Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

Grundy, Seamus; Bentley, Andrew; Tschopp, Jean‐Marie

doi:10.1159/000335993

Cited by 60 publications

(57 citation statements)

References 65 publications

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“…Areas of abnormal parenchymal and pleural lesions could also be identified with this technique in normal individuals during thoracoscopy for other causes (14). These findings suggest that PSP is probably a more diffused (and inflammatory) disease of the pleura than a localised one (15). This recent theory is also supported by the findings of infrared thoracoscopy (16).…”

Section: Development Of New Devicessupporting

confidence: 53%

Research in Thoracoscopy (Pleuroscopy)

Froudarakis¹

2013

Plev Bult

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Thoracoscopy (pleuroscopy) is the gold standard in the diagnosis and treatment of pleural diseases. With the development of novel devices, thoracoscopy has become very popular among pulmonologists, since it solves diagnostic and therapeutic problems in pleural disease. Its diagnostic yield is 95% in patients with malignant pleural disease. Its main therapeutic application is pleurodesis with talc poudrage, achieving a success rate of 90% for malignant pleural effusion and 95% for pneumothorax. In recent years, beside its diagnostic and therapeutic utility, thoracoscopy has become an important tool in the research of pleural pathophysiology and molecular biology, with the development of new devices in combination with novel molecular techniques and concepts. Collaboration between clinicians and researchers is crucial in further studying pleural diseases and thoracoscopy is certainly a means towards better understanding and treating these disorders. Therefore, young pulmonologists should be trained in thoracoscopy in the same way as they are in bronchoscopy.

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Section: Development Of New Devicessupporting

confidence: 53%

Research in Thoracoscopy (Pleuroscopy)

Froudarakis¹

2013

Plev Bult

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“…18 As most cases of primary pneumothorax are found to have emphysema-like changes and many diseases that lead to secondary pneumothorax are associated with cystic changes in the lung, it has been postulated that these cysts rupture and lead to alveolar and pleural air leakage. [18][19][20] However, fluorescein studies in patients with primary SP show leakage of fluorescent dye away from the emphysemalike changes. 18,21 In addition, 6% to 15% of patients without pneumothorax have been found to have blebs on thoracoscopy, so blebs alone are not sufficient for pneumothorax.…”

Section: Commentmentioning

confidence: 99%

“…18,21 In addition, 6% to 15% of patients without pneumothorax have been found to have blebs on thoracoscopy, so blebs alone are not sufficient for pneumothorax. 19,22,23 It is theorized that the pleura is structurally abnormal, leading holes or pores to form, allowing the leakage of air, so-called pleural porosity. 18,20 Whether the pleura is abnormal in the same way in each condition is unclear.…”

Section: Commentmentioning

confidence: 99%

A Unique, Histopathologic Lesion in a Subset of Patients With Spontaneous Pneumothorax

Belchis

Shekitka

Gocke

2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Spontaneous pneumothorax can be idiopathic (primary), or it can occur in association with an underlying predisposing condition (secondary). Spontaneous pneumothorax may be a harbinger of an undiagnosed clinical condition, which may be associated with serious systemic abnormalities, making early recognition and diagnosis important. The pulmonary pathology of some of these disorders has not been fully elucidated.Objective.-To review cases of pneumothorax in the hope of identifying pathologic features that might correlate to specific clinical syndromes.Design.-The pathology computer files at 3 hospitals were searched for all cases of spontaneous pneumothorax, primary and secondary, regardless of etiology during a 11-year period. Ninety-two cases were retrieved. Each of the cases was evaluated for reactive eosinophilic pleuritis, elastosis, pleural fibrosis, emphysema, intra-alveolar macrophages, cholesterol clefts, vasculopathy, and intraparenchymal or intrapleural cysts. Clinical information regarding asthma and smoking history, site of the pneumothorax, family history, radiographic findings, predisposing conditions, recurrence, age, and sex were extracted from the medical records.Results.-In 11 patients (12% of all the patients with spontaneous pneumothorax), a distinctive pattern of pleural fibrosis with islands of fibroblastic foci within a myxoid stroma was noted at the pleural-parenchymal interface or leading edge. These lesions correlated with a select subset of patients, consisting predominantly of young men.Conclusions.-Our review identified a distinct pattern of pneumothorax-associated fibroblastic lesions in a subset of cases of spontaneous pneumothorax. Whether this is related to the pathogenesis of the pneumothorax remains to be elucidated.

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“…PSP is usually caused by chronic destruction of subpleural blebs or bullae, due to imbalance of proteases and anti-proteases, chronic inflammation, hypoxia, and oxidative stress (4). Although PSP usually occurs in patients without clinically apparent lung disorder, 85% to 90% of patients with PSP show localized apical emphysema-like changes on chest computed tomography (CT) scan (4).…”

Section: Introductionmentioning

confidence: 99%

“…Although PSP usually occurs in patients without clinically apparent lung disorder, 85% to 90% of patients with PSP show localized apical emphysema-like changes on chest computed tomography (CT) scan (4). The formation of ELCs in PSP is associated with elastolysis, the degradation of elastic fibers, which is caused by an imbalance between oxidants and antioxidants, in which lung macrophages and type II pneumocytes play a crucial role (5).…”

Section: Introductionmentioning

confidence: 99%

Expression of redox sensing factor Nrf2 in lung macrophages and type II pneumocytes as a prognostic factor in pneumothorax recurrence

et al. 2017

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Background: Primary spontaneous pneumothorax (PSP) is a common clinical problem. However, PSP recurrence is still a major concern. Nuclear factor erythroid 2-related factor 2 (Nrf2) plays a protective role against oxidative airway diseases. The aim was to investigate the role of Nrf2 in PSP patients and its correlation with recurrence. Methods: Eighty-nine patients were enrolled and received wedge resection of lung with identifiable blebs.Nrf2 expression in resected lung tissues was determined by immunohistochemistry (IHC) and correlated with clinicopathological variables. The prognostic value of Nrf2 for incidence-of-recurrence was determined by Kaplan-Meier estimates and the significance of differences was evaluated by the log-rank test. Results: Nrf2 staining was predominantly observed in alveolar macrophages and type II pneumocytes of PSP patients and correlated with recurrence (P<0.001 and P=0.001, respectively) and PSP location (macrophages, P=0.013). High Nrf2 expression was correlated with better incidence-of-recurrence (macrophages, P=0.003; type II pneumocytes, P=0.003). Moreover, incidence-of-recurrence was better in patients with higher Nrf2 expression, especially those in the age ≤20, male, and non-smoking groups (macrophages, P=0.009, 0.006, and 0.012; type II pneumocytes, P=0.003, 0.011, and 0.010, respectively). Conclusions: High Nrf2 expression in alveolar macrophages and type II pneumocytes was significantly associated with the decreased recurrence risk and was the independent factor predicting a better incidenceof-recurrence in PSP. Our results suggest that Nrf2 activation in high risk patients may be a potential target for reducing PSP recurrence.

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Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

Cited by 60 publications

References 65 publications

Research in Thoracoscopy (Pleuroscopy)

Research in Thoracoscopy (Pleuroscopy)

A Unique, Histopathologic Lesion in a Subset of Patients With Spontaneous Pneumothorax

Expression of redox sensing factor Nrf2 in lung macrophages and type II pneumocytes as a prognostic factor in pneumothorax recurrence

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