To better determine the etiology and risk factors for the development of pneumothorax (PTX) in patients with acquired immunodeficiency syndrome (AIDS) and to assess which therapeutic approaches may allow earlier recovery. Methods: Retrospective review of the medical records of patients admitted to Cabrini Medical Center with the diagnosis of AIDS and PTX from January 1991 to January 1997. Results: Seventy patients with AIDS and 94 PTXs were identified; 50 patients had 74 spontaneous PTXs (SPTX), while 20 patients had 20 iatrogenic PTXs. Of the 50 patients with SPTX, 31(62%) were from PCP; 5 (10%) from bullous diseases; 4 (8%) idiopathic; 2 (4%) from Kaposi's sarcoma; 2 (4%) from Aspergillus; 2(4%) from bacterial pneumonia; 4 (8%) from various etiologies. Thirty patients (60%) had one episode of PTX; effective management was by thoracostomy tube (TT) alone in 12 patients; by observation (4);by sclerosing therapy (ST) and TT (2); by TT, thoracotomy and pleurodesis (1). The mean number of days to chest tube removal was 11. Twenty patients (40%) had recurrent or bilateral PTXs; effective management was by 9/44 by TT + ST in 9 patients; by TT alone (5); by observation (3); by TT and thoracoscopy (2); 2 patients were discharged on an one-way valve catheter. The mean number of days to chest tube removal was 18. Twenty-one patients died during hospitalization. All 20 patients with iatrogenic PTX were treated effectively: 12 by TT alone (mean of 4.8 days to TT removal); 8 by observation. Conclusions: There are multiple etiologies of AIDS-related SPTX. There is a high rate of in-hospital mortality. No uniformity was seen with the various treatment modalities. Due to the long length of chest tube placement, aggressive solutions should be considered earlier in the treatment of SPTX.
Full conference title:
The American Lung Association - American Thoracic Association Conference,1998