Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax?

Thoracic echography easily detects the sign of 'pleural sliding', due to the movement of the visceral pleura on the parietal pleura. This sign is absent when pleurodesis is present. This study was designed to test thoracic echography in the assessment of difference in pleurodesis obtained after abrasion or pleurectomy performed for spontaneous pneumothorax, mainly based on the presence or absence of the 'pleural sliding' sign.

The population was composed by 10 patients, 5 submitted to VATS complete pleurectomy and 5 to VATS pleural abrasion. Thoracic ultrasonography was performed 4-6 weeks after surgery by an anesthesist trained in thoracic echography blinded to the pleurodesis technique used. Pleurodesis was defined as excellent if pleural sliding was absent in all the 9 considered points, effective when it was present in less than 3 points, poor when it was present in 3 points or more.

Pleurodesis was excellent in all the pleurectomy patients and in 1 abrasion patient. In one case, pleural sliding was present at one single explored point and in the last 3 cases there were two contiguous points of pleural sliding. Interestingly, one of these patients developed partial recurrence of pneumothorax 3 weeks after echography exactly at the level of recorded pleural sliding.

Thoracic echography for the postoperative evaluation of pleurodesis is feasible and simple. An ideal pleurodesis is more likely after pleurectomy than after pleural abrasion. Areas of persisting pleural sliding are probably at risk of recurrence.