Thoracic morphological characteristics of primary spontaneous pneumothorax patients requiring surgical intervention

Primary spontaneous pneumothorax (PSP) is a condition commonly observed in adolescents, often associated with physical characteristics such as tall stature, low body weight, and a flat thoracic cage. However, the relationship between thoracic morphology and the development of PSP remains unclear. This study aimed to compare thoracic parameters between adolescent PSP patients and healthy controls and to identify potential thoracic risk factors for PSP.

A retrospective case-control study was conducted, including adolescent males aged 13-19 years who underwent surgery for PSP (PSP group) and age-matched healthy controls. Thoracic parameters were measured using 3D-reconstructed chest computed tomography (CT) scans and included transverse diameter (TD), sagittal diameter (SD), and right/left anteroposterior diameters (RAPD/LAPD). Vertical thoracic length was assessed from chest X-rays. Statistical analyses included Mann-Whitney U tests, Spearman correlation, and predictive modeling to identify significant risk factors.

The PSP group demonstrated significantly lower BMI and distinct thoracic morphology compared to controls. The SD/TD ratio was consistently lower across all thoracic levels in the PSP group, with the most pronounced difference observed at the sternal angle (P<0.001). Furthermore, vertical thoracic length was significantly greater in PSP patients (P<0.001). The predictive model for PSP development was significantly improved by incorporating the SD/TD ratio at the sternal angle (P=0.002) and the RAPD/TD ratio at the xiphisternal angle (P=0.008).

Adolescent PSP patients exhibit a unique thoracic morphology characterized by a flattened and flattened thoracic cage. The SD/TD ratio at the sternal angle and the RAPD/TD ratio at the xiphisternal angle emerged as potential risk factors for PSP development. These findings contribute to a deeper understanding of PSP pathophysiology and may inform future strategies for prevention and screening.