Clinical characteristics and in-hospital outcomes of pneumothorax in pneumoconiosis: a tertiary referral cohort study.

Background: Pneumoconiosis is a progressive occupational lung disease often complicated by secondary spontaneous pneumothorax, but detailed clinical data from tertiary centers are limited. Methods: We retrospectively analyzed 42 patients with pneumoconiosis and pneumothorax admitted to a tertiary university-affiliated hospital in China from January 2020 to July 2025. Clinical characteristics, laboratory and imaging findings, management strategies, and in-hospital outcomes were analyzed, with predefined subgroup comparisons between first-time and recurrent pneumothorax. Results: The cohort included 42 patients (40 men and 2 women) with a mean age of 57.4 years; most were smokers (73.8%), and nearly all had stage III pneumoconiosis (92.9%). Right-sided pneumothorax was more common than left-sided or bilateral disease, and pulmonary infection was noted in 76.2% of patients. Chest tube drainage was the primary treatment (88.1%), while pleurodesis, medical thoracoscopy, and bronchoscopic occlusion were used in selected cases. Patients with recurrent pneumothorax had significantly longer chest tube duration (median 15.5 vs. 4.5 days; U = 47.0, Conclusion: Pneumothorax in pneumoconiosis, typically occurring in advanced disease and often complicated by infection, is frequently associated with prolonged chest tube drainage, highlighting the importance of early recognition, individualized management, and infection control.