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.
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.
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.2–3
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.
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited:
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.