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Less Is More?

Michael H. Baumann, MD, FCCP
Author and Funding Information

Affiliations: Jackson, MS 
 ,  Dr. Baumann is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center.

Correspondence to: Michael H. Baumann, MD, FCCP, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, 2500 North State St, Jackson, MS 39216; e-mail: mbaumann@medicine. umsmed.edu



Chest. 2001;120(1):1-3. doi:10.1378/chest.120.1.1
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COPD likely remains the most common cause of secondary spontaneous pneumothoraces.1 However, AIDS-related pneumothoraces, particularly those associated with Pneumocystis carinii pneumonia (PCP), might be the leading cause of secondary spontaneous pneumothoraces in the urban setting.2 Wait and Estrera2 noted that 36% of secondary spontaneous pneumothoraces in patients admitted to Parkland Memorial Hospital (Dallas, TX) are due to AIDS, with the majority from underlying PCP; COPD accounted for only 13% of secondary spontaneous pneumothoraces in patients admitted to the hospital. Factoring out procedure- and volutrauma (mechanical ventilation)-related pneumothoraces, a secondary spontaneous pneumothorax may complicate 1.6 to 2.0% of AIDS patients.34 AIDS-related pneumothorax mortality ranges from as low as 10 to 18%34 to as high as 50%.5 Volutrauma-related pneumothoraces in AIDS patients are also common. In one series,3 15 of 50 AIDS-related pneumothoraces (30%) were due to volutrauma. This type of pneumothorax may carry a high mortality (100%), and PCP is also frequently implicated.3 Hence, a spontaneous pneumothorax may represent a valid reason to evaluate the HIV status of a patient and to search for PCP in a known HIV-positive patient.

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