Pneumothorax is a rare complication of pulmonary hydatid disease and has been reported only once in Britain (Connellan et al, 1979), although it has been described in areas where the disease is endemic (Waddle, 1950; Tomalino, 1959; Bakir & Al-Omeri, 1969; Xanthakis et al, 1972). A case is described in which a patient with hydatid disease presented with a spontaneous pneumothorax. The diagnosis was not made until he underwent thoracotomy and lung biopsy following the development of secondary lung parenchymal and pleurai cysts a year later.
A previously fit 22-year-old non-smoking mechanic from the Isle of Skye presented with a history of mild pleuritic left-sided chest pain associated with an incessant cough and slight effort dyspnoea. His symptoms were not alleviated by antibiotic therapy. A chest radiograph taken two months later showed a left-sided tension pneumothorax.
After transfer to the regional hospital he was treated with an intercostal suction drain for two weeks. The pneumothorax resolved slowly and the patient was sent home well. The chest radiograph at this time showed fully expanded lungs but also a minimal opacity projected over the left hilum. On the three month follow-up, the radiographic appearances were unchanged. After six months had elapsed the final check radiograph revealed, in addition, a discrete, well-defined opacity 1.0 cm in diameter in the left mid-zone anteriorly (Fig. 1), although the patient now felt fit and was working normally.
SUMMARY Magnetic resonance imaging was used to measure the effect of inhalation of 7% CO2 and hyperventilation with 60% 02 on human cranial cerebrospinal fluid volume. During CO2 inhalation there was a reduction in the cranial CSF volume ranging from 0-7-23-7 ml (mean 9-36 ml). The degree of reduction in cranial CSF volume was independent of the individual subject's increase in endexpiratory pCO2 or mean arterial blood pressure, in response to hypercapnia. During hyperventilation with high concentration oxygen the cranial CSF volume increased in all subjects (range 0 7-26-7 ml, mean 12-7 ml). The mean changes in cranial CSF volume, induced by hypercapnia and hypocapnia, were very similar to the expected reciprocal changes in cerebral blood volume.The original Monro-Kellie doctrine concerning intracranial volume was corrected by George Burrows' in 1846 who, for the first time, incorporated the CSF and suggested that the blood and CSF volumes were reciprocally inter-related. Since then, cerebral blood volume has been estimated by various techniques, and changes described both in response to physiological stimuli and pathological conditions.23 Measurements of the total cranial CSF volume in humans have only recently become possible as a result ofrecent developments in magnetic resonance imaging (MRI).4We have used MRI to observe the effects of vasodilation and vasoconstriction on total cranial CSF volume in normal human subjects. Our aims were to determine ifindeed there were reciprocal changes in cranial CSF volume, and if so to determine their magnitude. (c) CSF volume and hyperventilation during highflow oxygen Twelve healthy subjects were studied before and during hyperventilation with high flow oxygen. There were eight males and four females aged from 20-38 years (mean 29-1 years).
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