Work

Primary spontaneous pneumothorax: reassessing the role of chest CT in surgical decision-making

Year: 2025

Type: article

Abstract: Purpose Primary spontaneous pneumothorax (PSP) is a common condition managed either conservatively or surgically. This study investigated whether specific chest X-ray or computed tomography (CT) characteristics can predict the need for surgical intervention and clarified the role of each imaging modality in surgical planning. Methods We retrospectively reviewed records of all PSP patients at a university hospital from 2013 to 2024. Only patients with available imaging were included in the analysis. Radiographic characteristics, clinical data, and outcomes were collected. Univariate analysis and logistic regression were performed to identify predictors of surgical intervention. Results Ninety-one patients were included, with 35 (38.5%) undergoing surgical intervention. Chest X-ray findings did not significantly correlate with surgical decisions (odds ratio (OR) = 0.920, 95% confidence interval (CI) 0.239–3.533, P = 0.903). Patients with recurrent pneumothorax were more likely to require surgery (74.3% vs. 25.7%, P < 0.0001). Logistic regression revealed that symptom onset 1 day prior to admission increased the likelihood of surgery 4.122-fold compared to same-day onset (95% CI 1.004–19.920, P = 0.049). Eighteen patients underwent CT scanning, and their chest X-ray findings closely correlated with CT findings (kappa’s score = 0.944, 95% CI 0.83–1.00). Conclusions Chest X-ray findings alone are insufficient predictors of surgical intervention in PSP. Instead, prolonged symptom duration and a history of recurrence are key determinants of surgical need. The strong correlation between X-ray and CT findings suggests that routine preoperative CT may add little value, particularly in young patients. Further prospective studies are needed to validate these results. Graphical abstract

Source: Indian Journal of Thoracic and Cardiovascular Surgery

DOI: 10.1007/s12055-025-02014-6

Authors: Mohammad Abu El Hija, Harbi Khalayleh, Guy Pines

Institutions: Kaplan Medical Center, Hebrew University of Jerusalem

Language: English

Topic: Pleural and Pulmonary Diseases

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,890