Chest
Special Reports: ArticlesRole of CT in the Management of Pneumothorax in Patients with Complex Cystic Lung Disease
Section snippets
Case 1
A 23-year-old woman with severe lung disease (FEV1 31% predicted; FVC, 33% predicted; diffusion of carbon monoxide, 25% predicted) due to Langerhans' cell histiocytosis presented with acute breathlessness. In the past she had had bilateral pleurectomies for recurrent pneumothorax. A plain chest radiograph demonstrated a right apical pneumothorax. Simple tube drainage failed, and the patient underwent thoracotomy and oversewing of the air leak. Postoperatively, the air leak recurred, infection
Discussion
Patients with cystic lung disease are particularly likely to have pneumothorax. However, the reticular pattern, bullous formation, and partial adherence of the lung to the chest wall that are so prevalent in such patients make identification of pneumothorax difficult. In addition, instances of pneumothorax in such patients are rarely simple so that while comparison with prior radiographs or the taking of a lateral radiograph1 may be useful, plain chest radiographs may fail to identify the
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Cited by (37)
Giant pulmonary bullae in children
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Ventilation perfusion scanning can help in determining the regional function of a particular part of the lung but has largely been replaced by CT scan. CT scan can also provide important characteristics of the bulla, such as size (volume), position and most importantly the condition of the residual lung, and can also help differentiate bullae from simple pneumothorax which may result in unnecessary intervention [1,4,9,14–16]. Bullae may regress by itself, autobullectomized.
Pneumothorax in cystic fibrosis: beyond the guidelines
2016, Paediatric Respiratory ReviewsCitation Excerpt :Therefore a low threshold is justified for the use of a chest CT scan to aid evaluation and management. They allow a more accurate assessment of size of a pneumothorax, identify a site for the chest drain insertion and help confirm resolution following treatment [7]. Aspiration is recommended in the BTS guidelines however there is little evidence to support this in CF patients.
Chemical pleurodesis for spontaneous pneumothorax
2013, Journal of the Formosan Medical AssociationCitation Excerpt :Although chest CT scans can reveal the underlying pathophysiologic lesions that cause spontaneous pneumothorax and can be regarded as the “gold standard” in the detection of small pneumothoraces and in size estimation,23,24 the American Collage of Chest Physicians (ACCP) does not recommend the routine use of this imaging technique for patients with first-time primary or secondary pneumothoraces.21 CT may, however, be useful for evaluating patients with recurrent secondary pneumothorax, to determine the best treatment for persistent air leakage, or to plan a surgical intervention.25 The British Thoracic Society (BTS) recommends using CT when required to differentiate between pneumothorax and bullous lung disease, when aberrant tube placement is suspected and when the plain chest radiograph is difficult to read owing to the presence of subcutaneous emphysema.4
Pneumothorax in the critically ill patient
2012, ChestCitation Excerpt :The technology is particularly useful in patients with significant underlying lung disease, which may obscure chest radiographic findings. Specifically, CT scanning is an excellent tool to differentiate bullous lung disease from pneumothorax, which may help avoid unnecessary drainage attempts that may result in the creation of a parenchymal-pleural fistula.35 Pneumothorax size can best be calculated with CT imaging.
Pneumothorax and Barotrauma
2008, Critical Care Medicine: Principles of Diagnosis and Management in the AdultChest Radiography
2007, Cardiothoracic Critical Care
revision accepted November 15.