Prevalence of Pulmonary Bullae and Blebs in Postmortem CT Imaging With Potential Implications for Diving Medicine

We would like to thank Drs Tetzlaff and Eichhorn for their useful comment on our study. 1 We agree with the authors that, based on literature, divers with bullae and blebs in the lungs have a potential risk on pulmonary barotrauma and subsequent cerebral air embolism. As mentioned in our study, there is a lack of information on the incidence of bullae and blebs in the healthy population, and performing prospective trials on this topic is indeed unethical. Most case reports or case series of divers with pulmonary barotrauma and a CT of the thorax showing abnormalities such as bullae, blebs, or air trapping suggest a causal relationship between these lung abnormalities and pulmonary barotrauma. Two arguments can be posed to refute that causality. First, when no CT scans are available from the patients before the accident, it cannot be ruled out that these abnormalities are actually the result of the barotrauma in these divers. Second, because we found an incidence of small bullae and/or blebs in one-third of the general population without underlying lung disease, 1 it can be expected that these abnormalities are also found in a large number of divers that suffered pulmonary barotrauma, not necessarily being the cause or lead point of the pneumothorax.

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confidence: 86%

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Bakker

Tijsterman

Bakker-Teunissen³

et al. 2020

Chest

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“…[3][4][5][6] As previously reported, the sizes of the bullae were smaller than 3 cm in 90% of patients who underwent surgery for PSP, 6) bullae are usually 2 cm in size. 7,8) In fact, blebs are more common than bullae in patients with PSP. 8) Additionally, contralateral asymptomatic bullae were found in 49% of the patients with unilateral PSP and more than 80% of existing bullae were multiple.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Histopathological Diagnosis of Placental Transmogrification of the Lung after Bullectomy for Recurrent Spontaneous Pneumothorax: A Case Report and Literature Review

Shiraishi

Akamine

Kato

et al. 2022

ATCS

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We report a 33-year-old man who presented with recurrent right pneumothorax. Computed tomography (CT) showed the presence of a large bulla with a maximum diameter of 8 cm in the right middle lobe; he subsequently underwent bullectomy. Histopathology revealed that pulmonary parenchyma adjacent to the bulla represented nodular proliferation of clear cells characterized by a papillary structure resembling placental chorionic villi. Immunohistochemically, clear cells were positive for CD10, suggesting placental transmogrification of the lung (PTL). We reviewed 36 surgical cases of PTL, and only 2 cases (5.6%), including our case, were operated for spontaneous pneumothorax. Bullous lesions secondary to PTL tend to appear as unilateral large cystic masses in non-upper lobes, which is atypical for primary spontaneous pneumothorax (PSP). Although PTL is considered a very rare cause of secondary pneumothorax, we must carefully differentiate this condition.

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“…19,20 Third, blebs and bullae are detected in asymptomatic individuals on CT scan and thoracoscopy at rates ranging from 4% to 33%. [21][22][23] There are alternative theories for the pathophysiology of PSP. "Pleural porosity" is the concept that mesothelial cells on the visceral pleura are thought to be replaced by a more porous inflammatory layer that allows air leakage into the pleural space.…”

Section: Pathophysiologymentioning

confidence: 99%

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

Wilson

Rymeski

et al. 2021

JACEP Open

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Primary spontaneous pneumothorax (PSP) is a relatively common problem in emergency medicine. The incidence of PSP peaks in adolescence and is most common in tall, thin males. Recent advances in the care of patients with PSP have called into question traditional approaches to management. This clinical review highlights the changing management strategies for PSP and concludes with a proposed evidence-based pathway to guide the care of adolescents with PSP.

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Prevalence of Pulmonary Bullae and Blebs in Postmortem CT Imaging With Potential Implications for Diving Medicine

Cited by 21 publications

References 9 publications

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Unexpected Histopathological Diagnosis of Placental Transmogrification of the Lung after Bullectomy for Recurrent Spontaneous Pneumothorax: A Case Report and Literature Review

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

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