Higher-Resolution CT May Predict Pneumothorax After BLVR, With Isam Albaba, MBBS

In an interview with HCPLive at the 2026 American Thoracic Society (ATS) International Conference in Orlando, Florida, Isam Albaba, MBSS, from the department of thoracic medicine & surgery at Temple University Hospital, discussed how functional air trapping on CT imaging may help identify patients at the greatest risk for pneumothorax following bronchoscopic lung volume reduction (BLVR).

BLVR is increasingly used in select patients with severe chronic obstructive pulmonary disease (COPD), particularly those with advanced emphysema. Pneumothorax remains the most frequent complication and can lead to prolonged hospitalization, chest tube placement, and, in severe cases, valve removal.

The study presented at ATS evaluated whether pre-procedural CT imaging could better stratify risk than traditional selection measures such as fissure integrity alone. Investigators focused on functional air trapping within the ipsilateral non-target lobe, using advanced quantitative CT techniques.

“Fissure integrity is a starting point,” Albaba said. “If they do not have fissure integrity, they are not eligible for BLVR. [It] doesn't necessarily determine [if] pneumothorax [will happen].”

Some studies have suggested that greater fissure completeness and integrity may be associated with a greater likelihood of pneumothorax, which is physiologically plausible since more complete fissures allow greater volume redistribution to the ipsilateral lobe. However, on their own, these measures are not strong or reliable predictors of pneumothorax development.

“It's not just about how much volume goes into the ipsilateral,” he said. “It's also about how fragile that tissue is and how much air trappings [is] happening in the fragile lung, as opposed to areas that are not as fragile and likely to have a defect in the pleural space that will…result in a pneumothorax.”

The analysis found that functional air trapping specifically within emphysematous regions of the lung (fAT-E) was the strongest predictor of pneumothorax risk. Static CT measures alone were not sufficient, underscoring the importance of dynamic physiologic imaging.

A threshold of approximately 25% to 27% functional air trapping provided the best discrimination between patients who did and did not develop pneumothorax, with greater specificity in refined analyses (94% vs 75%).

Albaba noted that scan quality itself plays an important role in interpretation. The data becomes less reliable if a patient does not achieve adequate inspiratory and expiratory volumes. For instance, a change of ≥ 1 liter between scans significantly improves the accuracy of functional air trapping measurements.

The findings suggest that incorporating quantitative CT metrics into pre-procedure planning could help clinicians better anticipate complications and potentially refine post-BLVR monitoring strategies. Currently, many patients are routinely hospitalized for observation after valve placement due to pneumothorax risk, contributing to substantial healthcare utilization.

Future research will focus on validating these imaging biomarkers across larger cohorts and integrating them into prospective BLVR planning algorithms to better personalize procedural risk assessment.

Editor’s note: Albaba has no reported disclosures.

References

Albaba I, Deller E, Lalwani A, et al. Functional Air Trapping Predicts Pneumothorax After BLVR. Poster presented at ATS 2026 in Orlando, Florida, on May 19.