Management of primary spontaneous pneumothorax in marijuana smokers: about 81 cases

Abstract

<bold>Introduction:</bold> Marijuana use has recently increased among young adults worldwide. We aimed to describe clinical, radiological profile and therapeutic management of primary spontaneous pneumothorax (PSP) in cannabis smokers. <bold>Methods:</bold> A retrospective study, including cannabis-smoking patients hospitalized for PSP in pulmonology and thoracic surgery departments of Charles Nicolle Hospital between January 2018 and December 2022 was conducted. <bold>Results:</bold> We included 81 cannabis-smoking patients with PSP. The average cannabis consumption was 52 joints/month. 98,7 % (n=80) smoked tobacco. All patients were males and the mean age was 28±7 years. Socioeconomic conditions were poor in 73% of patients. Symptoms were dominated by chest pain (90.1%) and dyspnea (35.6%). Pneumothorax was on the right side in 58.02% and large in 91.3%. A thoracic CT scan was performed in 12.6% of cases showing the presence of blebs in 54.5% of cases. Treatment was drainage in 55.5%, followed by surgery in 37%, immediate surgery in one case of cases and strict rest with oxygen in 6.1%. Drain site was the 4th intercostal space in 58% of cases. Surgical approach was video-assisted thoracoscopy in all cases. Emphysema was identified during surgical exploration in 96.8%. The mean duration of thoracic drainage was 6.86 days. The average hospital stay was 7.68 days. Complications were noted in 38.2% : persistent detachment in 29 cases, infection in one case and hemothorax in one case. Evolution during the meanfollow up period of 12 months or more was marked by recurrence in 46.9%. <bold>Conclusion</bold> Management of primary spontaneous pneumothorax in Cannabis users seems to be complicated with a high percent of surgical cases.