Korean J Thorac Cardiovasc Surg 2019; 52(2): 91-99  https://doi.org/10.5090/kjtcs.2019.52.2.91
Do Blebs or Bullae on High-Resolution Computed Tomography Predict Ipsilateral Recurrence in Young Patients at the First Episode of Primary Spontaneous Pneumothorax?
Sungjoon Park , M.D.1, Hyo Jun Jang , M.D.2, Ju Hoon Song , R.N.2, So Young Bae , M.D.2, Hyuck Kim , M.D., Ph.D.2,3, Seung Hyuk Nam , M.D.4, Jun Ho Lee , M.D., Ph.D.2
1Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea; 2Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Seoul, Korea; 3Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea; 4Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Guri, Korea
Corresponding author: Hyo Jun Jang, Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea,
(Tel) 82-2-2290-8463 (Fax) 82-2-2290-8466 (E-mail) rgo38@naver.com
Received: September 17, 2018; Revised: October 17, 2018; Accepted: October 22, 2018.; Published online: April 5, 2019.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment.
Methods: A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT.
Results: The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<20 kg/m2), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor.
Conclusion: The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.
Keywords: Pneumothorax, Recurrence, Computed tomography, Bullae


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