The pathogenesis of the primary spontaneous pneumothorax is the rupture of subpleural bleb or bullae and subsequent sudden collapse of the affected lung. Mostly, the bullae or blebs are present bilaterally, but detecting the number, size, and
location
of the causating foci by plain chest film is quite difficult.
We have performed chest CT scans for detecting the bullous lesions in 33 cases of primary spontaneous pneumothorax, and compared the results with surgical findings.
1. Seventy-four blebs were identified in the chest CT scan, and 100 blebs or bullae were detected surgically(Sensitivity was 0.74).
2. Diagnosis rate was 80%(40/50) at right upper lobe, 75.7%(28/37) at left upper lobe, 55.6% at right lower lobe, and 25.0% at left lower lobe, respectively.
3. Blebs or bullae smaller than 1cm of its diameter were detected by 57.1%(24/42) of sensitivity, and in the cases of size larger than 1 cm , it revealed 86.2%(50/58) of sensitivity respectively.
4. Of the 45 cases, 7 cases were false negative(15.6%) , most of these were ruptured or small size(<0.5cm).
5. One case was false positive, which was irregular adhesion at the apex of the lung.
6. We could detect blebs or bulls with preoperative CT scans in 84.4%(38/45) of total patients.
In could detect blebs or bullae with preoperative CT scans in 84.4%(38/45) of total patients.
In conclusion, chest CT scan is a very advantageous diagnostic tool for proper management and preventing recurrence of primary spontaneous pneumothorax patient. (Korean J Thoracic Cardiovas Surg 1994; 27:209-213)
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