Original Research: Pulmonary Procedures |

A New Method to Detect Air Leakage in a Patient With Pneumothorax Using Saline Solution and Multidetector-Row Spiral CT ScanSaline-Filled CT Thoracography to Detect Air Leak

Kozo Nakanishi, MD, PhD; Akihiro Shimotakahara, MD, PhD; Yuko Asato, MD, PhD; Toshihiro Ishihara
Author and Funding Information

From the Department of General Thoracic Surgery (Drs Nakanishi and Shimotakahara), Department of Pulmonary Medicine (Dr Asato), and Department of Radiology (Mr Ishihara), National Hospital Organization Saitama Hospital, Wako, Saitama, Japan.

Correspondence to: Kozo Nakanishi, MD, PhD, Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama, 351-0102, Japan; e-mail: konakanishi-ths@umin.ac.jp

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(3):940-946. doi:10.1378/chest.12-2678
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Background:  The purpose of this study was to establish a new CT scan method to show signs of air leakage and to detect the point of the lung leak in patients with spontaneous pneumothorax by using saline solution and phonation.

Methods:  Eleven patients with spontaneous pneumothorax who had a chest tube placed and underwent an operation because of continuing air leakage were studied. After a plain chest CT scan was performed, 0.9% saline was injected into the affected pleural cavity. A CT scan was acquired again while the patient vocalized continuously. The CT images were evaluated by two thoracic surgeons. All patients underwent video-assisted thoracoscopic surgery to confirm their points of leakage and were treated for spontaneous pneumothorax.

Results:  Bubble shadows were seen in nine of 11 cases. In seven of those nine cases, multiple bubbles formed foam or wave shadows. These cases had a small pleural fistula. In the other two cases with a large fistula, air-fluid level in bulla and ground-glass attenuation areas were seen in the pulmonary parenchyma. In all 11 cases, some air-leakage signs were seen on CT scan, and a culprit lesion was presumed to exist by analyzing CT imaging findings and confirming with a surgical air-leak test.

Conclusions:  With a saline injection and vocalization, CT scan could demonstrate air-leak signs in patients with spontaneous pneumothorax. This method does not require contrast medium, special instruments, or high skill and, thus, is a novel and useful examination to detect the culprit lesion in pneumothorax.

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