Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax

Abstract

Background and Objective This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE). Methods From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively. ResultsThe incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p \ 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p \ 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481-3.330, p \ 0.001). ConclusionWe discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI [3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.

Radiographic chest wall abnormalities in primary spontaneous pneumothorax identified by artificial intelligence

“…Furthermore, the VPD is also concentrated in the CAP and absent in other areas; hence, the vessel penetrates the chest wall in the absence of a CAFAP cushion, precipitating a hole. The relationship of chest wall deformities and pneumothorax has been previously established [ 8 , 42 , 43 ]. Contrary to previous assumptions, this study proposes that VPD may not be the primary cause of PSP; rather, CAP emerges as a potential culprit.…”

“…This perspective offers a nuanced understanding, suggesting that CAP, rather than VPD, may play a pivotal role in the development of PSP, with the association to VPD arising from a common root cause, the deficiency of the CAFAP cushion. BB were observed in 26.5 % of cases with an elevated Haller index in individuals with pectus excavatum, demonstrating a bleb formation odds ratio of 2.221 (95 % confidence interval 1.481–3.330, p < 0.001) [ 8 ].…”

“…With the advances in surgical optical resolution and instrumentation, all the ruptured lung cases in PSP can be identified at the apical area of the chest cavity, including the apex of the upper lobe and the superior segment of the lower lobe of the lung [ 7 ]. In a previous study, chest wall deformity was found to be linked to PSP [ 8 ]. In addition, our previous report on the association of vascular penetration defects (VPD) and PSP was among the first in medical literature to describe the etiological relationship between chest-wall structural defects and PSP [ 9 ].…”

Prevalence of comorbidities in a surgical pectus excavatum population

“…Two-thirds of patients diagnosed with Marfan syndrome have concomitant pectus excavatum while Marfan syndrome is found in 5 % of patients with pectus excavatum referred for surgery (5). Moreover, conditions such as obstructive sleep apnoea and pulmonary blebs are found to be highly prevalent in pectus excavatum patients (7,8).…”

Bilateral tension pneumothoraxes in buffalo chest several months after Nuss procedure for pectus excavatum

“…We read with great interest the report by Huang et al presenting the association between primary spontaneous pneumothorax (PSP) and pectus excavatum (PE) [ 1 ]. They reviewed computed tomography (CT) images of 471 PE patients and found bleb formation in 123 patients (26.5%) and pneumothorax incidence rate of 5.6% in the bleb group and 0.5% in the non-bleb group.…”