Predictors of Contralateral Recurrence in Patients With Primary Spontaneous Pneumothorax

The recurrence of primary spontaneous pneumothorax (PSP) requires readmission to the hospital and additional medical costs. Therefore, the identification of predictors for recurrence may help reduce additional burdens.

To investigate the outcome of asymptomatic contralateral bullae in individuals diagnosed with ipsilateral primary spontaneous pneumothorax (PSP) and examine the risk factors contributing to the incidence of contralateral pneumothorax.

A retrospective analysis from January 2014 to May 2023, of 18-50 years old patients who underwent thoracoscopic bullectomy for PSP management at a university hospital. However, we excluded patients older than 50 years of age, patients with traumatic pneumothorax, and bilateral PSP.

A total number of 184 episodes of PSP cases were reviewed and contralateral recurrence was observed in 14.3% of patients. Significant associations were identified between contralateral recurrence and the presence of contralateral bullae on high-resolution CT (HRCT) (p = 0.002), as well as the number (p = 0.003) and side of the affected hemithorax (p = 0.036). Patients lacking contralateral bullae, those with a single bulla, or right-sided PSP had lower contralateral recurrence likelihood. Initial PSP side was a significant predictor, with a 2.8 times higher likelihood (p = 0.046). Additionally, increasing bullae number in chest CT scans was correlated with a 44% decrease in the odds of contralateral pneumothorax (p = 0.038).

Patients presenting with PSP and evident contralateral bullae on imaging, should be closely followed up and informed about the significant risk to avoid recurrences and complications.