Radiological Predictors of Recurrent Primary Spontaneous Pneumothorax Following Non-surgical Management

Background: Studies to date have not identified any reliable predictors for recurrence of primary spontaneous pneumothorax (PSP) on plain chest radiograph (CXR). The aim of this study was to assess whether abnormalities on CXR at first presentation of PSP can be used to predict recurrence of PSP. Method: The study included all patients admitted to The Canberra Hospital between 1998 and 2004. CXRs taken at initial presentation were reviewed retrospectively by an independent radiologist. Radiological abnormalities on CXR included: pleural thickening: blebs/bullae; pleural irregularities and pleural adhesions. Results: One hundred patients were followed up for a mean duration of 57 months. The total rate of recurrence was 54%. Multivariate analysis found that the presence of an abnormality (irrespective of the type) increased the likelihood of recurrence and the risk of recurrence increased with each additional abnormality. Patients having one, two and three or more abnormalities were 3.0 (95% CI. =2.09, 3.91, p=0.018), 5.3 (95% CI. =4.47, 6.13, p< 0.001) and 12.6 (95% CI. =11.57, 13.63, p< 0.001) times more likely to develop recurrence respectively. Conclusion: In view of these results we now offer surgical treatment at first presentation PSP in patients in whom we identify two or more radiological abnormalities on CXR.