title: The utility of computed tomography in the management of patients with spontaneous pneumothorax.
abstract: BACKGROUND
  Spontaneous pneumothorax may result from rupture of subpleural blebs. Computed tomography (CT) has been used to identify blebs to serve as an indication for thoracoscopy. We reviewed our experience with spontaneous pneumothorax to assess the utility of CT in these patients.
  
  
  METHODS
  A retrospective review was conducted of all patients who underwent an operation for spontaneous pneumothorax from January 1999 to October 2009. All procedures were performed thoracoscopically.
  
  
  RESULTS
  We identified 39 pneumothoraces in 34 patients who underwent evaluation and a procedure for spontaneous pneumothorax. Mean age was 16.1 years (range, 10-23 years), with an average of 1.7 spontaneous pneumothoraces before operation (range, 1-4). Preoperative chest CT scans were obtained in 26 cases. Blebs were demonstrated on 8 CT scans. The presence of blebs was confirmed at operation in all 8 patients. Of the 18 negative scans, 14 (77.8%) were found to have blebs intraoperatively, 7 of these patients were initially managed nonoperatively and developed recurrence. The sensitivity of CT for identifying blebs was 36%.
  
  
  CONCLUSIONS
  Chest CT does not appear to be precise in the identification of pleural blebs and a negative examination does not predict freedom from recurrence. Operative decisions should be based on clinical judgment without the use of preoperative CT.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Laituri
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valusek
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Rivard
authors.forename: Carissa L
authors.initials: CL
authors.lastname: Garey
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D001768:Blister / Q000150:complications / Q000000981:diagnostic imaging; D002648:Child; D006801:Humans; D010995:Pleural Diseases / Q000150:complications / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D055815:Young Adult