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Communications to the Editor |

What Is A Spontaneous Pneumothorax? FREE TO VIEW

Dorit Weissberg, MD; Dov Weissberg, MD, FCCP
Author and Funding Information

Affiliations: Tel Aviv University Sackler School of Medicine Tel Aviv, Israel,  Hospital de Poniente, El Ejido Almería, Spain

Correspondence to: Dov Weissberg, MD, FCCP, E. Wolfson Medical Center, Holon 58100, Israel.



Chest. 2002;121(3):1002. doi:10.1378/chest.121.3.1002
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To the Editor:

In their report on tracheal injury caused by paraquat, Ruiz-Bailen and colleagues1 stated, in the “Abstract,” that the patient presented with acute respiratory insufficiency and a spontaneous (sic!) pneumothorax. In the “Discussion” section they wrote again that “very rarely, spontaneous (!) extraalveolar air appears …” etc.

What does spontaneous mean? According to Webster’s New Universal Unabridged Dictionary2(definition 1), spontaneous means “coming or resulting from a natural impulse or tendency.” Dorland’s Medical Dictionary defines spontaneous as “occurring without external influence.”3

In the reported case, the pneumothorax caused by ingestion of paraquat was anything but spontaneous, and by referring to it as such, the authors did not really mean it. Medical terminology is important and should be used with precision.

Ruiz-Bailen, M, Serrano-Corcóles, MC, Ramos-Cuadra, JA (2001) Tracheal injury caused by ingested paraquat.Chest119,1956-1957. [PubMed] [CrossRef]
 
 Webster’s New Universal Unabridged Dictionary. 1996; Barnes & Noble. New York, NY:.
 
 Dorland’s Illustrated Medical Dictionary. 28th ed. 1994; Saunders. Philadelphia, PA:.
 
To the Editor:

We are grateful for the opportunity to respond to the interesting comments made by Drs. Weissberg and Weissberg on our article in CHEST (June 2001).1Spontaneous pneumothorax, defined as that which occurs without previous trauma or other evident cause, can be categorized as primary or secondary according to the existence or not of a previous initial lesion of the lung parenchyma.23

Our patient arrived at the emergency department with a pneumothorax of unknown origin and with no known history of lung disease, so that he initially received a diagnosis of primary spontaneous pneumothorax. Nevertheless, if the origin of the pneumothorax was not the tracheal lesion alone, but also a subsequent ARDS induced by paraquat poisoning, we could describe it as a secondary spontaneous pneumothorax, considering it to be induced by the acute lung injury, with the possible formation of subpleural bullae followed by rupture. Moreover, the appearance of spontaneous pneumothorax has been previously reported as a form of presentation of paraquat poisoning and explained by the resulting lung injury.4 For these reasons, the assertion that a pneumothorax induced by paraquat poisoning cannot be described as spontaneous seems, at the very least, controversial.

References
Ruiz-Bailén, M, Serrano-Corcoles, MC, Ramos-Cuadra, JA Tracheal injury caused by ingested paraquat.Chest2001;119,1956-1957. [PubMed] [CrossRef]
 
Peters, JI, Sako, EY Pneumothorax. Fishman, AP Elias, JA Fishman, JA eds.Fishman’s pulmonary diseases and disorders 3rd ed.1998,1445 McGraw-Hill. New York, NY:
 
Light, RW Pneumothorax. Murray, N eds.Textbook of respiratory medicine 2nd ed.1994,2193 Saunders. Philadelphia, PA:
 
Chen, KW, Wu, MH, Huang, JJ, et al Bilateral spontaneous pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema: a rare presentation of paraquat intoxication.Ann Emerg Med1994;23,1132-1134. [PubMed]
 

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References

Ruiz-Bailen, M, Serrano-Corcóles, MC, Ramos-Cuadra, JA (2001) Tracheal injury caused by ingested paraquat.Chest119,1956-1957. [PubMed] [CrossRef]
 
 Webster’s New Universal Unabridged Dictionary. 1996; Barnes & Noble. New York, NY:.
 
 Dorland’s Illustrated Medical Dictionary. 28th ed. 1994; Saunders. Philadelphia, PA:.
 
Ruiz-Bailén, M, Serrano-Corcoles, MC, Ramos-Cuadra, JA Tracheal injury caused by ingested paraquat.Chest2001;119,1956-1957. [PubMed] [CrossRef]
 
Peters, JI, Sako, EY Pneumothorax. Fishman, AP Elias, JA Fishman, JA eds.Fishman’s pulmonary diseases and disorders 3rd ed.1998,1445 McGraw-Hill. New York, NY:
 
Light, RW Pneumothorax. Murray, N eds.Textbook of respiratory medicine 2nd ed.1994,2193 Saunders. Philadelphia, PA:
 
Chen, KW, Wu, MH, Huang, JJ, et al Bilateral spontaneous pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema: a rare presentation of paraquat intoxication.Ann Emerg Med1994;23,1132-1134. [PubMed]
 
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