Semin Respir Crit Care Med 2008; 29(4): 427-440
DOI: 10.1055/s-2008-1081285
© Thieme Medical Publishers

Pleural Interventions: Management of Acute and Chronic Pneumothorax

Najib M. Rahman1 , Robert J.O Davies1 , Fergus V. Gleeson2
  • 1Oxford Pleural Unit and Oxford University, Churchill Hospital, Oxford, United Kingdom
  • 2Department of Radiology, Churchill Hospital, Oxford, United Kingdom
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
23. Juli 2008 (online)

ABSTRACT

Pneumothorax is a common clinical entity that may present to a wide variety of medical specialties. Primary pneumothorax (in the presence of no known underlying lung disease) and secondary pneumothorax (in known lung disease) are distinct entities with varied etiology, treatment, and prognosis. Diagnosis is usually based on clinical history and basic radiology, but more advanced radiological techniques may be required in certain circumstances. There is relatively little evidence on which to base management decisions in patients with pneumothoraces, and many important aspects of management (e.g., aspiration vs intercostal drainage, chest drain size, use of suction) are often based on best practice and expert opinion. The etiology of pneumothorax will often inform the clinician whether a more conservative or more invasive approach is required. Radiological intervention techniques are valuable in the treatment of complicated pneumothoraces and in certain clinical situations.

REFERENCES

  • 1 Noppen M, De Waele M, Li R et al.. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage.  Am J Respir Crit Care Med. 2000;  162(3 Pt 1) 1023-1026
  • 2 Baumann M H, Noppen M. Pneumothorax.  Respirology. 2004;  9 157-164
  • 3 Sahn S A, Heffner J E. Spontaneous pneumothorax.  N Engl J Med. 2000;  342 868-874
  • 4 Light R W. Pneumothorax. In: Pleural Diseases. 4th ed. Philadelphia; Lippincott/Williams & Wilkins 2001: 284-319
  • 5 Gupta D, Hansell A, Nichols T, Duong T, Ayres J G, Strachan D. Epidemiology of pneumothorax in England.  Thorax. 2000;  55 666-671
  • 6 Melton III L J, Hepper N G, Offord K P. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.  Am Rev Respir Dis. 1979;  120 1379-1382
  • 7 Bense L, Eklund G, Wiman L G. Smoking and the increased risk of contracting spontaneous pneumothorax.  Chest. 1987;  92 1009-1012
  • 8 Sassoon C S, Light R W, O'Hara V S, Moritz T E. Iatrogenic pneumothorax: etiology and morbidity: results of a Department of Veterans Affairs Cooperative Study.  Respiration. 1992;  59 215-220
  • 9 Light R W. Management of spontaneous pneumothorax.  Am Rev Respir Dis. 1993;  148 245-248
  • 10 Withers J N, Fishback M E, Kiehl P V, Hannon J L. Spontaneous pneumothorax: suggested etiology and comparison of treatment methods.  Am J Surg. 1964;  108 772-776
  • 11 Baumann M H. Treatment of spontaneous pneumothorax.  Curr Opin Pulm Med. 2000;  6 275-280
  • 12 Cardy C M, Maskell N A, Handford P A et al.. Familial spontaneous pneumothorax and FBN1 mutations.  Am J Respir Crit Care Med. 2004;  169 1260-1262
  • 13 O'Rourke J P, Yee E S. Civilian spontaneous pneumothorax: treatment options and long-term results.  Chest. 1989;  96 1302-1306
  • 14 Shields T W, Oilschlager G A. Spontaneous pneumothorax in patients 40 years of age and older.  Ann Thorac Surg. 1966;  2 377-383
  • 15 Dines D E, Clagett O T, Payne W S. Spontaneous pneumothorax in emphysema.  Mayo Clin Proc. 1970;  45 481-487
  • 16 Light R W, O'Hara V S, Moritz T E et al.. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study.  JAMA. 1990;  264 2224-2230
  • 17 Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E. Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences.  Eur J Respir Dis. 1987;  71 365-371
  • 18 Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax.  Thorax. 2003;  58(Suppl 2) ii39-ii52
  • 19 Baumann M H, Strange C, Heffner J E et al.. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.  Chest. 2001;  119 590-602
  • 20 Mendis D, El-Shanawany T, Mathur A, Redington A E. Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed?.  Postgrad Med J. 2002;  78 80-84
  • 21 Jutley R S, Mason R, Cockburn J S. Discrepancies in the detection and management of spontaneous pneumothorax: eight years after publication of guidelines.  Scott Med J. 2001;  46 111-113
  • 22 Lesur O, Delorme N, Fromaget J M, Bernadac P, Polu J M. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax.  Chest. 1990;  98 341-347
  • 23 Bense L, Lewander R, Eklund G, Hedenstierna G, Wiman L G. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.  Chest. 1993;  103 433-438
  • 24 Donahue D M, Wright C D, Viale G, Mathisen D J. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax.  Chest. 1993;  104 1767-1769
  • 25 Smit H J, Wienk M A, Schreurs A J, Schramel F M, Postmus P E. Do bullae indicate a predisposition to recurrent pneumothorax?.  Br J Radiol. 2000;  73 356-359
  • 26 Warner B W, Bailey W W, Shipley R T. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax.  Am J Surg. 1991;  162 39-42
  • 27 Sihoe A D, Yim A P, Lee T W et al.. Can CT scanning be used to select patients with unilateral primary spontaneous pneumothorax for bilateral surgery?.  Chest. 2000;  118 380-383
  • 28 Cottin V, Streichenberger N, Gamondes J P, Thevenet F, Loire R, Cordier J F. Respiratory bronchiolitis in smokers with spontaneous pneumothorax.  Eur Respir J. 1998;  12 702-704
  • 29 Lichter I, Gwynne J F. Spontaneous pneumothorax in young subjects: a clinical and pathological study.  Thorax. 1971;  26 409-417
  • 30 Fujino S, Inoue S, Tezuka N et al.. Physical development of surgically treated patients with primary spontaneous pneumothorax.  Chest. 1999;  116 899-902
  • 31 Hatz R A, Kaps M F, Meimarakis G, Loehe F, Muller C, Furst H. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.  Ann Thorac Surg. 2000;  70 253-257
  • 32 Radomsky J, Becker H P, Hartel W. Pleural porosity in idiopathic spontaneous pneumothorax.  Pneumologie. 1989;  43 250-253
  • 33 Weissberg D, Refaely Y. Pneumothorax: experience with 1,199 patients.  Chest. 2000;  117 1279-1285
  • 34 Loubani M, Lynch V. Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous pneumothorax.  Respir Med. 2000;  94 888-890
  • 35 Korner H, Andersen K S, Stangeland L, Ellingsen I, Engedal H. Surgical treatment of spontaneous pneumothorax by wedge resection without pleurodesis or pleurectomy.  Eur J Cardiothorac Surg. 1996;  10 656-659
  • 36 Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax: with special reference to the ultrastructure of emphysematous bullae.  Chest. 1980;  77 771-776
  • 37 Noppen M, Dekeukeleire T, Hanon S et al.. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.  Am J Respir Crit Care Med. 2006;  174 26-30
  • 38 Baumann M H. Management of spontaneous pneumothorax.  Clin Chest Med. 2006;  27 369-381
  • 39 Currie G P, Alluri R, Christie G L, Legge J S. Pneumothorax: an update.  Postgrad Med J. 2007;  83 461-465
  • 40 Schramel F M, Golding R P, Haakman C D, Sutedja T G, de Jong K A, Postmus P E. Expiratory chest radiographs do not improve visibility of small apical pneumothoraces by enhanced contrast.  Eur Respir J. 1996;  9 406-409
  • 41 Glazer H S, Anderson D J, Wilson B S, Molina P L, Sagel S S. Pneumothorax: appearance on lateral chest radiographs.  Radiology. 1989;  173 707-711
  • 42 Carr J J, Reed J C, Choplin R H, Pope Jr T L, Case L D. Plain and computed radiography for detecting experimentally induced pneumothorax in cadavers: implications for detection in patients.  Radiology. 1992;  183 193-199
  • 43 Davies C L, Gleeson F V. Diagnostic radiology. In: Light RW, Lee YC Textbook of Pleural Diseases. 1st ed. London; Arnold 2003: 210-248
  • 44 Dulchavsky S A, Schwarz K L, Kirkpatrick A W et al.. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax.  J Trauma. 2001;  50 201-205
  • 45 Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.  Acad Emerg Med. 2005;  12 844-849
  • 46 Goodman T R, Traill Z C, Phillips A J, Berger J, Gleeson F V. Ultrasound detection of pneumothorax.  Clin Radiol. 1999;  54 736-739
  • 47 Slater A, Goodwin M, Anderson K E, Gleeson F V. COPD can mimic the appearance of pneumothorax on thoracic ultrasound.  Chest. 2006;  129 545-550
  • 48 Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraete A. Quantification of the size of primary spontaneous pneumothorax: accuracy of the Light index.  Respiration. 2001;  68 396-399
  • 49 Hoi K, Turchin B, Kelly A M. How accurate is the Light index for estimating pneumothorax size?.  Australas Radiol. 2007;  51 196-198
  • 50 Kelly A M, Loy J, Tsang A Y, Graham C A. Estimating the rate of re-expansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies.  Emerg Med J. 2006;  23 780-782
  • 51 Northfield T C. Oxygen therapy for spontaneous pneumothorax.  BMJ. 1971;  4 86-88
  • 52 Archer G J, Hamilton A A, Upadhyay R, Finlay M, Grace P M. Results of simple aspiration of pneumothoraces.  Br J Dis Chest. 1985;  79 177-182
  • 53 Ng A W, Chan K W, Lee S K. Simple aspiration of pneumothorax.  Singapore Med J. 1994;  35 50-52
  • 54 Andrivet P, Djedaini K, Teboul J L, Brochard L, Dreyfuss D. Spontaneous pneumothorax: comparison of thoracic drainage vs immediate or delayed needle aspiration.  Chest. 1995;  108 335-339
  • 55 Harvey J, Prescott R J. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee.  BMJ. 1994;  309 1338-1339
  • 56 Noppen M, Degreve J, Mignolet M, Vincken W. A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions.  Acta Clin Belg. 1997;  52 258-262
  • 57 Burgaud J C, Offenstadt G, Bencharif G, Hericord P, Amstutz P. Spontaneous pneumothorax: drainage by catheter or chest tube?.  Rev Pneumol Clin. 1985;  41 317-319
  • 58 Hernandez C, Zugasti K, Emparanza J et al.. Idiopathic spontaneous pneumothorax: treatment by small-caliber catheter aspiration compared to drainage though a chest tube.  Arch Bronconeumol. 1999;  35 179-181
  • 59 Wakai A, O'Sullivan R G, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults.  Cochrane Database Syst Rev. 2007;  (1) CD004479
  • 60 Marquette C H, Marx A, Leroy S et al.. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study.  Eur Respir J. 2006;  27 470-476
  • 61 Henry M T. Simple sequential treatment for primary spontaneous pneumothorax: one step closer.  Eur Respir J. 2006;  27 448-450
  • 62 So S Y, Yu D Y. Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?.  Thorax. 1982;  37 46-48
  • 63 Bevelaqua F A, Aranda C. Management of spontaneous pneumothorax with small lumen catheter manual aspiration.  Chest. 1982;  81 693-694
  • 64 Conces Jr D J, Tarver R D, Gray W C, Pearcy E A. Treatment of pneumothoraces utilizing small caliber chest tubes.  Chest. 1988;  94 55-57
  • 65 Minami H, Saka H, Senda K et al.. Small caliber catheter drainage for spontaneous pneumothorax.  Am J Med Sci. 1992;  304 345-347
  • 66 Vedam H, Barnes D J. Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax.  Intern Med J. 2003;  33 495-499
  • 67 Tsai W K, Chen W, Lee J C et al.. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults.  Am J Emerg Med. 2006;  24 795-800
  • 68 Rusch V W, Capps J S, Tyler M L, Pierson D L. The performance of four pleural drainage systems in an animal model of bronchopleural fistula.  Chest. 1988;  93 859-863
  • 69 Batchelder T L, Morris K A. Critical factors in determining adequate pleural drainage in both the operated and nonoperated chest.  Am Surg. 1962;  28 296-302
  • 70 Powner D J, Cline C D, Rodman Jr G H. Effect of chest-tube suction on gas flow through a bronchopleural fistula.  Crit Care Med. 1985;  13 99-101
  • 71 Clementsen P, Evald T, Grode G, Hansen M, Krag J G, Faurschou P. Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter: a prospective randomized study.  Respir Med. 1998;  92 593-596
  • 72 Saji H, Nakamura H, Tsuchida T et al.. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor.  Chest. 2002;  121 1521-1526
  • 73 Manhire A, Charig M, Clelland C et al.. Guidelines for radiologically guided lung biopsy.  Thorax. 2003;  58 920-936
  • 74 Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography.  AJR Am J Roentgenol. 2007;  188 37-41
  • 75 Covey A M, Gandhi R, Brody L A, Getrajdman G, Thaler H T, Brown K T. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients.  J Vasc Interv Radiol. 2004;  15 479-483
  • 76 Yeow K M, Su I H, Pan K T et al.. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies.  Chest. 2004;  126 748-754
  • 77 Laurent F, Michel P, Latrabe V, Tunon de L M, Marthan R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors.  AJR Am J Roentgenol. 1999;  172 1049-1053
  • 78 Topal U, Berkman Y M. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy.  Eur J Radiol. 2005;  53 495-499
  • 79 Yamagami T, Kato T, Iida S, Hirota T, Yoshimatsu R, Nishimura T. Efficacy of manual aspiration immediately after complicated pneumothorax in CT-guided lung biopsy.  J Vasc Interv Radiol. 2005;  16 477-483
  • 80 Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T. Management of pneumothorax after percutaneous CT-guided lung biopsy.  Chest. 2002;  121 1159-1164
  • 81 Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Usefulness and limitation of manual aspiration immediately after pneumothorax complicating interventional radiological procedures with the transthoracic approach.  Cardiovasc Intervent Radiol. 2006;  29 1027-1033
  • 82 Matsuura Y, Nomimura T, Murakami H, Matsushima T, Kakehashi M, Kajihara H. Clinical analysis of reexpansion pulmonary edema.  Chest. 1991;  100 1562-1566
  • 83 Reed M F, Lyons J M, Luchette F A, Neu J A, Howington J A. Preliminary report of a prospective, randomized trial of underwater seal for spontaneous and iatrogenic pneumothorax.  J Am Coll Surg. 2007;  204 84-90
  • 84 Schramel F M, Postmus P E, Vanderschueren R G. Current aspects of spontaneous pneumothorax.  Eur Respir J. 1997;  10 1372-1379
  • 85 Sadikot R T, Greene T, Meadows K, Arnold A G. Recurrence of primary spontaneous pneumothorax.  Thorax. 1997;  52 805-809
  • 86 Lippert H L, Lund O, Blegvad S, Larsen H V. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax.  Eur Respir J. 1991;  4 324-331
  • 87 Baldt M M, Bankier A A, Germann P S, Poschl G P, Skrbensky G T, Herold C J. Complications after emergency tube thoracostomy: assessment with CT.  Radiology. 1995;  195 539-543
  • 88 Wan I Y, Toma T P, Geddes D M et al.. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients.  Chest. 2006;  129 518-526
  • 89 Ferguson J S, Sprenger K, Van N T. Closure of a bronchopleural fistula using bronchoscopic placement of an endobronchial valve designed for the treatment of emphysema.  Chest. 2006;  129 479-481

Fergus V GleesonM.D. 

Department of Radiology, Churchill Hospital

Old Road, Headington, Oxford, UK OX3 7LJ

eMail: fergus.gleeson@nds.ox.ac.uk

    >