Efficacy of Blebs Detection for Preventive Surgery in Children’s Idiopathic Spontaneous Pneumothorax

Hôpital Armand Trousseau Université Pierre et Marie Curie-Paris 6 Paris France
World Journal of Surgery (Impact Factor: 2.35). 01/2010; 34(1):185-189. DOI: 10.1007/s00268-009-0286-x

ABSTRACT BackgroundThis retrospective, single-center study was designed to assess our management strategy based on blebs detection on the initial
CT scan.

MethodsChildren younger than aged 18years 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.

ResultsTwenty-five children who presented with PSP were included. The mean age was 14.2±1.9years, 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%.

ConclusionsIn 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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    • "This makes a strong argument for not using CT in the management of these patients because the blebs not only are apparently difficult to find on CT but also don't necessarily predict outcome when found. In a recent small series of 14 children who underwent CT for bleb detection, the authors felt CT was useful because most of the patients with blebs identified on CT were found to have bullous disease during thoracoscopy [10]. This corroborated the result of a previous series of 43 children in which there were no false positives [11]. "
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