Original article
General thoracic
Role of Blebs and Bullae Detected by High-Resolution Computed Tomography and Recurrent Spontaneous Pneumothorax

https://doi.org/10.1016/j.athoracsur.2012.05.073Get rights and content

Background

The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial.

Methods

We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points.

Results

We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence.

Conclusions

The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral.

Section snippets

Material and Methods

This study was approved by the University of Modena and Reggio Emilia Ethics Committee, and individual consent to study participation was obtained from all patients.

Results

Data for 199 patients were recorded. Of these, 8 were lost to follow-up, and 15 underwent surgical intervention after the first PSP and were excluded from the analysis. Therefore, the study population comprised 176 patients. Their clinical characteristics are reported in Table 1 and HRCT findings in Table 2.

Mean time to ipsilateral recurrence was 12.8 months (range, 1 to 64 months). Mean time to contralateral recurrence was 41.7 months (range, 6 to 97 months). For patients who did not

Comment

Surgical therapy, consisting of blebs excision with pleurodesis, currently represents the most effective method for preventing recurrence [3, 4]. Although the video-assisted thoracoscopic procedure shows a fourfold increase in recurrence rate compared with an open operation [11], it is now preferred over a traditional open approach because of the shorter hospital stay, lower pain, and more favorable cost-effectiveness ratio [11, 12, 13].

At present, the need to prevent recurrence after a first

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