Korean J Thorac Cardiovasc Surg.  2017 Dec;50(6):424-429. 10.5090/kjtcs.2017.50.6.424.

Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax

• Choi J
• Ahn HY
• Kim YD
• I H
• Cho JS
• Lee J

• KMID: 2398372
• DOI: http://doi.org/10.5090/kjtcs.2017.50.6.424

Abstract

BACKGROUND
The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings.
METHODS
The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS.
RESULTS
Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%).
CONCLUSION
The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

Keyword

Secondary spontaneous pneumothorax; Bullae; Chest computed tomography; Video-assisted thoracoscopic surgery

MeSH Terms

Humans
Lung
Lung Injury
Pneumothorax*
Retrospective Studies
Rupture
Thoracic Surgery, Video-Assisted