Pneumothorax in drug abusers. An urban epidemic?

Although intravenous drug abuse is endemic in urban America, only 19 cases of pneumothorax from neck injections have been reported. For this reason, the experience at Detroit Receiving Hospital was reviewed. Data collected included patient demographics, size of pneumothorax, use of antibiotics, and complications related to tube thoracostomy. Of 525 diagnoses of pneumothorax between January 1, 1982 and December 31, 1984, 113 (21.5%) occurred as a result of drug abuse in 84 patients. Average patient age was 32 years (range 20 to 55 years). Thirty-eight (45%) were female. The number of admissions per year has increased, and 11 patients showed multiple admissions over the 3-year study period. Nine patients had bilateral collapse. One hundred six pneumothoraces (94%) were treated with closed thoracostomy with a tube-related hospital stay of 5 days, overall stay averaging 7 days. Only six patients received antibiotics for chest tube prophylaxis, and no in-hospital tube-related infections were identified. Thirteen patients developed residual pneumothorax following tube removal, but only two required a new tube. Pneumothorax in drug abusers is a serious urban problem and one with which physicians need be familiar.