*Indications of Surgery in Pneumothorax DOI: http://dx.doi.org/10.5772/intechopen.88640*

[17] Light RW. Pleural Diseases. 6th ed. Philadelphia: Lippincott, Williams and Wilkins; 2013

[18] Sadikot RT, Greene T, Meadows K, Arnold AG. Recurrence of primary spontaneous pneumothorax. Thorax. 1997;**52**:805

[19] Guo Y, Xie C, Rodriguez RM, Light RW. Factors related to recurrence of spontaneous pneumothorax. Respirology. 2005;**10**:378

[20] Hsu HH, Chen JS. The etiology and therapy of primary spontaneous pneumothoraces. Expert Review of Respiratory Medicine. 2015;**9**(5):655-665

[21] Roberts DJ, Leigh-Smith S, Faris PD, Blackmore C, Ball CG, Robertson HL, et al. Clinical presentation of patients with tension pneumothorax: A systematic review. Annals of Surgery. 2015;**261**(6):1068-1078

[22] Dagnegård HH, Rosén A, Sartipy U, Bergman P. Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax. Scandinavian Cardiovascular Journal. 2017;**51**(4):228-232

[23] Joshi V, Kirmani B, Zacharias J. Thoracotomy versus VATS: Is there an optimal approach to treating pneumothorax? Annals of the Royal College of Surgeons of England. 2013;**95**(1):61-64

[24] Schramel FM, Sutedja TG, Braber JC, van Mourik JC, Postmus PE. Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax. The European Respiratory Journal. 1996;**9**:1821-1825

[25] Torresini G, Vaccarili M, Divisi D, Crisci R. Is video-assisted thoracic surgery justified at first spontaneous

pneumothorax? European Journal of Cardio-Thoracic Surgery. 2001;**20**:42-45

[26] Chou SH, Cheng YJ, Kao EL. Is video-assisted thoracic surgery indicated in the first episode primary spontaneous pneumothorax? Interactive Cardiovascular and Thoracic Surgery. 2003;**2**:552-554

[27] Margolis M, Gharagozloo F, Tempesta B, Trachiotis GD, Katz NM, Alexander EP. Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients. The Annals of Thoracic Surgery. 2003;**76**:1661-1663

[28] Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: Evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest. 2005;**127**:2226-2230

[29] Chen JS, Hsu HH, Tsai KT, Yuan A, Chen WJ, Lee YC. Salvage for unsuccessful aspiration of primary pneumothorax: Thoracoscopic surgery or chest tube drainage? The Annals of Thoracic Surgery. 2008;**85**:1908-1913

[30] Ahmedzai S, Balfour-Lynn IM, Bewick T, et al. Managing passengers with stable respiratory disease planning air travel: British thoracic society recommendations. Thorax. 2011;**66**(Suppl. 1):i1-i30

[31] Hu X, Cowl CT, Baqir M, et al. Air travel and pneumothorax. Chest. 2014;**145**:688-694

[32] Duchateau FX, Legrand JM, Verner L, et al. Commercial aircraft repatriation of patients with pneumothorax. Air Medical Journal. 2013;**32**:200-202

[33] Smit HJM, Chatrou M, Postmus PE. The impact of spontaneous pneumothorax, and its treatment, on the smoking behaviour of young

**10**

*Pneumothorax*

**References**

[1] Noppen M, De Keukeleire T. Pneumothorax. Respiration.

[10] Kim MJ, Park I, Park JM, et al. Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods. PLoS ONE.

[11] Harvey J, Prescott RJ. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee. BMJ.

[12] Andrivet P, Djedaini K, Teboul JL, et al. Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration.

[13] Noppen M, Alexander P, Driesen P, et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: A multicenter, prospective, randomized pilot study. American Journal of

Respiratory and Critical Care Medicine.

[14] Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: A randomised study. The European Respiratory Journal.

[15] Parlak M, Uil SM, van den Berg JW. A prospective, randomised trial of pneumothorax therapy: Manual aspiration versus conventional chest tube drainage. Respiratory Medicine.

[16] Korczyński P, Górska K,

Nasiłowski J, et al. Comparison of small bore catheter aspiration and chest tube drainage in the management of spontaneous pneumothorax. Advances in Experimental Medicine and Biology.

2017;**12**:e0178802

1994;**309**:1338-1339

Chest. 1995;**108**:335-339

2002;**165**:1240-1244

2006;**27**:477-482

2012;**106**:1600-1605

2015;**866**:15-23

[2] Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Thorax. 2000;**55**(8):666-671

[3] Noppen M. Spontaneous pneumothorax: Epidemiology, pathophysiology and cause. European Respiratory Review.

[4] Won Choi II. Pneumothorax. Tuberculosis Respiratory Disease.

[5] MacDuff A, Arnold A, Harvey J. Management of spontaneous

pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax.

[6] Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, et al. ERS task force statement: Diagnosis and treatment of primary spontaneous

Respiratory Journal. 2015;**46**(2):321-335

[8] Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax.

[9] Wakai A, O'Sullivan RG, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database of Systematic Reviews.

2010;**19**(117):217-219

2014;**76**(3):99-104

2010;**65**(Suppl 2):ii18-ii31

pneumothorax. The European

[7] Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest.

2001;**119**:590-602

2007;**1**:CD004479

2003;**58**(Suppl 2):ii39-ii52

2008;**76**(2):121-127

adult smokers. Respiratory Medicine. 1998;**92**:1132-1136

[34] Hedevang Olesen W, Katballe N, Sindby JE, Titlestad IL, Andersen PE, Ekholm O, et al. Cannabis increased the risk of primary spontaneous pneumothorax in tobacco smokers: A case-control study. European Journal of Cardio-Thoracic Surgery. 2017;**52**(4):679-685

[35] Elsayed H, Kent W, McShane J, Page R, Shackcloth M. Treatment of pneumothoraces at a tertiary Centre: Are we following the current guidelines? Interactive Cardiovascular and Thoracic Surgery. 2011;**12**(3):430-433

[36] Kelly AM, Clooney M. Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia. Internal Medicine Journal. 2008;**38**(1):64-67

[37] Yoon J, Sivakumar P, O'Kane K, Ahmed L. A need to reconsider guidelines on management of primary spontaneous pneumothorax? International Journal of Emergency Medicine. 2017;**10**:9

[38] Kelly AM, Drudy D. Comparison of size classification of primary spontaneous pneumothorax by three international guidelines: A case for international consensus? Respiratory Medicine. 2008;**102**(12):1830-1832

[39] Salazar AJ, Aguirre DA, Ocampo J, Camacho JC, Díaz XA. Evaluation of three pneumothorax size quantification methods on digitized chest X-ray films using medical-grade grayscale and consumer-grade color displays. Journal of Digital Imaging. 2014;**27**(2):280-286

[40] Elsayed H, Roberts R, Emadi M, Whittle I, Shackcloth M. Chest drain insertion is not a harmless procedure: Are we doing it safely? Interactive Cardiovascular and Thoracic Surgery. 2010;**11**(6):745-748

**13**

**Chapter 2**

**Abstract**

Challenge

*and Estefania Quijano*

Primary Spontaneous

Pneumothorax, a Clinical

video-assisted thoracoscopic surgery (VATS), or open surgery.

**Keywords:** pneumothorax, pleural cavity, chest tube drainage,

video-assisted thoracoscopic surgery

**1. Introduction**

*Fabian Andres Giraldo Vallejo, Rubby Romero, Melissa Mejia*

Primary spontaneous pneumothorax (PSP) is a common disease in medical practice that affects young healthy people with a significant recurrence rate. PSP is the presence of air in the pleural space not caused by injury or medical intervention. Some risk factors include male gender, age, and smoking. Classic clinical presentation starts with acute-onset chest pain and shortness of breath. Physical examination can be normal in small pneumothoraces, but in larger pneumothoraces, breath sounds and tactile fremitus are typically decreased or absent, and percussion is hyperresonant. Chest X-ray can help confirm the diagnosis. Evacuation of air from the pleural cavity and prevention of future recurrences are the primary goals of treatment and depend on the patient's presentation. Initial deciding factors to direct the management are first-time or recurrent spontaneous pneumothorax and size of the pneumothorax. Treatment may include conventional chest tube drainage,

Pneumothorax is defined as an abnormal collection of air in the pleural cavity, which is a potential space between the two pleurae (visceral and parietal) of the lungs [1]. Itard, a student of Laennec, first coined pneumothorax in 1803, but it was not until 1932 that it was realized that spontaneous pneumothorax was not always caused by tuberculosis. Pneumothorax is classified as spontaneous, traumatic, or iatrogenic (**Figure 1**). Primary spontaneous pneumothorax (PSP) occurs in patients without underlying lung disease or without a precipitating event, and it is a common disease in medical practice with a significant global health problem affecting adolescent and young adults. Notwithstanding the absence of pulmonary disease, many of these patients have asymptomatic subpleural blebs and bullae; they are found in up to 90% of cases at thoracoscopy or thoracotomy and in up to 80% of cases on CT scanning of the thorax [2]. PSP is a benign condition, which resolves spontaneously in the majority of cases [3]. Secondary spontaneous pneumothorax is a complication of a preexisting lung disease and the major causes in descending order are airway disease (chronic obstructive pulmonary disease or cystic fibrosis),
