Pulmonary Apical Opacities on Thin-Section Computed Tomography: Relationship to Primary Spontaneous Pneumothorax in Young Male Patients and Corresponding Histopathologic Findings

Incidental Apical Pleuroparenchymal Scarring on Computed Tomography: Diagnostic Yield, Progression, Morphologic Features and Clinical Significance

PURPOSE

Apical pleuroparenchymal scarring (APPS) is commonly seen on chest computed tomography (CT), though the imaging and clinical features, to the best of our knowledge, have never been studied. The purpose was to understand APPS's typical morphologic appearance and associated clinical features.

PATIENTS AND METHODS

A random generator selected 1000 adult patients from all 21516 chest CTs performed at urban outpatient centers from January 1, 2016 to December 31, 2016. Patients with obscuring apical diseases were excluded to eliminate confounding factors. After exclusions, 780 patients (median age: 64 y; interquartile range: 56 to 72 y; 55% males) were included for analysis. Two radiologists evaluated the lung apices of each CT for the extent of abnormality in the axial plane (mild: <5 mm, moderate: 5 to 10 mm, severe: >10 mm), craniocaudal plane (extension halfway to the aortic arch, more than halfway, vs below the arch), the predominant pattern (nodular vs reticular and symmetry), and progression. Cohen kappa coefficient was used to assess radiologists' agreement in scoring. Ordinal logistic regression was used to determine associations of clinical and imaging variables with APPS.

RESULTS

APPS was present on 65% (507/780) of chest CTs (54% mild axial; 80% mild craniocaudal). The predominant pattern was nodular and symmetric. Greater age, female sex, lower body mass index, greater height, and white race were associated with more extensive APPS. APPS was not found to be associated with lung cancer in this cohort.

CONCLUSION

Classifying APPS by the extent of disease in the axial or craniocaudal planes, in addition to the predominant pattern, enabled statistically significant associations to be determined, which may aid in understanding the pathophysiology of apical scarring and potential associated risks.

The accuracy of computed tomography in detecting surgically resectable blebs or bullae in primary spontaneous pneumothorax

OBJECTIVES

Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax.

METHODS

This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae.

RESULTS

A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae.

CONCLUSION

The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.