Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment
- Resource Type
- Authors
- Karin Klooster; Wouter H. van Geffen; Nick H. T. ten Hacken; Dirk-Jan Slebos; Rienhart F. E. Wolf; Jorine E. Hartman; Huib A. M. Kerstjens
- Source
- Respiration, 94(2), 224-231. KARGER
- Subject
- Male
SEGMENTATION
Tissue Adhesions
Pleural adhesions
THERAPY
Pleural adhesion
law.invention
Postoperative Complications
0302 clinical medicine
Randomized controlled trial
Bronchoscopy
law
Lung volume reduction
030212 general & internal medicine
Lung
medicine.diagnostic_test
STATEMENT
Chronic obstructive pulmonary disease
Pneumothorax
Prostheses and Implants
Middle Aged
respiratory system
LUNG-VOLUME REDUCTION
FISSURES
medicine.anatomical_structure
Pulmonary Emphysema
Female
Radiology
medicine.symptom
Pulmonary and Respiratory Medicine
COMPUTED-TOMOGRAPHY SCANS
medicine.medical_specialty
Hyperinflation
COIL TREATMENT
Risk Assessment
OBSTRUCTIVE PULMONARY-DISEASE
Prosthesis Implantation
Lesion
03 medical and health sciences
medicine
Humans
Aged
Emphysema
business.industry
Endobronchial valve
medicine.disease
Valves
respiratory tract diseases
Surgery
HOMOGENEOUS EMPHYSEMA
030228 respiratory system
INTEROBSERVER AGREEMENT
Tomography, X-Ray Computed
business
- Language
- ISSN
- 1423-0356
0025-7931
Background: Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. Objective: To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. Methods: HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (5 mm). Results: The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score Conclusion: A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.