Chest
Volume 98, Issue 2, August 1990, Pages 341-347
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Computed Tomography in the Etiologic Assessment of Idiopathic Spontaneous Pneumothorax

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In an attempt to elucidate the origin of the so-called idiopathic spontaneous pneumothorax (ISP), clinical examination, pulmonary function tests, and computed tomography (CT) with visual quantification and density analysis were performed in 20 young patients two months after an ISP episode. Twenty controls were recruited for CT. The chest roentgenograms were normal in the two groups. The results indicated the presence of various types of emphysematous lesions (EL) in the ISP group located predominantly in the apical fields with subpleural location in 16 patients. Interestingly, diffuse but moderate centrilobular emphysema was noted in 12 of 20 patients. The EL visual quantification was always less than 5 percent of the CT slices’ total areas. The lung mean density shifted significantly toward the air density in the patient group (patients: -743 ± 57.5 HU vs controls -713 ± 59.5 HU, p<0.01). These findings suggest that CT may be useful for early assessment of EL in patients with ISP.

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MATERIAL AND METHODS

Twenty patients with ISP were studied two months after the pneumothorax episode. The procedure included clinical examination, chest roentgenogram, serum α1-antitrypsin dosage8 with phenotype electrophoretic determination,9 pulmonary function tests, and CT scan. They were selected from a series of pneumothoraces according to the following criteria: age below 45 years; no respiratory history; normal chest roentgenogram (posteroanterior and lateral films) assessed by three independent readers; and

Clinical Data

Idiopathic spontaneous pneumothorax occurred on the left side in 11 patients and on the right side in nine. Ten patients had recurrent ISP (ipsilateral in eight). Recent effort was the possible cause of the pneumothorax in five patients; ISP occurred at rest in the others. Weight and height were within the standards of the Metropolitan Life Insurance Company19 for the two groups. Nevertheless, the mean weight was significantly lower in the ISP group than in the control group: 65.3 ± 8.2 kg vs

DISCUSSION

Idiopathic spontaneous pneumothorax occurs most often in young adults,20, 21, 22 predominantly in tall men.2, 23, 24 Many authors hypothesize that tall lungs play a part in the genesis of bullae, implicating an increase in the pulmonary distension pressure.25, 26 Peters et al24 and Kawakami et al27 noted that the lung height was greater in their ISP patients than in their controls. In the present study, the clinical observations fit well with the literature data. However, the patients’ mean

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