Value of Computer Tomography in the Detection of Bullae and Blebs in Patients with Primary Spontaneous Pneumothorax

Mitlehner, W.; Friedrich, Michael; Dissmann, W

doi:10.1159/000196062

Cited by 136 publications

(103 citation statements)

References 22 publications

(44 reference statements)

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“…The role of blebs/bullae as a preexistent lesion for development of PSP has been questioned; in fact, some studies observed no correlation between its presence and the risk for PSP recurrence (6,8,9,11,12,(14)(15)(16)(17). However, there is some evidence on the lack of association between blebs and different recurrent patterns of PSP (ipsilateral or contralateral).…”

Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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IntroductionPrimary spontaneous pneumothorax (PSP) usually occurs in young, tall, and lean men, especially smokers with no obvious underlying lung disease. It arguably results from rupture of subpleural blebs or bullae. The most frequent complication of PSP is recurrence, which is estimated to occur in 20% to 60% after conservative treatment (1,2). More than 50% of patients with PSP have contralateral blebs/bullae and about a quarter will develop contralateral pneumothorax (3). The British Thoracic Society (BTS) guidelines include first recurrence of contralateral pneumothorax and synchronous bilateral PSP as the only indications for surgery of the contralateral lung (4). However, surgery of the contralateral lung to prevent possible complications remains controversial (5-7). To date, only few studies on small populations have discussed both ipsilateral and contralateral recurrences of PSP. The purpose of our study was to identify the predictors of ipsilateral and contralateral recurrences of PSP and to review literatures on the association of blebs/bullae on high resolution computed tomography (HRCT) of the chest with PSP recurrence. Knowing the risk factors for PSP recurrence may enable us to optimize patient selection to avoid further recurrence and complications.

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Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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show abstract

“…This observation is supported by articles that reported that blebs and bullae were detected in over 80% PSP patients treated with VATS [17][18][19]. In addition, there are some studies that reported that emphysema-like changes were detected by high-resolution CT in 80% of patients with a first episode of PSP [20,21].…”

Section: Discussionmentioning

confidence: 64%

Video-Assisted Thoracoscopic Pleurectomy in Spontaneous Pneumothorax Surgery

et al. 2015

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OBJECTIVES:Published experiences with thoracoscopic apical or total pleurectomy for patients with a pneumothorax are limited. We aimed to evaluate the long-term results and effectiveness of pleurectomy in our patients, that vast majority of whom underwent thoracoscopic apical or total pleurectomy. MATERIAL AND METHODS:Between January 2001 and December 2010, in the Istanbul University Medical School Department of Thoracic Surgery, 67 patients, consisting of 52 patients with a primary spontaneous pneumothorax and 15 with a secondary spontaneous pneumothorax who underwent 72 processes of thoracoscopic resection of blebs or bullae and pleural symphysis, consisting of 43% total pleurectomy, 42% apical pleurectomy plus pleural abrasion, and 15% non-pleurectomy pleurodesis procedures due to prolonged air leak or recurrent spontaneous pneumothorax, were analyzed retrospectively. The applied pleural procedures were: 1. total pleurectomy 2. apical pleurectomy and pleural abrasion for the remaining parts and 3. non-pleurectomy pleurodesis procedures. The long-term outcomes of patients undergoing the three different pleural procedures were compared. RESULTS:Total pleurectomy process, apical pleurectomy and abrasion process for remaining parietal pleura, and non-pleurectomy pleurodesis procedures were performed 31, 30, and 11 times, respectively. No recurrence was observed in the total pleurectomy group, 1 recurrence was observed for the apical pleurectomy plus pleural abrasion group, and 2 recurrences were observed for the nonpleurectomy group. CONCLUSION:Video-assisted thoracoscopic pleurectomy is a safe and effective method in spontaneous pneumothorax surgery. Especially, total pleurectomy has efficient results in the prevention of recurrences.

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“…No entanto, os estudos sobre a utilização de TCT nos casos de pneumotórax espontâneo não demonstraram correlação entre os achados morfológicos, como número e tamanho de bolhas, blebs, bolhas contralaterais ou fibrose envolvendo o parênquima pulmonar, e os índices de recorrência. Nesse sentido, a TCT nos casos de PEP, como método orientador da indicação de cirurgia, não deve ser utilizada rotineiramente (13)(14)(15) . Estabelecida a indicação de tratamento cirúrgico, impõe-se a questão: qual o melhor método?…”

Section: Discussionunclassified