Abstract
Background: Currently the need of Chest-CT in primary spontaneous pneumothorax (PSP) after first episode is a matter of debate. Emerging evidences support the use of CT-based Dystrophy Severity Score (DSS) to establish best treatment and predict recurrence. The purpose of this study was to evaluate the usefulness of chestCT to guide clinical practice after first episode of PSP.
Methods: Patients undergoing VATS for PSP, first episode, at a single centre between 2011 and 2015 were prospectively enrolled. Patients without preoperative CT scan were excluded. All patients were stage according to DSS and underwent talc poudrage; parenchymal resection was tailored according to Vanderschueren’s stage. All patients had clinical and radiological follow-up for at least 2 years.
Results: 301 patients (M/F:240/61; mean age 24 years±7.1) with first episode of PSP were included. At the time of surgery, 86 patients smoked (28.5%). All patients underwent VATS with talc poudrage, in 40 cases parenchymal resection was performed. There was no mortality or major morbidities. According to DSS, 225 patients (75%) were staged as low grade, 76 (25%) high grade. Recurrent pneumothorax occurred in 17 patients (5.6%), all with high grade DSS. All recurrences occurred within the first year of follow-up. At univariate analysis the most important risk factor for recurrence was DSS [HR 3.218,95% CI (2.112-4.905);p=0.000]).
Conclusion: Our result confirm that ChestCT is suitable to risk stratify patients after first episode of PSP. DSS can predict the need for upfront surgery and the necessity to follow up patients after VATS procedure to early detect and treat recurrences. Prospective RCT are mandatory to validate the use of CT in all PSP patients.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 3320.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
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