Published ahead of print on April 20, 2006, doi:10.1164/rccm.200602-259OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200602-259OC
Fluorescein-enhanced Autofluorescence Thoracoscopy in Patients with Primary Spontaneous Pneumothorax and Normal SubjectsInterventional Endoscopy Clinic and Respiratory Division, and Anaesthesiology Department, University Hospital AZ-VUB, Brussels, Belgium; Critical Care and Respiratory Division, University of Athens, "Evaggelismos" Hospital, Athens, Greece; Division of Pulmonary and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada; and Pulmonary Special Procedures Unit, Respiratory Division, University of California–San Diego, San Diego, California Correspondence and requests for reprints should be addressed to Marc Noppen, M.D., Ph.D., Head, Interventional Endoscopy Clinic, University Hospital AZ VUB, 101 Laarbeeklaan, B 1090 Brussels, Belgium. E-mail: marc.noppen{at}az.vub.ac.be Rationale: The exact site(s) and pathophysiology of air leakage in patients with primary spontaneous pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT). Objectives: To prospectively perform and compare WLT and FEAT in patients with spontaneous pneumothorax and in normal subjects. Methods: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects. Results: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Actual fluorescein leakage was seen in two patients with PSP. Conclusions: Lungs in patients with PSP show significantly more abnormalities at WLT when compared with normal subjects. High-grade FEAT lesions were exclusively present in PSP, and predominantly at lung zones that appeared normal at white light inspection. These findings suggest that significant parenchymal abnormalities are not limited to lesions visible during WLT, such as blebs and bullae.
Key Words: fluorescein • spontaneous pneumothorax • thoracoscopy This article has been cited by other articles:
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