SPONTANEOUS pneumothorax is an infrequent complication of pulmonary disease as seen in a general hospital. There is frequently, and quite properly, a tendency to attribute the condition to tuberculosis, but if there is little or no evidence of a pre-existing tuberculous infection, other causes should also be considered. The standard textbooks of medicine list a variety of conditions as possible causes of spontaneous pneumothorax and are in general agreement as to their relative importance as etiologic factors. During recent years, attention has been called to the frequency of rupture of an emphysematous bleb as the reason for an otherwise unexplained pneumothorax. It is agreed that an infarct, if septic, may break down and permit the passage of free air into the pleural cavity. It is fortunate that the latter does not often happen, since pulmonary infarction is a not uncommon complication in postoperative patients and in others whose circulation is inadequate.Infarcts of the lung are usually of recent origin when first seen, and they will usually be found to have changed appreciably in size or radiographie density if repeated examinations are made during the ensuing few days. This relatively rapid change in the lesion as shown on serial roentgenograms calls attention to the fact that the process is an acute one and therefore unlike the usual tuberculous process, which, though active, is not likely to change definitely in appearance within the space of a few days. If necrosis occurs within the infarcted area and pneumothorax results, there is likely to be a rapid outpouring of purulent exú-date, thus giving rise to a pyopneumothorax.Pulmonary infarction is secondary to a pathologic process elsewhere in the body. If, therefore, a pneumothorax is found in a patient known to have a disease that may give rise to the formation of emboli, infarction should be considered as a possible cause of the pneumothorax. The possibility becomes a probability if an area of consolidation is present at or near the base of the lung, and especially if there is an inflammatory process elsewhere in the body. The following two cases are illustrative of these facts.
Case ReportsCase 1 (N. E. D. H. 86423). The patient was a 17-yearold boy who was first seen in the New England Deaconess Hospital in March, 1937, at which time he was suffering from a moderately severe ulcerative colitis of recent onset.He was under the care of Dr. E. P. Joslin and his associates. Ha remained in the hospital 36 days and during the latter part of his stay had only one stool daily. During this time he gained 8 pounds, and the temperature and pulse were essentially normal.The patient was readmitted to the hospital during August, 1937, and again in June, 1938, because of recurrence of the diarrhea, with the occasional passing of blood. Figure 1. Case 1.This film was taken on the third hospital day. There is consolidation at the left base laterally.Proctoscopy and roentgen examination with barium enema showed findings characteristic of ulcerative colitis. He was dis...
