Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax

Menstrual History is Important for Diagnosing Catamenial Pneumothorax and Hemoptysis

“…Bronchial cytologic confirmation for catamenial hemoptysis was < 30%, since catamenial hemoptysis was mostly present as pleural sites of thoracic endometriosis [3].…”

“…Catamenial hemoptysis is often confused with pulmonary arteriovenous malformation; therefore, some cases require confirmation by bronchial cytology [3].…”

Surgery for primary spontaneous pneumothorax

“…The first point of discussion is the appropriate time to proceed with surgery in patients with PSP. There is an agreement that a final solution should be offered to the patient in case of recurrent ipsilateral PSP, simultaneous bilateral PSP, episode of PSP following a previous episode of contralateral PSP, first episode of tension pneumothorax, significant spontaneous hemopneumothorax at first episode, persistent air leak through the chest tube for more than 5-7 days or failure of the lung to re-expand despite adequate pleural space drainage in the first episode (3)(4)(5)(6). In addition, surgery at first episode of PSP should be offered in specific groups or individual patients with certain characteristics.…”

“…In the recently published statement by the European Respiratory Society and the guidelines published by the Spanish Society of Pulmonology and Thoracic Surgery on diagnosis and treatment of PSP, it is well noted that VATS bullectomy/pleurodesis has similar recurrence rates with that of open thoracotomy. This fact is explained by the larger experience obtained with the VATS procedures throughout the years (4,6).…”

“…The main important variances are first, the resection or not of the lung apex in the absence of obvious blebs/bullae and second, the technique used to obtain a permanent pleurodesis. Parietal pleurectomy of various extent (apical or subtotal or of any other extent), pleural abrasion, chemical pleurodesis with talc or other agent (i.e., povidone-iodine, as described in the commented article) are the acceptable and commonly employed techniques to perform pleurodesis (3)(4)(5)(6)(7)(8)13,14). Parietal pleurectomy is considered the best technique to achieve pleurodesis, however it has the disadvantage of possible bleeding resulting in the formation of clotted hemothorax (7).…”