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: 2.64). 01/2010; 34(1):185-189. DOI: 10.1007/s00268-009-0286-x


This retrospective, single-center study was designed to assess our management strategy based on blebs detection on the initial CT scan.
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.
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%.
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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    • "Figure 1 shows a general outline of our novel early diagnostic method. In the future, the algorithm may be real time coupled with either ultrasound or CT scan data to quantify patient risk of pneumothorax earlier and improve the current diagnostic benchmark of only 75% lesion sensibility [6]. Unlike competitive diagnostic procedures for pneumothorax such as infrared thermography [1], our proposed method relies on detecting pathological hallmarks in tissue behavior before acute lung collapse actually occurs. "
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    Full-text · Article · May 2013 · Computational and Mathematical Methods in Medicine
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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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