PURPOSE: Primary Spontaneous Pneumothorax (PSP) is an extremely rare condition of unknown etiology characterized by abnormal accumulation of air in the pleural space from a non-traumatic cause. The disorder appears less commonly in children and there is a paucity of data on adolescents. Oftentimes no underlying lung disease is identified. Although many patients with PSP are observed to have subtle indications of undiagnosed lung disease, like apical blebs, the etiology of these blebs is uncertain, and the casual relationship is not always ascertained. Underlying hyperinflation as a cause of PSP has not systematically reported.
METHODS: We present a series of three patients with primary spontaneous pneumothorax and severe undiagnosed hyperinflation as a possible etiology. The first patient (A) presented at age 14 years old, the second patient (B) at 17 years old, and the third patient (C) at age 7. All three were treated with supplemental oxygen ranging from 50%- 100%. Pulmonary function tests (PFTs) were performed within 10 days of the pneumothorax.
RESULTS: Patient A Patient B Patient CTLC 164% 143% 123%FRC 244% 183% 170%RV 333% 197% 202%RV/TLC 199% 135% 164%All patients had a history of childhood asthma. Patient (A) was on intermittent asthma therapy at the time of the pneumothorax. Follow-up on the three ranged from 6-17 months. All patients were treated with aggressive asthma regimens of bronchodialators, anticholinergics, and inhaled corticosteroids. No patient required surgical or chemical pleurodesis.
CONCLUSION: We speculate that PSP develops secondary to severe unrecognized hyperinflation which may be related to untreated asthma. .
CLINICAL IMPLICATIONS: Appropriate treatment of asthma may eliminate the reoccurrence of pneumothorax and obviate the need for surgical intervention.
DISCLOSURE: Kevin Trice, No Financial Disclosure Information; No Product/Research Disclosure Information