Pleurodesis in spontaneous pneumothorax by means of tetracycline. Follow-up evaluation of a method.

The validity of previous recommendation of early thoracoscopy and tetracycline pleurodesis in the management of spontaneous pneumothorax without thoracoscopically visualized true cyst was assessed under non-trial, normal hospital conditions. Among 46 patients treated during a year, seven underwent immediate thoracotomy following finding of large cysts. Of the remaining 39 patients, 11 had recurrence of pneumothorax after a median of 11 (range 2-64) weeks. Repeat thoracoscopy then showed large cyst or bullous emphysema in seven cases. Tetracycline pleurodesis was again performed in the others. In continued observation for at least 2 years there were no further recurrences. The importance of meticulous thoracoscopy is stressed. The demonstrated diagnostic errors do not detract from the value of tetracycline pleurodesis when spontaneous pneumothorax is caused by rupture of only tiny blebs on the surface of an otherwise healthy lung. The procedure is fast, simple and efficacious.