Surgically treated pneumothorax. Radiologic and pathologic findings

Our plain-English summary of Surgically treated pneumothorax. Radiologic and pathologic findings, by K.G. Jordan, J.S. Kwong, J. Flint, et al (Chest, 1997).

The study

• Authors: K.G. Jordan, J.S. Kwong, J. Flint, N.L. Müller
• Journal: Chest
• Published: 1997;111(2):280-5
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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.

In plain English

This study looked back at 116 consecutive patients (88 men and 28 women, aged 16 to 81). Each had surgery between January 1990 and October 1994 for a collapsed lung (pneumothorax) that kept coming back or would not resolve. The authors worked in radiology and pathology departments in Vancouver. Two radiologists reviewed the chest X-rays taken before surgery, and the 21 CT scans available, without knowing the tissue results. These images were then compared with the tissue removed at surgery. Chest X-rays showed lung abnormalities in 79 of 116 patients (68%), most often a bulla, an air-filled space at the top of the lung (51 patients). The tissue showed emphysema in 106 of 116 patients (91%). Two patients had mesothelioma: pleural tissue was infiltrated by malignant mesothelioma, both had pleural masses or thickening on X-ray, and CT suggested the diagnosis. The article does not discuss asbestos. The authors concluded that most such patients have emphysema or an isolated bulla. They added that missing these on X-ray probably does not affect treatment. They noted that the study was retrospective, X-ray techniques varied, and few patients had CT.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review comparing preoperative chest radiographs and CT scans with the pathology of surgical specimens
• Who was studied: 116 consecutive patients (88 men, 28 women, aged 16 to 81 years) who had surgery for recurrent or persistent pneumothorax between January 1990 and October 1994; 21 of them had preoperative CT. The authors were from the University of British Columbia and Vancouver Hospital and Health Sciences Centre, Canada.
• Main results:
  • Chest radiographs showed parenchymal (lung tissue) abnormalities in 79 of 116 (68%) patients
  • The most common radiographic abnormality was an apical bulla, seen in 51 (44%) patients
  • 20 of 21 (95%) CT scans showed parenchymal or pleural abnormalities; in 10 of the 21 patients, CT showed findings not apparent on the chest radiograph
  • Resected specimens showed emphysema with or without bullae in 106 of 116 (91%) patients
  • 110 (95%) of the patients had a diagnosis of emphysema or of an isolated bulla or bleb
  • Mesothelioma was diagnosed in two of the five patients who had pleural masses or thickening on the chest radiograph
  • In the two patients with mesothelioma, CT defined the lesions better than the radiographs, and the diagnosis was suggested
• The authors' conclusion: The authors concluded that most patients needing surgery for pneumothorax have emphysema or an isolated bulla, and that although these may be missed on the radiograph and seen on CT, this probably does not affect treatment
• Limitations the authors state:
  • The study was a retrospective analysis of the radiographs and CT scans
  • The radiographs were obtained with different techniques and in different projections
  • CT was performed in only a small number of cases and the technique varied, so the role of CT could not be assessed adequately

Topics

Medical terms in this study, explained in our Lexicon: Pneumothorax, Chest X-Ray, CT Scan, Thoracotomy, Pleural Thickening, Emphysema, Acinar, Mesothelioma.

Related studies

• Pneumothorax and malignant mesothelioma in patients over the age of 40 — J.D. Sheard, W. Taylor, et al. (1991)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)

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