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Background  The preoperative detection of emphysema like changes (ELCs) is necessary for the successful treatment of pneumothorax. High resolution computed tomography (HRCT) has been used for the preoperative detection of ELCs. However, the traditional HRCT method uses only the axial view, which is perpendicular to the distribution of ELCs. This is not an ideal diagnostic method for the evaluation of ELCs.    Methods  Forty-eight patients with pneumothorax had multi-detector computed tomography (MDCT) reconstruction using the coronal view. ELCs were evaluated in the axial and coronal view by a radiologist. A surgeon performed intra-operative examinations of the ELCs. The sensitivity of the different views was compared.    Results  The detection sensitivity was 74.4% (70/94) for the axial view and 91.5% (86/94) for the axial-coronal combined view. The intra-operative detection rate was 95.7% (90/94). The preoperative detection of ELCs on the axial-coronal combined view was significantly higher than on the conventional axial view alone (p < 0.01).    Conclusions  Evaluation of ELCs on the axial and coronal combined HRCT improved the sensitivity of preoperative detection of ELCs compared to the conventional single axial HRCT. This increased sensitivity will help decrease the recurrence with VATS.

journal of cardiothoracic surgery

The feasibility of axial and coronal combined imaging using multi-detector row computed tomography for the diagnosis and treatment of a primary spontaneous pneumothorax