Idiopathic Spontaneous Pneumothorax

Tueller, Edward E.; Crise, Nancy; Belton, John C.; McLaughlin, Richard F.

doi:10.1378/chest.71.3.419

Cited by 9 publications

(6 citation statements)

References 5 publications

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“…Histopathological and electron microscopic analysis of tissue obtained during bullectomy in patients with spontaneous pneumothorax have revealed obstruction and stenosis of the distal airways due to bronchial wall inflammation and peribronchial fibrosis [35,36]. These findings suggest an obstruction check-valve mechanism as the cause of spontaneous pneumothorax.…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Current aspects of spontaneous pneumothorax

Schramel¹,

Postmus²,

1997

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In spite of the fact that blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they seldom seem to be the actual cause of the pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the pneumothorax during transpulmonary pressure changes.The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary spontaneous pneumothorax. Eur Respir J 1997; 10: 1372-1379 Pneumothorax is defined as the presence of air in the pleural cavity [1]. As early as 1819, LAENNEC [2] described the symptoms and signs of a patient with a pneumothorax. Although most pneumothoraces were then caused by tuberculosis, he also found pneumothoraces during autopsies of patients with apparently healthy lungs; he named these "pneumothorax simple". Aetiology and pathogenesisToday, pneumothoraces are divided into spontaneous pneumothorax, occurring without a preceding event, and traumatic pneumothorax, due to direct or indirect trauma. Iatrogenic pneumothoraces, resulting from diagnostic or therapeutic medical procedures, are also categorized as traumatic pneumothoraces.Spontaneous pneumothoraces are divided into primary and secondary spontaneous pneumothoraces. Secondary spontaneous pneumothoraces are associated with underlying pulmonary pathology, usually chronic obstructive pulmonary disease (COPD). Acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii infections appear to play an increasing role in the aetiology of secondary spontaneous pneumothoraces [3].No underlying pulmonary disease is present in patients with primary spontaneous pneumothorax. However, blebs and bullae seem to play a role in the pathogenesis, since they are frequently found during thoracoscopy, thoracotomy or sternotomy (table 1). Thoracoscopic studies have shown the presence of blebs and bullae in 48-79% of patients with unilateral primary spontaneous pneumo-thorax [4][5][6][7][8]. With the development of video-assisted techniques, the recognition of blebs and bullae during thoracoscopy has improved. In more than 76% of patients,

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Section: Aetiology and Pathogenesismentioning

confidence: 99%

Current aspects of spontaneous pneumothorax

Schramel¹,

Postmus²,

1997

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“…These oxidative stressors have been shown to contribute to the pathogenesis of SP in some studies [15]. An increase in interstitial mass and a proliferation of epithelial cells has been reported as a response to pulmonary stress and insult including exposure to ozone [9]. By way of these effects on lung tissue, increased levels of ozone in the inhaled air may contribute to the pathogenesis and occurrence of SP.…”

Section: Discussionmentioning

confidence: 99%

“…It is also interesting that similar ultrastructural changes are seen in lungs both in response to acute ozone exposure and in the occurrence of spontaneous pneumo thorax. These changes include proliferation of epithelial cells and an increase in the intersitial mass and edema [9,10]. As certain climatic parameters have shown weak and controversial associations with the incidence of SP, there is a need to invesitigate possible other associations.…”

Section: Discussionmentioning

confidence: 99%

“…The possible impact of changes in ozone level on the occurrence of SP has not been studied before. Similarity between electron microscopic findings of ozone effects on lung tissue and electron microscopic findings of SP encourage us to expect an association between ozone concentration and the occurrence and severity of pneumothorax [9,10]. We aimed to evaluate the association between the occurrence of SP and ozone levels.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous pneumothorax and ozone levels: is there a relation?

Abul

Karakurt

Bostancı

et al. 2011

Multidisciplinary Respiratory Medicine

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Study objectivesAlthough links between meteorological conditions and spontaneous pneumothorax (SP) have been proposed, the reports are controversial. In this study ozone levels, which are known to have some adverse effects on lung tissues, were investigated as a potential triggering factor of SP. At present there is not sufficient information about the effects of ozone on SP.MethodsOf a total 79 pneumothorax patients recruited for the study, 21 secondary pneumothorax cases were excluded. In the remaining 58 SP patients, meteorological data at the time of SP occurrence were recorded.ResultsThe number of SP patients was higher in spring than in the other seasons (p < 0.05). There was an association between the SP frequency and the average ozone level at different seasons (F 3,52 = 19.45, p = 0.001). The average ozone level was higher in spring (363 ± 25 Dobson) than during the other seasons (autumn 296 ± 18 Dobson; summer 321 ± 26 Dobson; winter 324 ± 32 Dobson) (p = 0.001). There was a positive correlation between SP frequency and the average ozone values for each season (r = 0.301, p = 0.024). There was no significant correlation between the severity of SP and ozone level (r = 0.236, p = 0.16).ConclusionsThe number of SP patients increases in spring when ozone levels are highest. Ozone is known to affect alveolar cells and cause interstitial edema. Ozone causes damage to the lung interstitium by way of oxidative stress. Rupture of unrecognized underlying blebs/bullae has been proposed as a cause of SP. Increased levels of ozone may be a triggering factor for these ruptures.

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“…In some human cases of spontaneous pneumothorax blebs or bullae are not found grossly and microscopically : even under electron microscopically (Tueller et al 1977). Reid (1967) divided emphysematous cysts in humans into three groups using gross and clinical criteria, although Ohata and Suzuki (1980) report- ed that in Reid type 1 emphysematous bullae, the major change is what Miller named bleb formation.…”

Section: Discussionmentioning

confidence: 99%

Mechanical production of pleural cysts in isolated rat lungs: An experimental model for pleural blebs.

Mitsuhashi

1987

Tohoku J. Exp. Med.

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Idiopathic Spontaneous Pneumothorax

Cited by 9 publications

References 5 publications

Current aspects of spontaneous pneumothorax

Current aspects of spontaneous pneumothorax

Spontaneous pneumothorax and ozone levels: is there a relation?

Mechanical production of pleural cysts in isolated rat lungs: An experimental model for pleural blebs.

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