[Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications].

OBJECTIVE The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications. PATIENTS AND METHODS We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated. RESULTS The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P=.92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P=.03). The number and size of the bullae had no significant influence on recurrence (P=.51). CONCLUSIONS The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan.