Surgical Treatment Of Spontaneous Pneumothorax Research Articles

Robotic-Assisted Pleurectomy Is a Safe and Effective Surgical Treatment for Spontaneous Pneumothorax

IntroductionSpontaneous pneumothorax is a common thoracic surgical problem. To prevent recurrence, surgical options include blebectomy, mechanical or chemical pleurodesis, pleurectomy, or a combination of these operations. Pleurectomy is associated with lower recurrence rates but may be technically challenging via video-assisted thoracoscopic surgery. We report the first series of robotic-assisted pleurectomy (RAP) for spontaneous pneumothorax. MethodsA retrospective, single-center analysis was conducted on consecutive patients undergoing RAP for spontaneous pneumothorax from 2017 to 2023. Patients with prior surgery on the same side for pneumothorax were excluded. Demographics, comorbidities, functional status, intraoperative and perioperative variables were collected. 30-d readmission, 30-d mortality, and recurrence were recorded. ResultsThirty-six patients underwent RAP during the study period with a median follow-up of 36 mo. Patients had a median age of 41.5 (interquartile range [IQR] 21.5-68) y and were mostly male (80.6%) and past smokers (44.4%) with 66.6% having a primary spontaneous pneumothorax. The median time to chest tube removal was 3 d (IQR 2-3) and the median length of stay was two days (IQR 2-4). Complications occurred in seven patients with the majority (85.7%) having a grade 2 Clavien-Dindo classification score. There was no 30-d mortality or recurrence. ConclusionsRobotic-assisted pleurectomy for spontaneous pneumothorax is a safe and effective operation that can be used to prevent future recurrence.

Uniportal versus multiportal video-assisted thoracoscopic surgery for spontaneous pneumothorax

BackgroundMultiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS.MethodsFrom January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes).ResultsA total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes.ConclusionsThis study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.

Video-assisted thoracoscopic (VATS) era in surgical treatment of spontaneous pneumothorax

Background: VATS is now regarded by many surgeons to be the gold standard in the surgical management of a variety of thoracic conditions, such as spontaneous pneumothorax (SP), pleural diseases, and indeterminate lung nodules. Aim and objectives: to describe different VATS techniques in patients with spontaneous pneumothorax.Summary: Several clinical management issues remain unanswered. Firstly, the duration of prolonged air leak that warrants VATS remain controversial. Current recommendations range from five days by BTS to three days advocated by our institute with more than a decade of experience with VATS for SP. Furthermore, whether VATS should be offered to all patients with low general anesthetic risk presenting with first episode of SP is unclear. Furthermore, the evolution of surgical techniques to allow ipsilateral thoracoscopic approach to treat contralateral bullous lesion may redefine the indications for CT scan in SP. Technically, the debate will continue among the surgeons on the type of VATS procedure that will minimize pneumothorax recurrence. Most surgeons will agree that some form of bullectomy (endoscopic staple or suturing) is mandatory. However, the nature of pleurodesis (mechanical, chemical, or both) that follow is often at the discretion of the individual clinician.

Surgical treatment of spontaneous pneumothorax in a patient with pleuropulmonary blastoma in a 2-year-old girl

Introduction. Pneumothorax is a life-threatening condition which may be the first manifestation of a tumor in the chest cavity in children.Material and methods. The article describes a clinical case of a two-year-old patient with spontaneous pneumothorax.Results. By literature data, pleuropulmonary blastoma is the most common malignant tumor of the thoracic cavity in young children. It is a thin-walled single or multi-cavity formation located on the lung periphery. It has a high risk of metastases, relapses as well as a tendency to higher malignancy degree. Therefore, the overall survival of patients is significantly reduced in case of late tumor detection. It is known that at early stages the structure of pleuropulmonary blastoma is similar to that of the bullous transformation in lungs, and in most cases it does not have characteristic clinical manifestations; therefore, early diagnostics of the neoplasm in case of pneumothorax depends on surgeon’s oncological alertness and on the tactics chosen by him/her to treat the complication. The performed videothoracoscopic resection of the cystic formation in the left lung did not only helped to achieve aerostasis within the short time, but it also helped to find out the cause of the complication: it was a rare malignant tumor of the lung - pleuropulmonary blastoma.Conclusion. The tumor process at the preoperative stage is difficult to suspect in children because in most cases there are no specific clinical symptoms. So, an active surgical tactics in treating cystic lung formations in patients with pneumothorax allows not only to eliminate the complication, but also to identify a malignant neoplasm at the initial stage.

Спонтанный пневмоторакс: некоторые аспекты этиологии, патогенеза и лечения (обзор литературы)

The review article discusses the prevalence, etiology, pathogenesis, and treatment of spontaneous pneumothorax. The vascular, mechanical, obstructive, infectious, and enzymatic theories of the occurrence of emphysematous lung changes as the main cause of developing spontaneous pneumothorax are described; the role of smoking as the main etiological factor and its influence on the recurrence rate of spontaneous pneumothorax are studied. The issues of choosing primary cure tactic are considered. The effectiveness of conservative treatment, puncture and drainage of the pleural cavity as methods of treatment and pleurodesis for the prevention of recurrences of spontaneous pneumothorax are described. A comparativeassessment of various methods of pleural cavity obliteration is given: chemical pleurodesis (by sterile talc, minocycline, povidone-iodine, 50% glucose solution, autologous blood and its components, autologous adipose tissue, pseudomonas aeruginosa sensitive hemagglutinin, picibanil), apical pleurectomy, pleuroabrasion. The experience of using YAG-ND and CO2 as methods of physical pleurodesis, intraoperative Staple Line Coverage with polyglyconic acid and fibrin gel is described. The necessity of active surgical tactic in the treatment of patients with spontaneous pneumothorax developed on the base of undifferentiated connective tissue dysplasia has been substantiated. The advantages, disadvantages, indications and contrindications to different ways of surgical treatment (thoracotomy, video-assisted minithoracotomy, thoracoscopy) are discussed. The strategy for choosing treatment methods depending on the volume of pneumothorax, the severity of bullous changes, the presence of concomitant diseases, chronic obstructive pulmonary disease, and the value of the Charlson comorbidity index is considered. The expediency of using video-assisted minithoracotomy as the safest and most effective method of surgical treatment of spontaneous pneumothorax has been substantiated. The effectiveness of surgical interventions depending on the timing of their implementation is considered.

Spontaneous pneumothorax as a complication of lung injury due to COVID-19

The objective of the study: to study the course and clinical outcomes of spontaneous pneumothorax (SP) in patients with lung injury due to COVID-19.Subjects and methods. Clinical and radiation data of 11 patients (above 18 years old) with SP due to COVID-19 were retrospectively analyzed, they all were treated in the thoracic surgery department. COVID-19 was confirmed in all patients by laboratory tests. According to the chest computed tomography, the patients had signs typical of viral pneumonia and SP.Results. The surgical treatment of SP that included thoracocentesis on the pneumothorax side and closed drainage of the pleural cavity allowed resolving the pneumothorax and inflating the lung fully in 10/11 patients within 4 days on average (max = 7 days) from the moment when the surgery was done. The lethal outcome was in 1/11 (9.1%) patient which occurred 1 day after the diagnosis and successful drainage of the bilateral SP, the patient had symptoms of acute cardiovascular failure.

Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients.

There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien-Dindo classification) were analysed for efficacy and safety assessment, respectively. Median postoperative air leaks continued for 0 days (range 0-25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00-1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38-27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

Treatment of recurrent or persistent spontaneous pneumothorax in children with synthetic glue pleurodesis

Abstract Background/purpose The optimal treatment of recurrent pneumothorax or persistent air leak after standard surgical treatment of spontaneous pneumothorax in children is poorly defined. This study reports a preliminary experience with synthetic glue pleurodesis as definitive treatment for recurrent or refractory spontaneous pneumothorax (RPSP) in children. Methods A retrospective review of two cases of RPSP in children treated with synthetic glue using an image-guided interventional delivery system was performed. Results Two males (ages 13 and 16) with twice recurrent SP after video-assisted thoracic surgery (VATS) were reviewed. Both patients were treated with a radiologically-guided catheter application of synthetic glue to the presumed site of air-leak on the visceral pleural surface of the lung. Pneumothoraces resolved within 24 hours in both patients, and there have been no recurrences at a median of 12 months follow-up. Conclusions Synthetic glue pleurodesis shows early therapeutic promise for RPSP in children, as a salvage therapy after previous VATS.

Relapse Bullous Emphysema Complicated by Spontaneous Pneumothorax, after Radical Bullectomy

Actuality The social significance of spontaneous pneumothorax due to the fact that in recent years a growing number of patients with pulmonary bullous emphysema and, accordingly, with spontaneous pneumothorax, as well as the fact that the structure is dominated by patients of working age persons. To date, some difficulties persist in choosing the adequate diagnostic and treatment tactics in this disease.
 Objective In a clinical example to show the importance of an integrated approach to of surgical treatment for spontaneous pneumothorax, caused bullous emphysema.
 Materials and methods A clinical case of recurrent bullous emphysema complicated by recurrent spontaneous pneumothorax in a patient 32 years old, six years earlier underwent radical surgery - bullectomy on the first episode of spontaneous pneumothorax.

Surgical treatment of spontaneous pneumothorax associated with lobal emphysema in a dog

Surgical treatment of spontaneous pneumothorax associated with lobal emphysema in a dog

Catamenial pneumothorax: A scourge not to be ignored

Catamenial pneumothorax (CP) is defined as spontaneous pneumothorax occurring within 72 h before or after the onset of menstruation. It is the most common form of thoracic endometriosis syndrome (TES), which includes catamenial hemoptysis, catamenial hemothorax, catamenial hemopneumothorax, and endometrial nodular lung mass. The purported pathogeneses are the retrograde menstruation and implantation of endometrial tissue in the thoracic cavity, the entry of endometrial cells into the venous system and metastatic spread of endometrial tissue, the coelomic metaplasia and the effect of the potent prostaglandin F2 causing the rupture of subpleural blebs at peak of menstruation. This condition was considered a rare entity even in our local setting; however, a prospective study about a decade ago showed that 25% of women hospitalized in an 18-month period for surgical treatment of spontaneous pneumothorax had this condition. The diagnosis is established by clinical evaluation with chest computerized tomography scan and video-assisted thoracoscopy, and immediate multimodality treatment using hormonal and surgical interventions will substantially reduce morbidity and mortality.

Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors

Catamenial pneumothorax and thoracic endometriosis (TE) are still under diagnosed. The purpose of this study is to increase the diagnostic accuracy for these conditions in patients with spontaneous pneumothorax and to identify their risk factors. We conducted a retrospective study on all consecutive women of reproductive age referred to our Centre for surgical treatment of spontaneous pneumothorax between July 2000 and January 2009. The study population comprised 156 premenopausal women of whom 49 (31.4%) had catamenial and/or TE-related pneumothorax. Over a quarter of these 49 patients had a previous history of recurrent thoracic or scapular catamenial pain. They experienced their first pneumothorax episode at an older age (mean ± SD) (34.0 years ± 6.7) than women with idiopathic pneumothorax (28.7 ± 6.1 years, P < 0.001). Pelvic endometriosis was found in 51% of women with catamenial and/or TE-related pneumothorax. After adjustment for confounding factors by multiple logistic regression analysis, the results show that, infertility [odd ratio (OR) = 4.21, 95% confidence interval (CI) = 1.28-13.88] and a history of pelvic surgery with a uterine procedure and/or uterine scraping (OR = 2.85, 95% CI = 1.12-7.26) were the strongest predictors of catamenial and/or TE-related pneumothorax. Infertility and uterine procedures are significantly associated with catamenial and/or TE-related pneumothorax. Scapular or thoracic pain during menses often precedes the occurrence of pneumothorax and is highly specific for the diagnosis of TE. Our results suggest that in women with pelvic endometriosis, these symptoms should be systematically investigated for an earlier diagnosis of TE.

Female Gender Negatively Affects Clinical Outcome of Surgical Treatment for Spontaneous Pneumothorax

Female Gender Negatively Affects Clinical Outcome of Surgical Treatment for Spontaneous Pneumothorax

Retrospective Study of Thoracoscopic Apical Pleurectomy and Mechanical Pleural Abrasion for Spontaneous Pneumothorax

Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97±44 minutes in group A and 77±18 minutes in group B (p＞0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156±87 cc in group A and 147±87 cc in group B (p＞0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7±25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature

Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax.

Catamenial and Noncatamenial, Endometriosis-related or Nonendometriosis-related Pneumothorax Referred for Surgery

Catamenial and endometriosis-related pneumothorax are considered relatively rare entities. Their clinical characteristics and outcome are incompletely known. To evaluate the frequencies, clinical characteristics, and outcomes of catamenial and endometriosis-related pneumothoraces occurring in women with no underlying lung disease referred for surgical treatment. Clinical files of all the women of reproductive age referred to our center during a 6-year period for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax (CP) was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses. All histologic slides were reviewed to confirm initial diagnoses. A total of 114 women underwent video-assisted thoracic surgery; 28 women (24.6%) had CP (right-sided in all but one), and diaphragmatic abnormalities (perforations and/or nodules) were observed in 22 of them. Diaphragmatic abnormalities were seen in 21 of 86 patients with non-CP. Histologic examination found endometriosis, mainly diaphragmatic, in 18 of 28 CPs and 11 of 86 non-CPs. A 6-month antigonadotropic treatment was prescribed postoperatively to women with either CP or endometriosis-related pneumothorax. Mean follow-up was 32.7 (+/-18.5) months. Recurrence rates in CP, non-CP but endometriosis-related, and non-CP non-endometriosis-related pneumothoraces were 32, 27, and 5.3%, respectively. Our experience shows that (1) CP and/or endometriosis-related pneumothoraces account for an important percentage of spontaneous pneumothoraces referred for surgery, (2) diaphragmatic abnormalities seem to play a fundamental role in their pathogenesis, and (3) management is difficult because of the high recurrence rate.

Optimal Timing for Surgical Treatment to Prevent Recurrence of Spontaneous Pneumothorax

Persistent air leakage and recurrence are the most common indications for the surgical treatment of spontaneous pneumothorax; however, the optimal timing for surgery is still unclear. The subjects of this study were 90 patients treated for either primary spontaneous pneumothorax (PSP; n = 58) or secondary spontaneous pneumothorax (SSP; n = 32). We compared the incidence of prolonged air leak, the rate of recurrence of pneumothorax, the time from the first episode of pneumothorax to recurrence, and the postoperative complications in the two groups. We also analyzed the recurrence rate after treatment with observation and tube drainage versus surgery. Seventy-three patients were treated with tube thoracostomy or oxygen therapy for the first episode of pneumothorax. Surgery was performed in 32 patients; for the first episode of pneumothorax in 17 and for the second or third episode in 15. Postoperative complications developed in six (18.7%) patients and 24 of 73 patients who did not undergo thoracotomy suffered recurrence. The incidence of a second episode was 32.9% and the incidence of a third episode in the 18 patients who suffered recurrence after conservative treatment was 61.1%. None of the patients who underwent surgery suffered recurrence. Tube thoracostomy is still the treatment of choice for first-time spontaneous pneumothorax. However, because the incidence of a third episode of pneumothorax after conservative treatment is high, surgical treatment should always be considered for patients with recurrence. In short, surgical intervention is safe and effective and minimizes the chance of recurrence of both PSP and SSP.

Catamenial Pneumothorax: A Prospective Study

To evaluate the incidence of catamenial pneumothorax (CP) among women who have been referred for the surgical treatment of spontaneous pneumothorax (SP) and to study its pathogenic mechanisms. A prospective study of women of reproductive age who have been referred to our center for the surgical treatment of SP. Patients with pneumothorax secondary to a known lung disease were excluded. A university hospital. At the preoperative evaluation, special attention was given to the investigation of a possible temporal relationship between pneumothorax and menses. Video-assisted thoracoscopy constituted the operative technique of choice. The lung was inspected to identify blebs or bullae and the origin of possible air leaks. Signs of thoracic endometriosis were also carefully searched for. The diaphragm was systematically inspected to search for holes and/or endometrial implants. When limited diaphragmatic abnormalities were found, a partial diaphragmatic resection was carried out using an endoscopic stapler. In case of lesions that were not accessible by a purely endoscopic approach, a utility minithoracotomy was used. In an 18-month period, 32 women with SP were referred for surgery. In eight cases, the catamenial character of the pneumothorax was recognized by clinical history. In all these patients, the following diaphragmatic abnormalities were found at surgery: holes (one patient); endometrial implants (three patients); and both (four patients). Visceral pleural endometriosis was found in one patient. During pathologic examination, diaphragmatic endometriosis was confirmed in seven of the eight cases. In one patient, it was associated with pulmonary and pleural endometriosis. In only one patient (with multiple diaphragmatic holes and a pulmonary nodular brown lesion), endometriosis could not be confirmed at histology, but signs of parenchymal focal hemorrhages were found. Our experience shows that (1) CP is more frequent than expected and (2) diaphragmatic abnormalities seem to play a fundamental role in its pathogenesis.

Comparison of Videothoracoscopy and Axillary Thoracotomy for the Treatment of Spontaneous Pneumothorax

Surgical treatment of spontaneous pneumothorax can be done through a thoracotomy or a video-thoracoscopic approach. Although the videothoracoscopic technique is currently popular it is not obviously superior to a more traditional axillary thoracotomy approach. We compared our recent experience with both techniques to determine the optimal surgical treatment for spontaneous pneumothoraces. A retrospective review of 79 patients treated surgically (34 thoracotomy and 45 thoracoscopy) for spontaneous pneumothoraces was done. Patients were treated between 1991 and 1997. Patients older than 60 years of age and those with spontaneous pneumothoraces secondary to generalized pulmonary emphysema were excluded. There were no operative deaths. Recurrence rate [thoracotomy, two of 34; thoracoscopy, three of 45 (P < 0.89)], air leak exceeding 7 days [thoracotomy, three of 34; thoracoscopy, three of 45 (P < 0.73)], operating room times [thoracotomy, 54 +/- 26 minutes; thoracoscopy, 53 +/- 16 minutes (P < 0.59)], and postoperative length of stay [thoracotomy, 5.7 +/- 4.3 days; thoracoscopy, 4.7 +/- 4.4 days (P < 0.26)] were not significantly different for the two techniques. We conclude that axillary thoracotomy and videothoracoscopy are equally effective surgical treatments for spontaneous pneumothoraces. A large randomized trial would be needed to determine whether one approach is truly superior to the other.

Can CT Scanning Be Used To Select Patients With Unilateral Primary Spontaneous Pneumothorax for Bilateral Surgery?

Despite advances in the surgical treatment of spontaneous pneumothorax, the timing of surgical intervention continues to be a subject of controversy. We test the hypothesis that CT scanning can help to predict the probability of the occurrence of primary spontaneous pneumothorax (PSP) by detecting lung bullae. Prospective, longitudinal cohort study. Between May 1994 to March 1995, 28 consecutive patients (23 men; age range, 18 to 47 years; mean, 29 years) with unilateral PSP who were to undergo video-assisted thoracic surgery (VATS) received preoperative CT of the thorax. CT scans were interpreted by one radiologist blinded to the clinical data for the presence of bullae in both lungs. All patients were followed-up in our outpatient clinic for an average of 59.0 months (range, 54 to 64 months). Eighty-eight percent of the blebs or bullae identified intraoperatively were demonstrated on preoperative CT scans. CT scans also showed the presence of lung blebs or bullae in the contralateral lung in 15 patients (53.6%). During the follow-up period, 4 of these 15 patients (26.7%) with contralateral blebs developed PSP in the untreated lung; none of the patients who did not have contralateral blebs (n = 13) developed PSP (p = 0.04 [chi(2) analysis]). The detection of lung bullae by CT scanning in the contralateral lung following unilateral PSP is associated with a higher rate of subsequent occurrence of pneumothorax in that lung. Thus, CT scanning can be used to predict the risk of occurrence of this condition, allowing preemptive surgical intervention in selected patients.