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Published ahead of print on June 23, 2004, doi:10.1164/rccm.200404-438CR

Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 680-682

A more recent version of this article appeared on September 15, 2004
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Submitted on May 10, 2004
Accepted on June 16, 2004

Fluoresceine-enhanced Autofluorescence Thoracoscopy in Primary Spontaneous Pneumothorax

Marc Noppen1*, Grigoris Stratakos1, Sylvia Verbanck1, Jan D'Haese1, Marc Meysman1, and Walter Vincken1

1 Interventional Endoscopy Clinic, Anaesthesiology Department and Respiratory Division, University Hospital AZ VUB, Brussels, Belgium

* To whom correspondence should be addressed. E-mail: marc.noppen{at}az.vub.ac.be.

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. Especially, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluoresceine followed by autofluorescence thoracoscopy allowed in vivo localization of various lung area's of extensive subpleural fluoresceine accumulation which were not, or only partly visibly abnormal during normal white light thoracoscopy . No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality which remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect fluorescein enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax , and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.
Key words: spontaneous pneumothorax, autofluorescence, fluoresceine, thoracoscopy




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