Risk of Primary Spontaneous Pneumothorax According to Chest Configuration

Abstract

Background We compared the chest configurations of patients with primary spontaneous pneumothorax (PSP) and age-sex-matched controls to determine the presence of chest wall deformities in patients with PSP.

Methods We retrospectively enrolled 166 male patients with PSP (age, 18–19 years) and 85 age-sex-matched controls without PSP, who simultaneously underwent chest computed tomography (CT) and radiography at one of two institutes. After correcting for height, the following thoracic parameters were comparatively evaluated between the two groups: maximal internal transverse (T) and anteroposterior (W) diameters of the chest, maximal internal lung height (H), Haller index (T/W), and T/Height, T/H, W/Height, W/H, and H/Height ratios.

Results Patients were taller than the control subjects (176.5 cm ± 5.9 cm versus 174.4 cm ± 5.6 cm; p = 0.007). After controlling for height, the patient group exhibited lower T and W and greater H and Haller index values than the control group (T: 95% confidence interval [CI], 24.8–25.2 cm versus 25.9–26.5; W: 95% CI, 8.9–9.2 cm versus 10.1–10.6 cm; H: 95% CI, 25.2–25.9 cm versus 23.4–24.4 cm; and Haller index, 95% CI, 2.7–2.9 versus 2.4–2.6; all, p < 0.001). The patient group also exhibited lower T/Height, T/H, W/Height, and W/H ratios and greater H/Height ratio than the control group.

Conclusions Patients with PSP have an anteroposteriorly flatter, laterally narrower, and craniocaudally taller thorax than subjects without PSP, suggesting that chest configuration is associated with the development of pneumothorax.

Keywords

pneumothorax - chest configuration - risk - computed tomography - chest radiographs

^* These authors contributed equally to this work.

Author Contributions

• Conceptualization: Chul Hwan Park, MinDong Sung, Jason Jungsik Song, Sungsoo Lee

• Data curation: Chul Hwan Park, MinDong Sung, Hee Min Park, Junu Kim, Jin Hur

• Formal analysis: Chul Hwan Park, MinDong Sung, Kyunghwa Han

• Investigation: Chul Hwan Park, Geun Dong Lee, Young Woo Do, Jason Jungsik Song

• Methodology: Chul Hwan Park, MinDong Sung, Tae Hoon Kim, Jason Jungsik Song, Sungsoo Lee

• Supervision: Tae Hoon Kim, Jason Jungsik Song, Sungsoo Lee

• Validation: Geun Dong Lee, Young Woo Do

• Writing—original draft: Chul Hwan Park, MinDong Sung, Sungsoo Lee

• Writing—review and editing: Chul Hwan Park, Geun Dong Lee, Young Woo Do, Sungsoo Lee

• References

• 1 Lee S, Kim HR, Cho S. , et al; Korean Pneumothorax Study Group. Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial. Ann Thorac Surg 2014; 98 (06) 2005-2011
• 2 Melton III LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis 1979; 120 (06) 1379-1382
• 3 Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 1987; 92 (06) 1009-1012
• 4 Ouanes-Besbes L, Golli M, Knani J. , et al. Prediction of recurrent spontaneous pneumothorax: CT scan findings versus management features. Respir Med 2007; 101 (02) 230-236
• 5 Forgacs P. Stature in simple pneumothorax. Guys Hosp Rep 1969; 118 (01) 199-204
• 6 Lee SH, Choi H, Kim S. , et al. Association between anger and first-onset primary spontaneous pneumothorax. Gen Hosp Psychiatry 2008; 30 (04) 331-336
• 7 Peters RM, Peters BA, Benirschke SK, Friedman PJ. Chest dimensions in young adults with spontaneous pneumothorax. Ann Thorac Surg 1978; 25 (03) 193-196
• 8 Casha AR, Manché A, Gatt R. , et al. Is there a biomechanical cause for spontaneous pneumothorax?. Eur J Cardiothorac Surg 2014; 45 (06) 1011-1016
• 9 Saita K, Murakawa T, Kawano H, Sano A, Nagayama K, Nakajima J. Chest wall deformity found in patients with primary spontaneous pneumothorax. Asian Cardiovasc Thorac Ann 2013; 21 (05) 582-587
• 10 Masuda M, Kuwano H, Okumura M. , et al; Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery. Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2014; 62 (12) 734-764
• 11 Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342 (12) 868-874
• 12 Hobbs BD, Foreman MG, Bowler R. , et al; COPDGene Investigators. Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014; 11 (09) 1387-1394
• 13 Hazelrigg SR, Landreneau RJ, Mack M. , et al. Thoracoscopic stapled resection for spontaneous pneumothorax. J Thorac Cardiovasc Surg 1993; 105 (03) 389-392 , discussion 392–393
• 14 Forgacs P. Gravitational stress in lung disease. Br J Dis Chest 1974; 68 (01) 1-10
• 15 Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax. With special reference to the ultrastructure of emphysematous bullae. Chest 1980; 77 (06) 771-776
• 16 West JB. Distribution of mechanical stress in the lung, a possible factor in localisation of pulmonary disease. Lancet 1971; 1 (7704): 839-841
• 17 Withers JN, Fishback ME, Kiehl PV, Hannon JL. Spontaneous pneumothorax. Suggested etiology and comparison of treatment methods. Am J Surg 1964; 108: 772-776
• 18 Primrose WR. Spontaneous pneumothorax: a retrospective review of aetiology, pathogenesis and management. Scott Med J 1984; 29 (01) 15-20
• 19 Spontaneous pneumothorax and apical lung disease. BMJ 1971; 4 (5787): 573