaneous pneumothorax, active inflammation of a lung, particularly pulmonary tuberculosis, is not emphasized.
In terms of its incidence as broken down by age, patients in their twenties top the list with 28%, followed by those in their fifties, thus showing that its incidence assumes a sort of “two-peaks” pattern.
The causes of spontaneous pneumothorax among younger patients somewhat differ from those among older patients.
There is every reason to believe that the incidence of spontaneous pneumothorax among younger patients results, among other things, from the rupture of bullae or bleb due to constitutional factors without significant intratracheal pressure, and that the incidence among older patients involves also the rupture of emphysematous changes (bullae or blebs) of the lung induced by many other causes, such as coughing.
We have been led to believe the constitutional factors to be the cause of this disease, since the majority of these patients are twenty-five years old or younger, tall and slender, no other recognizable pulmonary diseases are found and the 11-OHCS levels in their blood are low. Moreover, this disease runs in the family, and we have experienced at least one case of spontaneous pneumothorax associated with Marfan's Syndrom.
In view of the fact that the method of treatment just using needle aspiration of pleural cavity results in a high rate of recurrence, we have made it our principle to use the method of catheter drainage and continuous suction (of the pleural cavity), in which no case of recurrence has been found.
However, thoracotomy and resection of blebs or bullae must be performed in the below-mentioned cases.
1. When no signs of pulmonary re-expansion are shown three days after drainage and continuous suction has been applied.
2. Younger patients with blebs and bullae observed through X-ray.
3. Patients with recurrent pneumothorax or chronic pneumothorax.
It must be noted at this point that since a patient who has his contralateral pulmonary function sharply reduced, e. g., a serious emphysematous case or contralateral pneumothorax developed during the operation, convalesces unsatisfactorily, the treatment with drainage, continuous suction and pleurodesis is preferable, and any thoracotomy must be resorted to with great caution.
