Abstract
BackgroundThe preoperative detection of emphysema like changes (ELCs) is necessary for the successful treatment of pneumothorax. High resolution computed tomography (HRCT) has been used for the preoperative detection of ELCs. However, the traditional HRCT method uses only the axial view, which is perpendicular to the distribution of ELCs. This is not an ideal diagnostic method for the evaluation of ELCs.MethodsForty-eight patients with pneumothorax had multi-detector computed tomography (MDCT) reconstruction using the coronal view. ELCs were evaluated in the axial and coronal view by a radiologist. A surgeon performed intra-operative examinations of the ELCs. The sensitivity of the different views was compared.ResultsThe detection sensitivity was 74.4% (70/94) for the axial view and 91.5% (86/94) for the axial-coronal combined view. The intra-operative detection rate was 95.7% (90/94). The preoperative detection of ELCs on the axial-coronal combined view was significantly higher than on the conventional axial view alone (p < 0.01).ConclusionsEvaluation of ELCs on the axial and coronal combined HRCT improved the sensitivity of preoperative detection of ELCs compared to the conventional single axial HRCT. This increased sensitivity will help decrease the recurrence with VATS.
Highlights
The preoperative detection of emphysema like changes (ELCs) is necessary for the successful treatment of pneumothorax
It is difficult to prove the cause of higher recurrence rates, it has been suggested that videoscopic inspection is less accurate than direct inspection; this is because the lung is collapsed during video assisted thoracic surgery (VATS), and the frequency of overlooking emphysematous like changes (ELCs) is higher with VATS procedures
All patients had bullectomy performed through an axillary thoracotomy
Summary
The preoperative detection of emphysema like changes (ELCs) is necessary for the successful treatment of pneumothorax. High resolution computed tomography (HRCT) has been used for the preoperative detection of ELCs. the traditional HRCT method uses only the axial view, which is perpendicular to the distribution of ELCs. the traditional HRCT method uses only the axial view, which is perpendicular to the distribution of ELCs This is not an ideal diagnostic method for the evaluation of ELCs. The recurrence of a pneumothorax after video assisted thoracic surgery (VATS), after the treatment of primary spontaneous pneumothorax, is higher than after thoracotomy procedures [1,2,3,4,5,6,7,8]. The purpose of this study was to evaluate the efficacy of axial and coronal combined views using the MDCT compared to conventional axial views, for the initial treatment of primary spontaneous pneumothorax
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