A new method to detect air leakage in a pneumothorax patient using saline solution and multidetector-row spiral computed tomography.
Chest. 2013 Apr 4;
Authors: Nakanishi K, Shimotakahara A, Asato Y, Ishihara T
ABSTRACT BACKGROUND: The purpose of this study was to establish a new computed tomography (CT) method to show signs of air-leakage and to detect the point of the lung leak in spontaneous pneumothorax patients by using saline solution and phonation. METHODS: Eleven spontaneous pneumothorax patients that had a chest tube placed and underwent an operation because of continuing air-leakage were studied. After a plain chest CT scan was performed, 0.9% saline was injected into the affected pleural cavity. A CT scan was acquired again while the patient vocalized continuously. The CT images were evaluated by two thoracic surgeons. All patients underwent video-assisted thoracoscopic surgery (VATS) to confirm their points of leakage and were treated for spontaneous pneumothorax. RESULTS: "Bubble" shadows were seen in 9 of 11 cases. In 7 of those 9 cases, multiple bubbles formed "foam" or "wave" shadows. These cases had a small pleural fistula. In the other 2 cases with a large fistula, "air-fluid level in bulla" and ground glass attenuation areas were seen in the pulmonary parenchyma. In all 11 cases, some air-leakage signs were seen on CT and a culprit lesion was presumed to exist by analyzing CT findings and confirming with a surgical air-leak test. CONCLUSIONS: With a saline injection and vocalization, CT could demonstrate air-leak signs in spontaneous pneumothorax patients. This method does not require contrast medium, special instruments or high skill and thus is a novel and useful examination to detect the culprit lesion in pneumothorax.
PMID: 23558756 [PubMed - as supplied by publisher]