Chest
Volume 111, Issue 2, February 1997, Pages 280-285
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Surgically Treated Pneumothorax: Radiologic and Pathologic Findings

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Objective

To compare the identifiable pulmonary abnormalities on preoperative chest radiographs and CT scans with the histologic findings in patients requiring surgical intervention for recurrent or persistent pneumothoraces.

Materials and methods

Chest radiographs were reviewed retrospectively in 116 consecutive patients (aged 16 to 81 years) who had undergone thoracotomy for recurrent or persistent pneumothorax. CT scans were performed in 21 patients. Chest radiographs and CT scans were reviewed by two observers without knowledge of the histologic findings. All specimens were reviewed by a surgical pathologist.

Results

Seventy-nine (68%) patients had parenchymal abnormalities and five (4%) had pleural thickening evident on the radiograph. The most common radiographic abnormalities included apical bullae (n=51), apical scarring (n=17), and diffuse emphysema (n=9). Twenty of 21 (95%) CT scans demonstrated either a parenchymal or a pleural abnormality. CT demonstrated emphysema in four patients with normal radiographs, as well as additional findings in six patients with abnormal radiographs. Histologically, 74 patients had focal irregular emphysema, 26 had distal acinar emphysema, six had mixed emphysema, four had isolated bullae or blebs, two had mesothelioma, and one each had the following: metastatic angiosarcoma, subpleural fibrosis, congenital cystic adenomatoid malformation, and tuberculous pleuritis with inactive interstitial fibrosis and honeycombing.

Conclusion

Most patients with surgically treated pneumothorax have emphysema or an isolated bulla. Although these findings may not be apparent on the radiograph and seen on CT, this probably does not affect patient management. In most cases of pneumothorax related to other causes, findings consistent with the diagnosis can be seen on the radiograph.

Section snippets

Materials and Methods

Chest radiographs were evaluated retrospectively in 116 consecutive patients who underwent surgical treatment for recurrent

or persistent pneumothorax between January 1990 and October 1994. One hundred patients (86%) had an identifiable pneumothorax on the preoperative chest radiograph. The remaining 16 patients had a history of recurrent pneumothorax and were being admitted to the hospital for elective surgery. These 16 patients had two or more radiologically documented episodes of spontaneous

Radiologic Findings

Parenchymal abnormalities were identified on the chest radiograph in 79 of 116 (68%) patients and pleural thickening or pleural masses were identified in five (4%) patients. Exclusively parenchymal abnormalities were present in 77 patients, with pleural abnormalities only in three patients, and mixed parenchymal and pleural abnormalities present in two patients. The most common parenchymal abnormality identified on the chest radiograph was an apical bulla seen in 51 (44%) patients. Other

Discussion

Rupture of small apical bullae or blebs and pulmonary parenchymal abnormalities are found in primary and secondary spontaneous pneumothoraces, respectively. The most common parenchymal abnormality associated with spontaneous pneumothorax has been emphysema. The prevalence of other associated pathologic abnormalities has varied.3, 5, 11

One hundred ten (95%) of the patients who required surgical intervention for persistent or recurrent pneumothoraces in our study had a diagnosis of emphysema or

References (14)

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