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Published on: March 12, 2020
Efficacy of blebs detection for preventive surgery in children's idiopathic spontaneous pneumothorax
Nadia Nathan1, Julia Guilbert, Michèle Larroquet
1Hôpital Armand Trousseau, Université Pierre et Marie Curie-Paris 6, 26 avenue du docteur Arnold Netter, Paris Cedex 12, France. nadia.nathan@trs.aphp.fr
Insights
Detecting blebs on CT scans in children with primary spontaneous pneumothorax (PSP) helps guide surgery. This can effectively prevent PSP recurrence, improving patient outcomes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Primary spontaneous pneumothorax (PSP) management in children requires effective strategies.
- Blebs, small air sacs on the lung surface, are often implicated in PSP.
- Initial CT scans are crucial for identifying potential causes of PSP.
Purpose of the Study:
- To evaluate a management strategy for pediatric PSP based on CT-detected blebs.
- To assess the utility of CT scans in identifying blebs for surgical decision-making.
- To determine if bleb detection influences the prevention of PSP recurrence.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) with PSP from 2000-2007.
- Inclusion criteria: primary spontaneous pneumothorax.
- Data collection focused on CT scan findings (blebs) and surgical outcomes.
Main Results:
- 14 out of 25 pediatric PSP patients (56%) showed blebs on CT scans.
- CT scan sensitivity for blebs was 75%, with a positive predictive value of 92% for surgical confirmation.
- Children with blebs who underwent surgery had no recurrence, while those without surgery experienced recurrence.
Conclusions:
- CT scan detection of blebs in children with PSP is sensitive and valuable.
- Identifying blebs via CT can guide surgical intervention to prevent PSP recurrence.
- This imaging-based strategy aids in optimizing PSP management in pediatric patients.
Background:
This retrospective, single-center study was designed to assess our management strategy based on blebs detection on the initial CT scan.
Methods:
Children younger than aged 18 years presenting with a primary spontaneous pneumothorax (PSP) between 2000 and 2007 in a University Children's Hospital (hospital Armand Trousseau, Paris, France) were included in this study.
Results:
Twenty-five children who presented with PSP were included. The mean age was 14.2 +/- 1.9 years, and the sex ratio was 2.1. There was no significant difference between patients with or without blebs with regard to the anthropomorphic data or the side of the pneumothorax. Six patients had recurrence, which, in most cases, was a grade 1 pneumothorax. Fourteen (56%) children showed blebs on CT scan, which was ipsilateral or bilateral in 13 cases and contralateral in 1 case. Eleven of these children had surgery, and all the remaining patients (n = 3) had recurrence. All the patients, except one, presenting blebs on the preoperating CT scan, showed blebs on the subsequent surgery (predictive positive value = 92%), and the CT-scan sensibility for blebs was 75%.
Conclusions:
In children, blebs detection on CT scan has a good sensitivity and may be a useful tool to determine the indication of lung surgery to prevent PSP recurrence.
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