Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.
BACKGROUND
The exact site(s) and pathophysiology of air leakage in patients with primary spontaneous pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT).


OBJECTIVE
To prospectively perform and compare WLT and FEAT in patients with spontaneous pneumothorax and in normal subjects.


METHODS
One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects.


RESULTS
WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Actual fluorescein leakage was seen in two patients with PSP.


CONCLUSIONS
Lungs in patients with PSP show significantly more abnormalities at WLT when compared with normal subjects. High-grade FEAT lesions were exclusively present in PSP, and predominantly at lung zones that appeared normal at white light inspection. These findings suggest that significant parenchymal abnormalities are not limited to lesions visible during WLT, such as blebs and bullae.
Noppen
Marc
M
Interventional Endoscopy Clinic and Respiratory Division, and Anaesthesiology Department, University Hospital, Brussels, Belgium. marc.noppen@az.vub.ac.be
Dekeukeleire
Tom
T
Hanon
Shane
S
Stratakos
Grigoris
G
Amjadi
Kayvan
K
Madsen
Priscilla
P
Meysman
Marc
M
D'Haese
Jan
J
Vincken
Walter
W
D000328:Adult; D005260:Female; D019793:Fluorescein; D005453:Fluorescence; D005456:Fluorescent Dyes; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012907:Smoking; D013906:Thoracoscopy / Q000379:methods*
D005456:Fluorescent Dyes; D019793:Fluorescein