Computed Tomography Predictors of Pneumothorax and Hemoptysis after Endobronchial Valve Therapy for Emphysema

Abstract

Background: Endobronchial valve (EBV) volume reduction is a widely studied treatment for severe emphysema. Despite studies demonstrating efficacy of EBV therapy, there are complications associated with the procedure, including pneumothorax and hemoptysis. Aim: To evaluate computed tomography (CT) predictors of pneumothorax and hemoptysis in EBV treated patients over 5-years. Methods: We retrospectively analyzed 92 patients treated with EBV between October 2012 and 2017 in six hospitals in South America. All quantitative CT measures were generated by VIDA Diagnostics Inc. (Coralville, IA, USA). CT measurements investigated include: the total lung volume, low attenuation areas of the lung below -950HU (LAA950), fissure integrity (FI), and gradient, the difference in LAA950 between target and ipsilateral lobes. A multivariable logistic regression model for pneumothorax/hemoptysis after EBV was generated using CT measures as predictors. Results: Of the 92 patients investigated, two were treated bilaterally; 37 were female (40.2%). Thirteen patients developed pneumothorax (14.1%) and three (3.2%) presented with hemoptysis after EBV treatment. Multivariable logistic regression analysis revealed that target side lung volume percent (p=0.047), FI (p=0.03) and gradient (p=0.03) significantly predicted pneumothorax/hemoptysis after EBV. Conclusions: CT measures predicted pneumothorax/hemoptysis after lobar exclusion with EBV. Future studies should investigate the potential of CT measurements to identify patient with high risk of pneumothorax/hemoptysis before EBV treatment and enable more careful monitoring of these patients after EBV treatment.