IATROGENIC PNEUMOTHORAX: ETIOLOGY, CLINICAL AND THERAPEUTIC ASPECTS

The development of invasive thoracic procedures performed for diagnostic and/or therapeutic purposes is associated with an increased incidence of iatrogenic pneumothorax.

To describe the causes, clinical manifestations, and treatment modalities of iatrogenic pneumothorax, with the aim of better understanding the issues related to their prevention and management.

Prospective descriptive and analytical observational study with active case notification conducted over a two-year period, from April 1, 2023, to April 1, 2025, at the Mohammed V Military Hospital in Rabat, including all patients with clinically and/or radiologically confirmed iatrogenic pneumothorax.

The study included 82 patients who presented with iatrogenic pneumothorax. The median age was 65 years [54; 70], with extremes ranging from 16 to 92 years. Of the patients, 50 (61%) were male and 32 (39%) female. The procedure causing iatrogenic pneumothorax was mainly therapeutic in 50 (61%). 45 (54.9%) patients had an underlying pulmonary pathology and 37 (45.1%) had an underlying extra-pulmonary pathology. The most frequent causes of iatrogenic pneumothorax were central venous catheterization in 34 (41.5%), followed by CT-guided transthoracic lung biopsy in 17 (20.7%) and barotrauma by mechanical ventilation in 11 (13.4%). The most frequent type of treatment was tube thoracostomy with or without needle aspiration in 45 cases (54.9%), followed by conservative treatment in 30 cases (36.6%). Follow-up under these different types of treatment was complicated in 20.7% of cases. Except for mobilization of the chest drain in the management of pneumothorax persisting beyond 7 days, 5 patients had benefited from pleurodesis, including one in the patient's bed and four by uni-portal video-assisted thoracic surgery (U-VATS). Seven patients out of the 82 cases died, i.e. 8.5%, and there was a statistically significant association between ASA Score and mortality with a P-value of 0.01.

The increasing frequency of iatrogenic pneumothorax requires heightened vigilance. Identifying and preventing avoidable risk factors must be a priority in order to limit its incidence and strengthen the safety of interventional practices.