Role Of Computed Tomography In The Diagnosis Of Pneumothorax In Patients With Complex Cystic Lung Disease

Abstract

Background: Pneumothorax is a serious, sometimes fatal complication of cystic lung disease in patients with lymphangioleiomyomatosis (LAM) and Birt-Hogg-Dubé (BHD) syndrome among other diffuse cystic lung diseases usually due to spillage of air from ruptured subpleural cysts. Chest radiography is still the first imaging study in most cases but this has considerably less sensitivity when there are extensive cystic changes. Consequently, high-resolution computed tomography (HRCT) has emerged as the gold standard for identification and characterization of pneumothorax in this cohort. Objective: We describe the clinical presentation and CT appearance of pneumothorax in cystic lung disease patients, as well as assess the diagnostic utility and management-utility of thoracic imaging. Methods: We prospectively recruited 50 consecutive patients with pneumothorax who were assessed clinically and underwent CT. This included demographic, smoking history, duration of symptoms, previous pneumothorax and infection history. CT scan imaging was evaluated for the location of pneumothorax, cyst size and distribution as well as associated findings including pleural thickening; ruptured cysts; or trapped lung.

Results: Of the patients, 90% were aged between 41 and80 years, while62%were male. Incidentally, 64% of cases had symptoms starting within less than six hours after presentation; cough (36%) and dyspnea (30%) were the most frequently complained symptoms in our population; moreover, a previous history of pneumothorax was present in only half. Pneumothorax was right sided in 44% of patients, left sided in 34% and bilateral in 22% on CT. Most cysts were lower-lobe (48%) or diffuse (34%), sizes <3 cm in 90%. Pleural thickening was the most common associated finding (48%); In conclusion, these findings affirm a robust association between cystic lung formation and pneumothorax incidence as well as risk of recurrence.

Conclusion CT imaging is also key to identifying and confirming pneumothorax in patients with cystic lung disease, providing details regarding the features of the underlying condition responsible for pneumothorax development, its distribution or complications that are crucial when it comes to clinical decisions. Identification of high-risk imaging patterns early on would allow for reduced rates of recurrence and potentially even better outcomes, emphasizing the role that chest CT plays as a gold-standard modality in these more ambiguous clinical scenarios over traditional comparisons with chest radiography.