• Asif Azam, Ahsan Zahid, Qaiser Abdullah, Noman Qayyum, Mostafa Abdelmoteleb, and Muhammad Badar Ganaie.
• Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK.
• Clin Med (Lond). 2022 Jan 1; 22 (1): 717471-74.

IntroductionCT 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.ObjectivesWe aimed to assess the role of DSS during first episodes of PSP in predicting the need for early surgery and recurrence.MethodsWe 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.ResultsForty-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.ConclusionDSS 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.© Royal College of Physicians 2022. All rights reserved.

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