Utility of computed tomography (CT) to predict need for early surgery and recurrence after first episode of primary spontaneous pneumothorax (PSP)

Background: CT scanning is not presently advocated by guidelines after first episode of PSP. There is emerging evidence that emphysema like changes and Dystrophy Severity Score (DSS) on CT can predict need for early surgery and recurrence after first episode of PSP. Aim: To assess the role of CT based DSS after first episode of PSP in predicting need for early surgery and recurrence. Methods: Retrospective review of consecutive PSP episodes (n=86) admitted at our institution from 01/01/2016 – 31/12/2017. Patients were categorised as low grade (score 0-3) or high grade (score 4-6) DSS on CT (table 1) by radiologist who was blinded to eventual patient outcomes. Results: 20 PSP patients had CT at first presentation. Median age was 28 years, 95% male, 80% smokers (25% low grade, 94% high grade DSS). 4 patients had low grade DSS; all were managed non-surgically and none had recurrence over 12 months. 16 patients had high grade DSS of which 14 (88%) were managed by surgical intervention and 3 had contralateral recurrence over 12 months follow up. Conclusion: CT based DSS seems to predict need for early surgery and recurrence after first episode of PSP. CT can be used to risk stratify PSP patients and identify those at risk of failure of conventional treatment and early recurrence. Smoking status appears to have a link with high grade DSS. Further prospective randomized studies are needed to validate these findings.