Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax
- Authors
- Jang, Hyo Jun; Lee, Jun Ho; Nam, Seung Hyuk; Ro, Sun Kyun
- Issue Date
- Aug-2020
- Publisher
- OXFORD UNIV PRESS INC
- Keywords
- Primary spontaneous pneumothorax; Occurrence; Blebs; Bullae
- Citation
- EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, v.58, no.2, pp.365 - 370
- Indexed
- SCIE
SCOPUS
- Journal Title
- EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
- Volume
- 58
- Number
- 2
- Start Page
- 365
- End Page
- 370
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/145313
- DOI
- 10.1093/ejcts/ezaa054
- ISSN
- 1010-7940
- Abstract
- OBJECTIVES: This retrospective cohort study aimed to analyse the impact of asymptomatic blebs/bullae on the occurrence of primary spontaneous pneumothorax (PSP) by monitoring the natural course of contralateral blebs/bullae in patients with ipsilateral pneumothorax.
METHODS: From January 2003 to December 2017, 1055 patients [age 19.63.98years (mean standard deviation), 953 men] experiencing the first episode of unilateral PSP were enrolled in this study, excluding patients aged 30years or more. The presence, number and maximal size of the blebs/bullae were investigated in contralateral asymptomatic lungs based on high-resolution computed tomography.
RESULTS: Multiple and single blebs/bullae were noted in contralateral lungs in 425 (40.3%) and 88 (8.3%) patients, respectively. The median follow-up period was 44.0 (interquartile range 71.5) months. The 1-, 3- and 5-year cumulative occurrence rates of PSP in contralateral lungs were 7.9%, 13.7% and 16.7%, respectively. On multivariable analysis, younger age [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.12-1.27; P<0.001) and multiple bullae (HR 4.42, 95% CI 3.06-6.38; P<0.001) were independent risk factors for spontaneous pneumothorax in the contralateral lung. The 5-year cumulative occurrence rates of PSP were significantly higher in patients with multiple blebs/bullae than in those with no or a single bleb/bulla (28.2% vs 8.5%, respectively; P<0.001).
CONCLUSIONS: Asymptomatic blebs/bullae often lead to PSP. If the patient is eligible for surgery for pneumothorax, preemptive surgery for contralateral bullae could be considered, especially in patients with multiple blebs/bullae.
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