Published ahead of print on April 20, 2006, doi:10.1164/rccm.200602-259OC Am. J. Respir. Crit. Care Med., Volume 174, Number 1, July 2006, 26-30 A more recent version of this article appeared on July 1, 2006
Submitted on February 21, 2006 Fluoresceine-enhanced Autofluorescence Thoracoscopy in Primary Spontaneous Pneumothorax and NormalsMarc Noppen1*,1 Interventional Endoscopy Clinic and Respiratory Division, University Hospital AZ-VUB, Brussels, Belgium, 2 Interventional Endoscopy Clinic and Respiratory Division, University Hospital AZ-VUB, Brussels, Belgium; Critical Care and Respiratory Division, University of Athens, "Evaggelismos" Hospital, Athens, Greece, 3 Interventional Endoscopy Clinic and Respiratory Division, University Hospital AZ-VUB, Brussels, Belgium; Division of Pulmonary and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada, 4 Interventional Endoscopy Clinic and Respiratory Division, University Hospital AZ-VUB, Brussels, Belgium; Pulmonary Special Procedures Unit, Respiratory Division, UCSD San Diego, San Diego, California, USA, 5 Anaesthesiology Department, University Hospital AZ-VUB, Brussels, Belgium * To whom correspondence should be addressed. 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 spontaneous pneumothorax patients and in normal subjects. Methods : one-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive PSP patients is compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects. Results : White light thoracoscopy abnormalities (anthracosis, cobblestone malformation and blebs/bullae) were more prevalent in PSP. Fluorescein enhanced autofluorescence thoracoscopy however showed high grade lesions in PSP only which furthermore often where present at areas which were normal, or only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two . Actual fluoresceine leakage was seen in 2 PSP patients. Conclusions : lungs in primary spontaneous pneumothorax patients show significantly more abnormalities at white light thoracoscopy when compared to normals. High grade fluorecein-enhanced autofluorescence thoracoscopy 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 white light thoracoscopy, such as blebs and bullae. Key words: spontaneous pneumothorax, thoracoscopy, fluorescein
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