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Is Preventive Bilateral Surgery Needed in Case of Bilateral Bullae on HRCT at Unilateral Primary Spontaneous Pneumothorax  

Han, Jong-Hee (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Kang, Min-Woong (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Yu, Jeong-Hwan (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National UniversityDepartment of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Kim, Yong-Ho (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Na, Myung-Hoon (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Lim, Seung-Pyung (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Lee, Young (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Yu, Jae-Hyeon (Department of Thoracic and Cardiovascualr Surgery, College of Medicine, Chungnam National University)
Publication Information
Journal of Chest Surgery / v.40, no.3, 2007 , pp. 215-219 More about this Journal
Abstract
Background: Due to the advancement of video assisted thoracoscopic techniques, an operation for primary spontaneous pneumothorax is now considered a common procedure. However, whether a preventive operation is necessary when a contralateral bulla is found on High Resolution Computed Tomography (HRCT) at the time of the first primary spontaneous pneumothorax attack is still unknown. In this retrospective study, it was our intension to find whether contralateral bullae are related to the occurrence of pneumothorax. Material and Method: Between January 1999 and April 2006, 550 patients were admitted to the Chungnam University hospital with primary spontaneous pneumothorax, which was confirmed by the HRCT scans in 190 patents. In these 190 patients, 159 had not received a bilateral operation after their first primary spontaneous pneumothorax attack. In these 159 patients, the relationship between the presence of contralateral bullae and the occurrence of pneumothorax was measured. Result: In these 159 patients, 67 had contralateral bullae confirmed inform the HRCT scan, and 92 had no visible contralateral bullae, During the follow up period, 6 patients (8.9%) with contralateral bullae had an occurrence of contralateral pneumothorax, and 5 patients (5.4%) without contralateral bullae had an occurrence of contralateral pneumothorax. (p=0.529 [Fisher's exact test]) Conclusion: In patients with unilateral primary pneumothorax, an HRCT scan is a useful way of confirming contralateral pulmonary bullae. However, the presence of bullae is not a significant predictive sign of an occurrence of contralateral pneumothorax. Also, surgery for pneumothorax is not completely uncomplicated, and bilateral surgery is still doubtful. A further prospective study will be required to find the relationship between the bullae found on HRCT and the occurrence of pneumothorax.
Keywords
Pneumothorax; Tomography, computed; Bleb; Lung surgery;
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1 Hatz RA, Kaps MF, Meimarakis G, et al. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg 2000; 70:253-7   DOI   ScienceOn
2 Smit HJM, Wienk MA, Schreurs AJM, et al. Do bullae indicate a predisposition to recurrent pneumothorax? Br J Radiol 2000;73:356-9   DOI   PUBMED
3 Janssen JP, Schramel FM, Sutedja TG, et al. Videothoracoscopic appearance of first and recurrent pneumothorax. Chest 1995;108:330-4   DOI   ScienceOn
4 Hong EP, Park YT, Han SS. Risk factors of recurrent spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 1992;25:533-40
5 Jo JH, Lee YJ, Chang JW, et al. Clinical analysis of recurrent pneumothorax - a report of 52 cases. Korean J Thorac Cardiovasc Surg 1995;28:166-9
6 Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58(suppl II): ii39-ii52
7 Rhea JT, DeLuca SA, Greene RE. Determining the size of pneumothorax in the upright patient. Radiology 1982;144:733   PUBMED
8 Passlick B, Born C, Haussinger K, et al. Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg 1998;65:324-7   DOI   ScienceOn
9 Jheon SH, Lee EB, Cho JY, et al. Critical pathway for management of primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 2002;35:43-7
10 Kim YS, Sohn DS. Analysis of high resolution CT findings in patients with spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 1999;32:383-7
11 Kim MH, Lee CJ, Lim SH. Assessment of primary spontaneous pneumothorax using chest computerized axial tomography. Korean J Thorac Cardiovasc Surg 1993;26:209-13
12 Lazdunski LL, Kerangel X, Pons F, et al. Primary spontaneous pneumothorax: one-stage treatment by bilateral videothoracoscopy. Ann Thorac Surg 2000;70:412-7   DOI   ScienceOn
13 Shield TW, Locicero J, Ponn RB, et al. General thoracic surgery. 6th ed. Lippincott Williams and Wilkins, Philadelphia, pp 798-804, 2005
14 Sellke FW, Nido PJ, Swanson SJ. Sabiston and Spencer Surgery of the chest. 7th ed. Elsevier Saunders, Philadephia, pp 427-30, 2005
15 Sihoe AD, Yim AP, Lee TW, et al. Can CT scanning be used to select patients with unilateral primary spontaneous pneumothorax for bilateral surgery? Chest 2000;118:380-3   DOI   ScienceOn
16 Lippert HL, Lund O, Blegvad S, et al. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J 1991;4:324-31   PUBMED