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J Korean Soc Emerg Med > Volume 8(1); 1997 > Article
Journal of The Korean Society of Emergency Medicine 1997;8(1): 42-51.
A CLINICAL EVALUATION OF SPONTANEOUS PNEUMOTHORAX
Jeong Heon Lee, Jong Kun Kim, Kang Suk Seo, Young Kook Yun
Department of Emergency Medicine, College of Medicine, Kyungpook University, Korea.
ABSTRACT
Spontaneous pneumothorax is an accumulation of air in the pleural space with collapse of the lungs in the absence of external chest trauma. In this study, 175 cases of spontaneous pneumothorax experienced at emergency room of Kyungpook University Hospital from July 1995 to June 1996 were analyzed retrospectively. The results were summarized follows: 1. Sex ratio of male to female was 6.6:1 and the mean age was 36.7 years. 2. In clinical symptoms, dyspnea was 85 cases(48.6%), chest pain 67 cases(38.3%), chest discomfort 18 cases(10.3%), coughing 2 cases(1.1%), and others 3 cases(1.7%). 3. In etiology of spontaneous pneumothorax, primary spontaneous pneumothorax was 118 cases(67.4%) and secondary spontaneous pneumothorax 57 cases(33.6%). The underlying pathologic lesion of secondary spontaneous pneumothorax showed pulmonary tuberculosis in 50 cases(28.6%), COPD in 5 cases(2.9%), bronchial asthma in 1 case(0.6%), and pneumoconiosis in 1 case(0.6%). 4. The incidence of recurrence was as follows; no previous history in 123 cases(70.3%), second attack in 35 cases(20.0%), third attack in 15 cases(8.6%), fourth attack in 1 case(0.6%), and fifth attack in 1 case(0.6%). 5. The interval of recurrence after last attack was as follows; less than 6 months in 36 cases(69.2%), between 6 months and 1 year in 5 cases(9.6%), between 1 and 2 years in 3 cases(5.8%), between 2 and 3 years in 2 cases(3.8%), and greater than 3 years in 6 cases(11.5%). 6. In distribution of the lesion sites, left was 93 cases(53.1%), right 80 cases(45.7%), and bilateral 2 cases(1.1%). 7. In degree of lung collapse, 17 cases(9.7%) were small(<20%), 127 cases(72.6%) moderate(20-40%), and 31 cases(17.7%) large(>40%). 8. The accompanied diseases of spontaneous pneumothorax were found in 17 cases, in which hydrothorax were 14 cases and hemothorax were 3 cases. 9. The employed management were as follows; bed rest with oxygen inhalation in 6 cases(3.4%), thoracentesis in 4 cases(2.3%), closed thoracostomy in 136 cases(77.7%), and open thoracotomy in 29 cases(16.6%). 10. The reexpansion time after chest tube insertion was as follows; less than 1 day in 147 cases (89.6%), between 1 and 2 days in 12 cases(7.3%), between 2 days and 1 week in 4 cases(2.4%), and greater than 1 week in 1 case(0.6%). 11. The duration of chest tube insertion was as follows; less than 1 week in 102 cases(62.2%), between 1 and 2 weeks in 34 cases(20.7%), between 2 and 3 weeks in 14 cases(8.5%), between 3 and 4 weeks in 7 cases(4.3%), and greater than 4 weeks in 7 cases(4.3%). 12. The complications of closed thoracostomy were as follows; incomplete lung expansion in 4 cases and empyema in 1 case. 13. The indications of open thoracotomy were as follows; bleb or bullae on chest X-ray in 12 cases (41.4%), persistent air leak in 8 cases(27.6%), recurrent pneumothorax in 4 cases(13.8%), incomplete lung expansion in 3 cases(10.3%), and contralateral pneumothorax history in 2 cases(6.9%). 14. The duration of hospitalization was as follows; less than 1 week in 100 cases(57.1%), between 1 and 2 weeks in 29 cases(16.6%), between 2 and 3 weeks in 22 cases(12.6%), between 3 and 4 weeks in 9 cases(5.1%), and greater than 4 weeks in 15 cases(8.6%).
Key words: Spontaneous pneumothorax
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