• Daniel Erez, Lilach Israeli-Shani, Gali Epstein Shochet, Daniel A King, Mahmood Abu-Akel, Zamir Dovrish, and David Shitrit.
• Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel.
• Isr Med Assoc J. 2020 Dec 1; 22 (12): 747-751.

BackgroundPrimary spontaneous pneumothorax (PSP) tends to occur in young adults without underlying lung diseases and is usually followed by limited symptoms, while secondary spontaneous pneumothorax (SSP) is a complication of a pre-existing lung disease. Surprisingly, for such common conditions, there is a considerable inconsistency regarding management guidelines.ObjectivesTo evaluate the risk factors for spontaneous pneumothoraxes and to summarize outcomes and complications based on our clinical experience.MethodsThis retrospective study group was comprised of 250 consecutive patients older than 18 years of age who were diagnosed with spontaneous pneumothorax and hospitalized at the Meir Medical Center (2004-2017). Data on demographic characteristics, indicating symptoms, chest X-rays, and chest computed tomography (CT) results were collected. Our experience and outcomes were then compared to a large multicenter study.ResultsMost of the patients were male (85%) and past or current smokers; 69% presented with PSP, while the rest were SSP. No occupational relation was noted. About 55% of the cases presented with a moderate or large pneumothorax (over 1/3 hemithorax). Most patients (56%) required chest tube drainage and 20% undergone surgery. Nearly 10% presented with a recurrent pneumothorax with the mean time to recurrence being 11 ± 20 days. Although the length of hospital stay of patients that underwent surgery was the longest (P < 0.001) for both PSP and SSP, the recurrence rate was actually reduced, suggesting some benefit for the surgical treatment option.ConclusionsOur experience showed that the traditional approach to the PSP treatment should be further considered, as previously suggested.

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