title: Natural course of spontaneous pneumothorax without bullae or blebs under high-resolution computed tomography.
abstract: BACKGROUND
  The cause of primary spontaneous pneumothorax (PSP) is known as rupture of some bullae or blebs.
  
  
  OBJECTIVE
  The aim of this study is to clarify the natural course of spontaneous pneumothorax in the absence of bullae or blebs under high-resolution chest computed tomography (HRCT).
  
  
  METHODS
  From January 2006 to December 2010, 854 patients with PSP were enrolled in the study group. All subjects received a chest CT scan and were reviewed retrospectively.
  
  
  RESULTS
  There were 56 PSP cases (6.5%) without bullae or blebs under HRCT. Treatments included oxygen therapy in 16 (28.5%) cases, arrow catheter insertion in 22 (39.2%) cases, closed thoracostomy in 17 (30.3%) cases, and 1 (1.7%) case received a video-assisted thoracoscopic surgery (VATS) operation. There were nine recurrent cases (16%). Of the nine cases, eight cases were treated with VATS operation. Several bullae or blebs were found in five of those nine operated cases, and there were severe inflammatory fibrotic changes on the apex of one of the nine operated cases.
  
  
  CONCLUSIONS
  Several bullae and blebs were revealed upon operation of PSP without previously detected bullae and blebs on HRCT. We cautiously recommend operating on PSP regardless of whether bullae and blebs are detected by HRCT as long as there are no contraindications to the operation.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Yoon
authors.initials: TY
authors.lastname: Oh
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Woon Ha
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joon Hyuk
authors.initials: JH
authors.lastname: Kong
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kang Seok
authors.initials: KS
authors.lastname: Baek
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Won Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yun Yi
authors.initials: YY
authors.lastname: Bang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D018579:Patient Selection; D011030:Pneumothorax / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult