The etiology and therapy of primary spontaneous pneumothoraces.

Primary spontaneous pneumothorax (PSP) remains a significant health problem in young adults. Subpleural blebs and bullae in the lung apices are likely to play important roles in pathogenesis. The optimal management of PSP has been a matter of debate and depends on the size of the pneumothorax, the symptoms and the time of occurrence. Observation or simple aspiration is used in the first episode, while surgery is recommended for recurrent or complicated pneumothorax. Recent advances in thoracoscopic surgery have provided a less invasive alternative in the surgical treatment of PSP, but there are concerns about higher recurrence rates than that following open thoracotomy. Studies have shown that the judicious use of chemical pleurodesis may decrease the rate of recurrence in surgical and nonsurgical patients. In this article, the etiology and pathophysiology of PSP are reviewed. The indications, safety and effects of currently available treatment modalities are also summarized.