SURGICALLY TREATED PNEUMOTHORAX - RADIOLOGIC AND PATHOLOGICAL FINDINGS

Objective: To compare the identifiable pulmonary abnormalities on preo perative chest radiographs and CT scans with the histologic findings i n patients requiring surgical intervention for recurrent or persistent pneumothoraces. Materials and methods: Chest radiographs were reviewe d retrospectively in 116 consecutive patients (aged 16 to 81 years) wh o had undergone thoracotomy for recurrent or persistent pneumothorax. CT scans were performed in 21 patients. Chest radiographs and CT scans were reviewed by two observers without knowledge of the histologic fi ndings, All specimens were reviewed by a surgical pathologist. Results : Seventy-nine (68%) patients had parenchymal abnormalities and five ( 4%) had pleural thickening evident on the radiograph, The most common radiographic abnormalities included apical bullae (n=51), apical scarr ing (n=17), and diffuse emphysema (n=9). Twenty of 21 (95%) CT scans d emonstrated either a parenchymal or a pleural abnormality. CT demonstr ated emphysema in four patients with normal radiographs, as well as ad ditional findings in six patients with abnormal radiographs, Histologi cally, 74 patients had focal irregular emphysema, 26 had distal acinar emphysema, six had mixed emphysema, four had isolated bullae or blebs , two had mesothelioma, and one each had the following: metastatic ang iosarcoma, subpleural fibrosis, congenital cystic adenomatoid malforma tion, and tuberculous pleuritis with inactive interstitial fibrosis an d honeycombing. Conclusion: Most patients with surgically treated pneu mothorax have emphysema or an isolated bulla, Although these findings may not be apparent on the radiograph and seen on CT, this probably do es not affect patient management, In most cases of pneumothorax relate d to other causes, findings consistent with the diagnosis can be seen on the radiograph.