Aetiology of Primary Spontaneous Pneumothorax

Abstract

Air in the pleural cavity is termed pneumothorax. When this occurs in the absence of trauma or medical intervention, it is called spontaneous pneumothorax. Primary spontaneous pneumothorax typically occurs in young patients without known lung disease. However, the idea that these patients have “normal” lungs is outdated. This article will review evidence of inflammation and respiratory bronchiolitis on surgical specimens, discuss the identification of emphysema-like change (i.e., blebs and bullae), the concept of pleural porosity and review recent data on the overexpression of matrix metalloproteinases in the lungs of patients who have had pneumothorax.

Radiographic chest wall abnormalities in primary spontaneous pneumothorax identified by artificial intelligence

“…One of the major findings of surgery and pathology in PSP is the ELC at the apex of the lung, which can explain some of the cases where no bleb was noted [ [5] , [6] , [7] , 35 ]. Smoking is the primary etiology of emphysema, but for non-smoking PSP patients, the etiology is indeterminate.…”

Autologous Blood Patch Pleurodesis for Secondary Spontaneous Pneumothorax: A Narrative Review, a Retrospective Case Series and State of Play in the UK

“…The aetiology of secondary spontaneous pneumothorax (SSP) is usually the rupture of blebs or emphysema-like structures. This results in an air leak: flow of air into the pleural space, through a tract either from the lung (alveolar-pleural fistula) or in central airways (bronchopleural fistula) [ 1 , 2 ]. The management of any pneumothorax is patient centred.…”

Special Issue on “Clinical Research of Spontaneous Pneumothorax”

“…This Special Issue in the Journal of Clinical Medicine (JCM) brings together a series of high-quality scientific contributions that try to weave a common thread that extends from the etiology to the treatment of SP [ 1 , 2 , 3 , 4 , 5 ]. The covered topics distinctly point out the issues related to PSP and SSP, although both diseases present some similar approaches in the diagnostic–therapeutic path.…”

“…The review by Halifax R [ 1 ] reports that PSP is more common in ectomorphic patients (tall and thin), with a low body mass index, and among smokers. A PSP is considered to occur without apparent cause and in the absence of significant lung disease.…”

“…Only two randomized controlled trials showed the superiority of surgery in terms of ipsilateral recurrence, and in those patients whose high-resolution computed tomography demonstrated bullae ≥2 cm [ 10 ]. Nevertheless, it is not clear if a SP occurring in patients with bullae ≥2 cm should be considered primitive without underlying pulmonary disease [ 1 ].…”