Evaluation of secondary spontaneous pneumothorax with multidetector CT

Hilliard, NJ; Marciniak, Stefan J.; Babar, Judith; Balan, Anu

doi:10.1016/j.crad.2012.10.008

Cited by 9 publications

(4 citation statements)

References 49 publications

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“…Secondary spontaneous pneumothorax (SSP) is commonly encountered in hospital practice [1, 2]. Air leaks can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula, of which APF is the most common.…”

Section: Introductionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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Background: Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. Objective: To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. Methods: This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. Results: In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. Conclusion: ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.

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Section: Introductionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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“…The chest CT-scan is superior to the CXR for assessing the size of a pneumothorax and to determine secondary pneumothorax etiologies [ 19 ]. However, the cost, time and radiation exposure do not support its use as a first-line examination.…”

Section: Summary Of the Resultsmentioning

confidence: 99%

“…Secondary causes of pneumothorax can be detected by chest CT-scan such as cystic, interstitial, obstructive or collagen diseases, infections, catamenial pneumothorax, cancer, or other rare diseases [ 19 , 190 , 191 ]. A normal CXR can occult some abnormalities, such as emphysema [ 192 ], or multiple cystic lung diseases [ 193 ].…”

Section: Summary Of the Resultsmentioning

confidence: 99%

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Jouneau,

Ricard,

Seguin-Givelet

et al. 2023

Ann. Intensive Care

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Introduction Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Methods Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. Results A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. Conclusion These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.

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“… 3 When blebs and bullae form owing to an underlying pulmonary pathology, most frequently smoking-induced pulmonary emphysema, they can give rise to secondary spontaneous pneumothoraces (SSPs). 4 …”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of the association between emphysematous change on thoracic computerized tomography scan and recurrent pneumothorax

Girish

Pharoah

Marciniak

2021

QJM: An International Journal of Medicine

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Objectives At least a third of patients go on to suffer a recurrence following a first spontaneous pneumothorax. Surgical intervention reduces the risk of recurrence and has been advocated as a primary treatment for pneumothorax. But surgery exposes patients to the risks of anaesthesia and in some cases can cause chronic pain. Risk stratification of patients to identify those most at risk of recurrence would help direct the most appropriate patients to early intervention. Many studies have addressed the role of thoracic computerised tomography (CT) in identifying those individuals at increased risk of recurrence, but a consensus is lacking. Our objective was to clarify whether CT provides valuable prognostic information for recurrent pneumothorax. Methods We conducted an exhaustive search of the literature for thoracic CT imaging and pneumothorax, and then performed a meta-analysis using a random effects model to estimate the common odds ratio and standard error. Results : Here we show by meta-analysis of data from 2475 individuals that emphysematous change on CT scan is associated with a significant increased odds ratio for recurrent pneumothorax ipsilateral to the radiological abnormality (OR 2.49, 95% CI 1.51 to 4.13). Conclusions : The association holds true for primary spontaneous pneumothorax when considering emphysematous changes including blebs and bullae. Features such as bullae at the azygoesophageal recess or increased Goddard score similarly predicted recurrent secondary pneumothorax, as shown by subgroup analysis. Our meta-analysis suggests that CT scanning has value in risk stratifying patients considering surgery for pneumothorax.

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Evaluation of secondary spontaneous pneumothorax with multidetector CT

Cited by 9 publications

References 49 publications

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Meta-analysis of the association between emphysematous change on thoracic computerized tomography scan and recurrent pneumothorax

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