Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature.


Journal Article

Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence.A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included.Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow-up was 36 months, and 63 ± 39% of recurrences occurred during the first year of follow-up. Elevated height/weight ratio and emphysema-like changes (ELCs) are associated with PSP recurrence. ELCs are present in 59%-89% (vs. 0-15%) of patients with recurrence and can be detected effectively with high-resolution CT scan (sensitivity of 84-88%). Surgical pleurodesis reduces the risk of recurrence substantially (4.0 ± 4% vs. 22 ± 15.5%).Risk of PSP recurrence seems to decline over time and is associated to certain radiological and clinical risk factors. This could be incremented by the stresses of compressed-air diving. A basis for informed patient-physician discussions regarding future diving is provided in this review.

Full Text

Duke Authors

Cited Authors

  • Villela, MA; Dunworth, S; Harlan, NP; Moon, RE

Published Date

  • March 2018

Published In

Volume / Issue

  • 45 / 2

Start / End Page

  • 199 - 208

PubMed ID

  • 29734572

Pubmed Central ID

  • 29734572

International Standard Serial Number (ISSN)

  • 1066-2936


  • eng