The utility of computed tomography in the management of patients with spontaneous pneumothorax

What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children?

“…In addition, only 16 patients (14.0%) had contralateral recurrence. Therefore, based on our results and the available reported data, 20) the presence of bilateral air-containing lesions does not appear to be sufficient justification to recommend single stage bilateral VATS for PSP. VATS to prevent recurrence should be considered only for the affected side.…”

“…However, the role of bullae or blebs in the development of recurrent pneumothorax is unclear, and some authors proposed that the decision for surgical intervention should be based on documented recurrence only. 5,10,20,21) The incidence of blebs/bullae on HRCT scans in paediatric population studies was reported to range from 30.8% to 100%, 6,14,17,19,20,22) and the recurrence rate after conservative treatment in patients with air-containing lesions was reported to range from 50% to 100% (Table 4). 6,17,19) These results are consistent with the results of our study of an incidence of blebs/bullae on HRCT scans of 55.3% (63/114) and the 60.3% recurrence rate associated with blebs/bullae on HRCT scans.…”

“…28) However, this factor does not appear to be a major contributor in the paediatric series because most paediatric patients are non-smokers. 20) The prediction of a contralateral recurrence is another controversial issue. Some authors suggested the presence of air-containing lesions on the contralateral lung was an independent predictive factor for contralateral pneumothorax and suggested considering single stage bilateral VATS for PSP.…”

Thoracic surgery Thoracoscopy in the treatment of spontaneous pneumothorax in children

“…However, the fact that the presence of bullae (or their remains) is revealed in the decisive majority of patients (77% in our own material) operated on due to persistent air leakage or pneumothorax recurrence suggests that the number of CT examinations can be reduced, especially since this examination becomes reliable with regard to detecting the presence of emphysematous bullae only after lung expansion. In our view and in accordance with the opinions presented by other authors, patients may be qualified for thoracoscopic treatment based on clinical examinations and X-rays of the chest [14]. Moreover, resecting the emphysematous bullae is not the only surgical treatment option; therefore, there is no reason to condition the qualification for surgery on their presence [1,4,13,15].…”

A 16-Year-Old Boy with Acute Chest Pain and Shortness of Breath

“…Some studies have shown that CT itself is poor for bleb identification, and that recurrence rates are similar between those with and without blebs. 11,12 In addition, an evidence-based management article from 2009 stated that there is no indication for the use of CT for bleb or bullae assessment after the initial occurrence of SP, 13 and this is in concordance with a 2001 consensus statement from the American College of Chest Physicians (ACCP). 14 However, a retrospective review from 2013 of 114 children undergoing conservative management after primary PSP found that the presence of blebs or bullae on high-resolution CT was a significant risk factor for ipsilateral recurrence.…”