Age and Clinical Presentation for Primary Spontaneous Pneumothorax

Ghisalberti, Marco; Guerrera, Francesco; Vico, Andrea De; Bertolaccini, Luca; Palma, Angela De; Fiorelli, Alfonso; Paladini, Piero; Ruffini, Enrico; Crisci, Roberto; Nosotti, Mario; Mendogni, Paolo

doi:10.1016/j.hlc.2020.05.107

Cited by 15 publications

(10 citation statements)

References 24 publications

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“…Environmental factors, such as smoke exposure, may increase the risk for PSP. 25 Compared with non-smokers, the relative risk of a pneumothorax is 4 to 7 times higher in light smokers (1-12 cigarettes/day) and up to 100 times higher in heavy smokers (>22 cigarettes/day). 26 There also are reported associations between cannabis smoking and/or vaping and PSP, but they are confounded by concomitant tobacco smoking.…”

Section: Pathophysiologymentioning

confidence: 95%

“…"Pleural porosity" is the concept that mesothelial cells on the visceral pleura are thought to be replaced by a more porous inflammatory layer that allows air leakage into the pleural space. 24 In addition, as adolescents with PSP frequently have tall, asthenic body types, 25 investigators have speculated that rapid longitudinal growth during adolescence generates greater distending pressure in the lung apex. 6,9,11 Whether greater porosity or greater distending pressures subsequently lead to the formation of blebs or bullae, or contribute to the development of a pneumothorax in individuals who already have localized ultrastructural defects, is unclear.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The primary symptom associated with the development of PSP is chest pain (Table 1). [5][6][7][8][9][10][11]25 Chest pain typically has an acute onset and is localized to the side of the pneumothorax. Bilateral pneumothoraces are unusual and reported in only 1.3% of cases.…”

Section: Presentationmentioning

confidence: 99%

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An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

Wilson

Rymeski

et al. 2021

JACEP Open

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Primary spontaneous pneumothorax (PSP) is a relatively common problem in emergency medicine. The incidence of PSP peaks in adolescence and is most common in tall, thin males. Recent advances in the care of patients with PSP have called into question traditional approaches to management. This clinical review highlights the changing management strategies for PSP and concludes with a proposed evidence-based pathway to guide the care of adolescents with PSP.

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Section: Pathophysiologymentioning

confidence: 95%

Section: Pathophysiologymentioning

confidence: 99%

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An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

Wilson

Rymeski

et al. 2021

JACEP Open

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“…Primary spontaneous pneumothorax (PSP) is defined as the spontaneous presence of air in the pleural space of patients without clinically apparent underlying lung disease (1). It is generally believed that PSP occurs in tall and thin males during adolescence and early adulthood (2)(3)(4)(5). Spontaneous rupture of subpleural blebs/bullae is commonly believed to be the major cause of PSP (5); subpleural blebs have been reported to be found in 76-100% of patients during videoassisted thoracoscopic surgery (6).…”

Section: Introductionmentioning

confidence: 99%

Parietal pleural small holes found in patients with primary spontaneous pneumothorax associated with relatively mild chest wall flatness: a retrospective study

Shiiya¹,

Tanaka²,

Sakuraba³

et al. 2022

J Thorac Dis

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Background: During surgery for spontaneous pneumothorax, parietal pleural small holes (PPSHs) are occasionally found around the apex of the intrapleural space; however, this has not been well recognized.Additionally, chest wall flatness is usually observed in patients with primary spontaneous pneumothorax (PSP) and PPSHs. This study aimed to investigate the prevalence of PPSH and evaluate the characteristics of patients with PPSH. We also investigated the degree of chest wall flatness in patients with PPSHs. Methods:We retrospectively reviewed all patients who underwent thoracoscopic surgery for pneumothorax at our department between April 2014 and May 2021. A propensity-matched analysis was used to compare the characteristics of patients with and without PPSH.Results: A total of 490 patients were enrolled in this study. PPSH was found in 45 of 297 (15.2%) patients with PSP and one of 193 (0.5%) patients with secondary pneumothorax. PSP was independently associated with the presence of PPSH after adjusting for age and sex [primary/secondary, odds ratio (OR) =34.3, 95% confidence interval (CI) =4.7-250.9; P<0.001]. Among patients with PSP, the flatness of the chest wall in patients with PPSH was not as severe as that in patients without PPSH {thoracic anteroposterior diameter (APDT) to transverse diameter (TDT) ratio; with PPSH: median =0.517 [interquartile range (IQR) =0.480-0.554] vs. without PPSH: median =0.487 (IQR =0.463-0.529; P=0.031)} after propensity score matching.Conclusions: PPSH is found in a non-negligible proportion of patients with PSP, and patients with PPSHs show a relatively mild flat chest among patients with PSP. Clinicians should be aware of PPSH, and further understanding of this condition may contribute to a better understanding of PSP.

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“…In Taiwan, the incidence of SP ranged 5.05 to 7.18 per 100,000 population, and the highest risk was 15-22 years with the incidence rates > 11/100,000 [2]. Most patients with SP manifested pain and dyspnea [3]. The tobacco smoking is a major risk factor for primary SP; chronic obstructive pulmonary disease is most frequently associated with secondary SP [4].…”

Section: Introductionmentioning

confidence: 99%

Risk of diaphragmatic hernia in patients with spontaneous pneumothorax

et al. 2022

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Background Few studies have implied the incidence of diaphragmatic hernia (DH) after spontaneous pneumothorax (SP) with unknown mechanisms. The current study aimed to identify whether there is an association between the DH and SP. Methods We selected 46,897 patients with SP (SP cohort) and 46,897 without SP (non-SP matched cohort) from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence of DH and its association with SP were assessed after stratifying different characteristics and comorbidities. Statistical analysis including chi-square test, t-test, cox proportional hazard model, and Kaplan–Meier method were used. Results The results suggested there were significant associations between SP and DH, especially in the subgroup of patients with older age (aged 40–64 years: 2.61-fold in adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.27–5.36; aged > 65 years: 1.97-fold in aHR, 95% CI 1.43–2.71), male sex (2.11-fold in aHR, 95% CI 1.56–2.85), hypertension (2.05-fold in aHR, 95% CI 1.30–3.23), diabetes mellitus (2.58-fold in aHR, 95% CI 1.37–4.86), and smoking-related disease (1.86-fold in aHR, 95% CI 1.28–2.71). The SP cohort has significantly correlated with DH within 5-year follow-up (< 2 years: 3.22-fold in aHR, 95% CI 2.10–4.94; 2–5 years: 1.70-fold in aHR, 95% CI 1.05–2.75). Conclusions The SP cohort had a higher incidence of DH than the non-SP matched cohort. A prospective study of indications based on the findings of the current research should be performed.

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Age and Clinical Presentation for Primary Spontaneous Pneumothorax

Cited by 15 publications

References 24 publications

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

Parietal pleural small holes found in patients with primary spontaneous pneumothorax associated with relatively mild chest wall flatness: a retrospective study

Risk of diaphragmatic hernia in patients with spontaneous pneumothorax

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