CHEST Guidelines-Diagnostic-Value-of-Quantitative-Chest-CT Sca (1)

Diagnostic-Value-of-Quantitative-Chest-CT Sca (1)

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The document presents a case study of an 18-year-old woman who experienced a spontaneous pneumothorax, a condition where air accumulates in the pleural space of the lungs, causing the lung to collapse. Remarkably, she had no previous medical history and was otherwise healthy. She suddenly developed sharp chest pain following water polo practice, and after clinical evaluation, a large left pneumothorax was revealed.<br /><br />To address the pneumothorax, the patient underwent video-assisted thoracoscopic surgery to resect apical blebs and perform mechanical pleurodesis, which involves adhering the lung to the chest wall to prevent future collapses. Histological examination confirmed the presence of subpleural blebs and bullous emphysema with fibrosis and chronic inflammation.<br /><br />Further assessments revealed that she had mild obstructive lung disease. A CT scan of the chest showed decreased lung parenchymal density, raising considerations of conditions such as bronchial atresia and Swyer-James syndrome. However, through quantitative imaging analysis (QIA), the final diagnosis was congenital lobar emphysema (CLE), characterized by overextension of a lung lobe due to airway obstruction.<br /><br />CLE is a rare congenital condition usually diagnosed in infancy but can occasionally present in adulthood. In this case, it manifested unusually as a spontaneous pneumothorax. While surgery is typically required in infancy, adult patients are often managed conservatively unless they display significant symptoms. The paper concludes with the importance of QIA in accurately diagnosing CLE, particularly distinguishing it from similar conditions like bronchial atresia. With her symptoms managed through the initial surgical intervention, no further treatment was necessary, allowing the patient to resume her physical activities.

Keywords

spontaneous pneumothorax

video-assisted thoracoscopic surgery

congenital lobar emphysema

subpleural blebs

quantitative imaging analysis

obstructive lung disease

bronchial atresia

Swyer-James syndrome

pleurodesis

water polo