CHEST Guidelines-Not-all-Blebs-Are-Created-Equal

Not-all-Blebs-Are-Created-Equal_chest

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The editorial by Preeti Gupta and Christopher M. Kapp discusses the findings of Jeong et al.'s study on the risk of contralateral spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax. PSP typically occurs in individuals without underlying lung disease and is influenced by factors such as smoking, male gender, and lower body mass index (BMI). Blebs and bullae are common findings in PSP patients, contributing to recurrent and contralateral pneumothoraxes.<br /><br />Jeong et al.'s study focused on evaluating contralateral blebs or bullae in individuals under 30 years old post-VATS. It found that while 80.2% of patients had contralateral blebs, only 15.2% experienced a contralateral pneumothorax. Factors like larger-sized blebs, younger age, smoking, and lower BMI increased the risk, with the recurrence rate declining over time.<br /><br />The study introduced a predictive model using variables such as age, smoking status, BMI, and bleb size, achieving a predictive accuracy with an area under the curve of 0.815. This model aims to aid in assessing the risk of contralateral pneumothorax, suggesting that conservative management might be preferable for minimally symptomatic patients, despite large blebs being a risk factor.<br /><br />Gupta and Kapp note the historical preference for intervention in PSP cases, such as needle aspiration or tube thoracostomy. However, the high detection rate of blebs and the low occurrence of contralateral pneumothorax support the potential of conservative management. Prophylactic blebectomy or pleurodesis could reduce the incidence but carry unnecessary risks. Future research should focus on validating predictive models for better informed management decisions, potentially identifying candidates who might benefit from early surgical interventions.

Keywords

contralateral spontaneous pneumothorax

video-assisted thoracoscopic surgery

primary spontaneous pneumothorax

blebs and bullae

predictive model

smoking

body mass index

conservative management

prophylactic blebectomy

pleurodesis