A biomechanical hypothesis for the pathophysiology of apical lung disease

Casha, Aaron; Manche, Alexander; Camilleri, Liberato; Gatt, Ruben; Dudek, Krzysztof; Pace-Bardon, Michael; Gauci, Marilyn; Grima, Joseph N.

doi:10.1016/j.mehy.2016.04.044

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…TB reactivation is indeed commonest in the apex of young low-BMI males, as is also primary spontaneous pneumothorax (PSP), a condition characterized by the presence of apical lung bullae. A common pathophysiology of TB and PSP is suggested by the fact that 5.4% of spontaneous pneumothorax patients had TB and 2.1% of patients with TB had PSP (22,23). This hypothesis also gives a potential explanation for the apical location of secondary TB in the lower lobe, whilst the conventional explanations of high apical oxygen levels and gravity for TB's apical localization appear to be invalid for the lower lobe (24).…”

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confidence: 99%

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The link between tuberculosis and body mass index

Casha¹,

Scarci²

2017

J. Thorac. Dis.

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The evidence behind the strong correlation between reactivation of tuberculosis (TB) and low body mass index (BMI) was reviewed. This strong association between TB and BMI occurred only with pulmonary TB and not extra-pulmonary TB, indicating that a low-BMI body build may in some way predispose to TB reactivation in the lungs. A possible explanation may be the congenital apical lung bullae that occur in 15% of the population and are likely to enlarge in young low-BMI males since biomechanical modeling of pleural stress has shown a massive 40x increase in apical pleural stress in low antero-posterior (AP) diameter chests associated with a low-BMI build. This suggests that pre-existing lung cavities may predispose to TB reactivation instead of current thinking that cavitation occurs after reactivation. Supporting this hypothesis is the relatively common incidence of both TB and primary spontaneous pneumothorax (PSP) occurring simultaneously. Furthermore, this hypothesis also gives a potential explanation for the apical location of secondary TB in the lower lobe as the conventional explanations of high apical oxygen levels and gravity appear to be invalid for the lower lobe. This opens up the possibility of a clinical trial that low-dose computerized tomography (CT) may be used to screen for the presence of subclinical apical bullae in low-BMI, high TB risk cohorts.

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“…There is also an association between the human immune response and BMI (25), which can explain the greatly increased risk of TB in HIV co-infected patients (26); however, this leads to more frequent extra-pulmonary TB (27) and does not explain the apical location of pulmonary TB as does the low AP diameter chests associated with a low-BMI build (23).…”

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confidence: 99%

The link between tuberculosis and body mass index

Casha¹,

Scarci²

2017

J. Thorac. Dis.

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“…A longer and flatter chest shape may affect the distribution of stress in the lung and result in the development of PSP, as reported by Peters et al [14]. Casha et al [15, 16] also reported a possible biomechanical explanation for spontaneous pneumothorax. They analyzed rib cage measurements in PSP patients and age‐matched chest trauma patients.…”

Section: Discussionmentioning

confidence: 82%

Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax

Huang

Lin

et al. 2020

World j. surg.

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Background and Objective This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE). Methods From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively. ResultsThe incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p \ 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p \ 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481-3.330, p \ 0.001). ConclusionWe discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI [3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.

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“…5 In tall, thin patients, the increased traction on the apices of upper lobes resulting from the mechanical constraints of narrow anterior-posterior diameter chests may explain the higher prevalence of apical upper lobe bullae typically found in young men. 10 In intravenous drug users, coalescence of cavities produced by foreign body emboli within the pulmonary capillary bed may result in bullae. 4 In patients undergoing lobectomies, tension along the staple line has been proposed to affect the likelihood of post-operative bullae formation.…”

Section: Discussionmentioning

confidence: 99%

Enlarging bullae and spontaneous pneumothorax associated with CPAP use: A case series of three patients

Navarrete-Welton,

Manzoor,

Minami

et al. 2024

JMV

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Objectives Spontaneous pneumothorax among patients with obstructive sleep apnea treated by nocturnal continuous positive airway pressure (CPAP) has not been well documented. Methods We present three cases of patients on chronic CPAP who experienced spontaneous pneumothorax without clear predisposing factors. Their personal and family medical histories, imaging characteristics, and CPAP settings are reviewed. Results In all three cases, the patients had bullae ipsilateral to the pneumothoraces that either formed (n = 1) or grew significantly (n = 2) after CPAP initiation. No other risk factors for pneumothorax or bullae were identified. Conclusions This case series demonstrates a need for further investigation into a possible connection between spontaneous pneumothorax, bullae development, and CPAP use. Keywords: obstructive sleep apnea, continuous positive airway pressure, bullae, complications of noninvasive mechanical ventilation, spontaneous pneumothorax

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A biomechanical hypothesis for the pathophysiology of apical lung disease

Cited by 7 publications

References 29 publications

The link between tuberculosis and body mass index

The link between tuberculosis and body mass index

Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax

Enlarging bullae and spontaneous pneumothorax associated with CPAP use: A case series of three patients

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