Spontaneous pneumothorax: features of its occurrence and course in patients treated over a three-year period in a thoracic surgery department

Objective. To consider currently known theories of spontaneous pneumothorax (SP). To study gender and age structure of the SP patient group, and to identify common patterns in the course of SP among patients in Gomel and the Gomel region.

Materials and methods. Literary data on the genesis of SP were analyzed. A retrospective analysis of 226 medical records of hospital patients treated for SP at the surgical thoracic department of the Gomel Regional Clinical Hospital in the period 2019–2021 was conducted. A comparative assessment of patients’ social, anthropometric, epidemiological, and clinical data was conducted. The obtained data were processed in the STATISTICA 10.0 software package using descriptive statistics.

Results. The gender and age distribution of patients with SP was determined. Males with an average age of 36,1 (95% CI 34.2 – 38.0, SD=14.6) in a formed group predominated (79.6%). It was found out that patients with primary spontaneous pneumothorax (PSP) were more common than secondary spontaneous pneumothorax (88% and 12%, respectively). Patients with a normal body mass index (BMI) predominated in the group, median value complied 20,4±3,2 kg/m². Other constitutional features important for determining the dysplastic phenotype could not be clarified within the retrospective study. The vast majority of patients had no precursors or trigger factors for the development of SP. Individual patients noted lifting weights the day before the onset of SP (n=11), training in the gym with strength exercises the day before SP or long-distance running (n=7), as well as presence of acute respiratory disease in a medical history (n 19) among the provoking factors. The majority of patients had right-sided SP (n=176; 77.9%) with the rupture localized in the S1-S2 segments. Macroscopic and microscopic histological material is shown signs of the bullous emphysema in 198 (87,6%) cases.

Conclusion. This study analyzes existing working hypotheses regarding the causes of SP. Gender and age structure of the patients with SP in the case of 226 patients treated at hospitals over a three-year period. PSP was more frequently diagnosed in young men in the study group that corresponds to published data. The frequency of occurrence and nosological forms of secondary SP were identified, among which chronic obstructive pulmonary disease predominated; secondary SP was significantly more common in elderly patients. The right-sided localization of the process with damage to the apical segments of the lungs prevailed. Multiple bullae that were not detected on X-ray images of the lungs were revealed in the vast majority of patients during the histological examination of lung tissue resected during surgical intervention. The volume of SP prior to surgical treatment amounted to a half of normal. Analysis of medical records revealed a lack of data for evaluation of the dysplastic phenotype of the patients according to the current criteria. A prospective study is needed for a detailed and comprehensive study of the role of connective tissue dysplasia in the development of SP, as well as the presence of histological markers indicating connective tissue dysfunction and fibrosis.

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