Multi-institutional retrospective cohort study of spontaneous pneumothorax

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

It is generally accepted that primary spontaneous pneumothorax (PSP) is found mostly in tall, thin young males. However, the precise etiology of PSP is unclear. We compared some thoracic structural angles of PSPs and controls in young males to determine the predominant factor. CT data of 43 male PSPs (age 21.88 ± 5.30) and 30 controls (age 21.47 ± 5.47) were collected. The angle of thoracic vertebrae slope (∠α), sternal slope angle (∠β), and tracheal-sternal stem angle (∠γ) were measured in the sagittal position. Carina angle (∠δ) was measured in the coronal position. After a propensity score match (PSM) of age and smoking history, the angles were comparatively evaluated. There were significant differences in all four angles between two unmatched groups, while only in three (∠β, ∠γ, and ∠δ) after PSM was performed. The correlation between ∠β and PSP was most significant, and R² was 0.456. The prediction accuracy of ∠β was 81.3%, OR was 1.386, 95% confidence interval was (1.095-1.754). The sternal slope angles in PSPs are greater than controls indicate the sternal slope angle is associates with the development of PSP and it could be a thoracic structural index to predict the risk of PSP occurrence. Clin. Anat. 33:605-609, 2020. © 2019 Wiley Periodicals, Inc.

[Management of spontaneous pneumothorax: about 138 cases]

Pneumothorax is a collection of air in the pleural cavity. We conducted a retrospective study of patients with spontaneous pneumothorax in the Department of Pneumology at the Ibn Sina Hospital in Rabat (2009-2011) with the aim to determine the epidemiological, clinical, radiological, therapeutic and evolutionary manifestation of spontaneous pneumothorax. The study involved 138 patients: 128 men and 10 women (17-83 years), with an average age of 44.5 +/- 17.4 years and sex ratio of 12/8. 81.2% of patients were smokers. Clinical symptomatology was chest pain (92%), dyspnea (60%). Chest radiograph showed total unilateral (110 cases); partial (10 cases); localized (6 cases); bilateral (4 cases); right (51.4%) or left (45.7%) PNO (pneumothorax). During our study period we found that 70% of patients had spontaneous primitive pneumothorax and 30% had PNO secondary to Chronic obstructive pulmonary disease (COPD) (44%) and pulmonary tuberculosis (TB) (39%). Initial management included patients hospitalization, chest drainage (95%), needle exsufflation (1%), rest and O2 (4%). It enables the lung to stick to the chest wall within 10 days in 63% of patients. Evolution was favorable in 89% of patients. Immediate complications included: subcutaneous emphysema (5 cases); infection (6 cases) and 3 deaths (cardiorespiratory arrest). Late complications included: recurrences in 11.6%; the first recurrence occurred in 13 cases (chest drainage in 11 cases and oxygen therapy in 2 cases) while the second recurrence occurred in 3 cases (surgery). This study shows the role of chest drainage and monitoring in the management of pneumothorax to avoid complications and especially to prevent recurrences, with a possible need to resort to surgery.

Pneumothorax-associated fibroblastic lesion in combination with localized pleural angiomatosis: A possible cause of juvenile spontaneous hemopneumothorax

Spontaneous hemopneumothorax is an uncommon but potentially life-threatening condition, with a potential for a rapid ventilatory collapse and a large collection of hidden blood loss into the pleural cavity. Here, we report the first case in the literature on pneumothorax-associated fibroblastic lesion in combination with localized pleural angiomatosis in a 19-year-old Caucasian male, resulting in massive spontaneous hemopneumothorax and hypovolemic shock. Our findings support a causal link between this condition and pneumothorax. The possible superimposed hemothorax is explainable by the pleural involvement of large angiomatous vessels, prone to rupture.

Rapid increase in the height and width of the upper chest in adolescents with primary spontaneous pneumothorax

BACKGROUND

We determined the chest height in a cohort of patients with primary spontaneous pneumothorax (PSP) who had received chest radiographic examinations prior to the attack. The aim of this study was to determine when their chest height began to change and how this was related to the PSP.

METHODS

From June 2009 to February 2012, the chest posteroanterior radiographs of 156 patients with PSP (Group 1) were reviewed. Among another 3134 patients with PSP, we identified 52 patients who had a chest posteroanterior radiograph prior to the attack (Group 2). We also recruited 196 controls for comparison (Group 3). The chest height and chest width at different levels were measured and analyzed.

RESULTS

Before 14 years of age, the chest height of patients in Group 2 was no different from that of patients in Group 3. By the age of 14 years, however, the chest height and upper chest width of patients with PSP was significantly higher than that of the normal controls. The difference from normal chest height did not increase at adulthood.

CONCLUSION

The rapid increase in chest height and upper chest width is a unique finding in patients with PSP. It might be attributable to the occurrence of PSP. This finding may also help to identify patients who are at risk of PSP.