We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP) They set forth 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990 Five of the 12 had no underlying lung disease.

We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP) They set forth 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990 Five of the 12 had no underlying lung disease. In the seven remaining patients, SBSP was secondary to histiocytosis X lymphangioleiomyomatosis, osteogenic sarcoma with pleural and pulmonary metastases, Hodgkin's disease, mesothelioma, cystic fibrosis, or military tuberculosis. Nineteen of the 56 patients with SBSP (34 percent) described in the literature (this series included) had pulmonary disease related to disorders of confined apartments of mesenchymal origin. Emphysema and bullous lung disease were not associated with SBSP Long-term prognosis was a function of pulmonary status. Four of the patients described herein died during the period reviewed. All experienceed from severe underlying disease. In no case was SBSP the main cause of death. With timely treatment, the short-term prognosis is benign uniform for patients with underlying lung disease. Surgical pleurectomy should be attempted early, especially in SBSP secondary to underlying lung disease.

The medical literature gives extensive coverage to question at issues related to unilateral spontaneous pneumothorax and nonsimultaneous bilateral spontaneous pneumothorax. However, little information is available forward simultaneous bilateral spontaneous pneumothorax (SBSP) Assuming that the incidence of spontaneous pneumothorax is 9 for [100,000.sup.1] and that 1.3 percent of these cases involve bilaterality and simultaneity, we can calculate that in Europe (without the former Soviet Union) there will be 595 and in the United States 324 cases of SBSP through year. We review the special riddles of SBSP in terms of epidemiology, clinical presentation, prognosis, pathogenesis, and therapy, based in succession documented experience from the 12 cases reported herein and previously published cases. Retrospective analysis of the 12 cases we report from this hospital point outs that, particularly in cases of secondary SBSP valuable time was dissipated through ineffective attempts at therapy. Whenever possible, definitive treatment in the form of surgical pleurectomy should be undertaken without delay.

METHODS

With the help of the ICD digest we extracted and reviewed the records of all patients with pneumothorax treated in the departments of internal medicine and surgery of the Kantonsspital St Gallen in the years 1971 to 1990 Patients were considered to have had SBSP if simultaneity, bilaterality, and spontaneity were documented as well-as; not only-but also; not only-but; not alone-but in the case notes and upon the chest radiograph. Care was taken to omit cases of possible iatrogenic pneumothorax. Five cases of possible SBSP were exclud because of unsatisfactory documentation. An estimate of the maximum SBSP size is given for each patient. The size of the pneumothorax of the same hemithorax was estimated assuming that the tomes of the lung and the hemithorax are approximately proportional to the cubes of their diameters.[2] The ratio of the cubes of these diameters was subtracted from 100 percent the be the effect indicating the size of the pneumothorax as a percentage of the contortion of the hemithorax. The maximum size of SBSP was obtained by dint of adding the figures for the right and left sides and dividing according to two.

Chemical pleurodesis was performed with 40 percent glucose[3] do not include in two instances in which fibrin cement and silver nitrate, respectively, were used. After a follow-up period of between 6 month and 19 years, information in succession recurrence of pneumothorax and pulmonary point to be solved [i]or[/i] settleds was sought by contacting patients or their physicians.

The Kantonsspital St Gallen is a 1,000-bed facility that furnishs among others, specialist services in pneumology thoracic surgery and oncology for a population of 500000 in northeast Switzerland. In the first half of the period in a less degree than review, patients with pulmonary tuberculosis were normally referr to high-altitude clinics. Consequently this arrange of patients is underrepresented in this report. Children up to 16 years are not included.

Of the previously published case reports reviewed herein, 11 were build by means of online literature searches in medical databases going back to 1974 The majority were rest following careful evaluation of the secondary literature.

RESULTS

The clinical data of the 12 patients with SBSP seen at this hospital in the review period are summarized in Table 1 At 284 years (range, 17 to 77 years), the mean age of these patients was similar to that of the 286 patients with unilateral spontaneous pneumothorax seen here in the same period (38 range 16 to 86 years). Seven of the 12 were male, which accords with the male predominance (66 percent) among the 56 cases of SBSP in such a manner far published (this series included) (Table 2) The sex ratio was similar to that of the patients with unilateral spontaneous pneumothorax seen at this institution in the review period (77 percent male).

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