Fluorescein-enhanced Autofluorescence Thoracoscopy in Primary Spontaneous Pneumothorax

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, 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 pne...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2004-09, Vol.170 (6), p.680-682
Main Authors: Noppen, Marc, Stratakos, Grigoris, Verbanck, Sylvia, D'Haese, Jan, Meysman, Marc, Vincken, Walter
Format: Article
Language:English
Subjects:
Administration, Inhalation
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Contrast Media - administration & dosage
Fluorescein - administration & dosage
Humans
Intensive care medicine
Lung - drug effects
Lung - physiopathology
Male
Medical sciences
Pneumothorax - diagnosis
Pneumothorax - physiopathology
Pneumothorax - surgery
Recurrence
Rupture, Spontaneous
Thoracoscopy - methods
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Summary:The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, 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 fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein 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 that 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.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.200404-438CR