CT Chest Protocol for Recurrent Pneumothorax

Rationale for Non-Contrast CT

The American College of Radiology recommends CT chest without contrast for evaluating patients with recurrent pneumothorax as it provides optimal visualization of lung parenchyma and pleural abnormalities without the need for contrast enhancement 1, 2
CT chest without IV contrast is the appropriate imaging modality for evaluating anatomical abnormalities that could predispose patients to recurrent pneumothorax, such as blebs, bullae, and other parenchymal abnormalities 1, 2
Non-contrast CT can effectively identify underlying pulmonary diseases that may contribute to pneumothorax recurrence, including emphysematous changes, bronchiectasis, and other structural abnormalities 2
There is no relevant literature supporting the routine use of contrast-enhanced CT for evaluation of uncomplicated pneumothorax 1

Contrast-enhanced CT may be indicated when there is suspicion of vascular abnormalities contributing to pneumothorax, such as pulmonary sequestration 3
Contrast-enhanced CT may be indicated if bronchial tumors are suspected as a cause of recurrent pneumothorax 3
CT with IV contrast is usually appropriate when evaluating for bronchopleural fistula 4, 5
Contrast-enhanced CT may be indicated for presurgical planning, particularly when identifying feeding vessels is important 3

The initial evaluation of recurrent pneumothorax should begin with chest radiography to confirm pneumothorax 6, 7
For uncomplicated recurrent pneumothorax, CT chest without IV contrast is the recommended subsequent imaging modality 1, 2
For suspected vascular anomalies, CT chest with IV contrast or CTA chest may be indicated 3
For suspected bronchopleural fistula, CT chest with IV contrast may be indicated 4, 5

Failing to evaluate for underlying lung pathology that may contribute to recurrence can be avoided by using non-contrast CT 2
Using contrast unnecessarily when non-contrast CT is sufficient for most cases of recurrent pneumothorax can be avoided by following the recommended protocol 1, 2
Not considering specialized CT protocols, such as CTA, when vascular anomalies are suspected can be avoided by using contrast-enhanced CT 3