PURPOSE: Ruptured bullae at the azygoesophageal recess (AER), pleural protrusion into the right posterior mediastinum extending from the azygos arch to the diaphragm, have received little attention to date. We evaluated the lesions responsible for right spontaneous pneumothorax and the types of the AER to clarify the frequency and characteristics of ruptured bullae at the AER.
METHODS: Eighty patients with right spontaneous pneumothorax underwent surgery for 5 years. The lesions responsible for pneumothorax were identified intraoperatively and by preoperative computed tomography (CT). We also defined the types of the AER by CT. In the deep AER, the medial extent of the AER exceeds the line connecting the median portions of the sternum and thoracic spine. In the shallow AER, the medial extent of the AER does not exceed it. We compared the sites of ruptured bullae in secondary spontaneous pneumothorax (SSP) patients with those in primary spontaneous pneumothorax (PSP) patients, especially paying attention to the types of the AER.
RESULTS: Ruptured bullae were found in 20 (SSP: 12, PSP: 8) at the AER and 60 (SSP: 11, PSP: 49) at other sites (p=0.003). The SSP patients showed a significantly higher incidence of ruptured bullae at the AER. In 78 patients, the deep AER was found in 24 (ruptured bullae at the AER: 12, at other sites: 12) and the shallow AER in 54 (ruptured bullae at the AER: 8, at other sites: 46) (p=0.002). The deep AER was found in 12 (SSP: 10, PSP: 2) and the shallow AER in 8 (SSP: 2, PSP: 6) of 20 patients with ruptured bullae at the AER (p=0.015). The deep AER was more frequently observed in SSP patients with ruptured bullae at the AER.
CONCLUSIONS: Ruptured bullae at the AER were common, and associated with the deep AER in SSP patients.
CLINICAL IMPLICATIONS: The presence of the deep AER in SSP patients is associated with ruptured bullae and can be predictive of rupture.
DISCLOSURE: The following authors have nothing to disclose: Tsuyoshi Takahashi, Tomohiro Murakawa, Jun Nakajima
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