TY - JOUR T1 - Utility of thoracic computed tomography to predict need for early surgery and recurrence after first episode of primary spontaneous pneumothorax JF - Clinical Medicine JO - Clin Med SP - 71 LP - 74 DO - 10.7861/clinmed.2021-0074 VL - 22 IS - 1 AU - Asif Azam AU - Ahsan Zahid AU - Qaiser Abdullah AU - Noman Qayyum AU - Mostafa Abdelmoteleb AU - Muhammad Badar Ganaie Y1 - 2022/01/01 UR - http://www.rcpjournals.org/content/22/1/71.abstract N2 - Introduction CT imaging is not advocated by British Thoracic Society guidelines after first episode of primary spontaneous pneumothorax (PSP). There is emerging evidence that emphysema-like changes and CT-based dystrophy severity score (DSS) can predict need for early surgery and recurrence.Objectives We aimed to assess the role of DSS during first episodes of PSP in predicting the need for early surgery and recurrence.Methods We conducted a retrospective analysis of consecutive PSP episodes (n=197) admitted to our institution from 1 January 2012 to 31 December 2017. DSS was calculated based on type, number and distribution of blebs and bullae. Patients were categorised as low-grade (0-3) or high-grade (4-6) DSS assessed by a thoracic radiologist.Results Forty-five PSP patients had CT at first presentation. Eight patients had low-grade DSS; all were managed non-surgically and none had recurrence over 12 months. Thirty-seven patients had high-grade DSS. Of these, 25 (67.5%) were managed surgically, with three having contralateral recurrence over 12 months; 12 (32.5%) were managed non-surgically, and of these two patients had ipsilateral recurrence over 12 months.Conclusion DSS seems to predict the need for early surgery and recurrence and CT can be used to risk-stratify patients after a first episode of PSP. ER -