Surgical management of spontaneous pneumothorax in patients with acquired immunodeficiency syndrome.

Spontaneous pneumothorax has been reported with increasing frequency in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. In the past year, we treated 4 patients with spontaneous pneumothorax. All of them were treated with closed tube thoracostomy, and 1 patient with bilateral apical cysts eventually required bilateral thoracotomies and pleurectomies. Only 1 patient had an uncomplicated hospital course. The remaining patients had prolonged air leaks, and 2 had synchronous pneumothoraces. Pneumothorax appears to be associated with P. carinii pneumonia. We recommend closed tube thoracostomy as the initial treatment in symptomatic patients. Pleurectomy for air leaks persisting longer than seven days can be safely performed in patients fit for thoractomy.