Noppen Marc, Dekeukeleire Tom, Hanon Shane, Stratakos Grigoris, Amjadi Kayvan, Madsen Priscilla, Meysman Marc, D'Haese Jan, Vincken Walter
Interventional Endoscopy Clinic and Respiratory Division, and Anaesthesiology Department, University Hospital, Brussels, Belgium.
Am J Respir Crit Care Med. 2006 Jul 1;174(1):26-30. doi: 10.1164/rccm.200602-259OC. Epub 2006 Apr 20.
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).
To prospectively perform and compare WLT and FEAT in patients with spontaneous pneumothorax and in normal subjects.
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.
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.
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.
原发性自发性气胸（PSP）患者漏气的确切部位和病理生理学尚不清楚。在一名PSP患者中，荧光素增强自体荧光胸腔镜检查（FEAT）显示在白光胸腔镜检查（WLT）期间未被注意到的实质异常区域。
前瞻性地对自发性气胸患者和正常受试者进行WLT和FEAT检查并比较。
将12例连续PSP患者进行的一次性FEAT和WLT检查及半定量病变的系统绘图，与17例对照受试者在序贯双侧胸腔镜检查期间进行的一次性FEAT和WLT检查进行比较。
WLT异常（炭末沉着症、鹅卵石样畸形和肺大疱/肺气囊）在PSP中更常见。然而，FEAT仅在PSP中显示高级别病变，这些病变常出现在正常区域或在WLT中仅显示炭末沉着症的区域。当存在肺大疱/肺气囊时，与肺大疱相关的FEAT异常仅在两例中出现。在两名PSP患者中观察到实际的荧光素渗漏。
与正常受试者相比，PSP患者的肺部在WLT时显示出明显更多的异常。高级别FEAT病变仅存在于PSP中，且主要出现在白光检查时看似正常的肺区域。这些发现表明，明显的实质异常不仅限于WLT期间可见的病变，如肺大疱和肺气囊。
