Clinico-pathological findings in stage-I primary spontaneous pneumothorax: analysis of 19 cases and literature review
Background: Some patients suffering from spontaneous primary pneumothorax have a normal appearing lung during video-assisted thoracic surgery (VATS; stage I). There is a paucity of data on microscopic appearances of lung biopsies in patients with stage I pneumothorax.
Objectives: This prospective study aims to test the hypothesis that there is no histologically normal lung tissue in patients suffering from stage-I primary spontaneous pneumothorax.
Methods: Apical VATS lung wedge resection was prospectively performed in patients with stage-I primary spontaneous pneumothorax. All specimens were sent for pathologic examination. The data recorded included age, sex, smoking history, tension pneumothorax, indications for surgery and hospital stay. A thorough literature review was also performed.
Results: Nineteen patients were operated on. Thirteen male and six female, mean age of 30 years. Twelve (63 %) patients were current smokers. Eleven patients had recurrent pneumothorax. Wedge lung biopsies were taken from the apex of the right upper lobe in 13 and the left upper lobe in six. One patient had a recurrent pneumothorax within 1 month. Pathologic examination demonstrated in all patients’ dilatation and destruction of the alveolar walls distal to the terminal bronchiole; fibrosis of the parenchymal septae; cystic dilatation of the airspaces and thickening of the visceral pleura. Literature review showed alteration of lung parenchyma with a striking variability.
Conclusions: This study confirms that no normal apical lung parenchyma exists in patients with stage-I primary spontaneous pneumothorax. In the era of evidence-based medicine, wedge apical lung biopsy is, therefore, desirable to obtain a histological cause in patients with stage-I primary spontaneous pneumothorax.