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. 2016 May-Jun;42(3):222-6.
doi: 10.1590/S1806-37562015000000230.

Etiology of primary spontaneous pneumothorax

[Article in English, Portuguese]
Roberto de Menezes Lyra  1   2
Affiliations

Etiology of primary spontaneous pneumothorax

[Article in English, Portuguese]
Roberto de Menezes Lyra. J Bras Pneumol. 2016 May-Jun.

Abstract
in English, Portuguese

With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). The aim of this pictorial essay was to improve the understanding of primary spontaneous pneumothorax and to propose a description of the major anatomical lesions found during surgery. RESUMO Com o advento da TCAR, o pneumotórax espontâneo primário passou a ser mais bem entendido e conduzido, pois sua etiologia pode ser atualmente identificada na maioria dos casos. O pneumotórax espontâneo primário tem como principal causa a rotura de uma pequena vesícula enfisematosa subpleural, denominada bleb ou de uma lesão enfisematosa parasseptal subpleural, denominada bulla. O objetivo deste ensaio pictórico foi melhorar o entendimento do pneumotórax espontâneo primário e propor uma descrição das principais lesões anatômicas encontradas durante a cirurgia.

Com o advento da TCAR, o pneumotórax espontâneo primário passou a ser mais bem entendido e conduzido, pois sua etiologia pode ser atualmente identificada na maioria dos casos. O pneumotórax espontâneo primário tem como principal causa a rotura de uma pequena vesícula enfisematosa subpleural, denominada bleb ou de uma lesão enfisematosa parasseptal subpleural, denominada bulla. O objetivo deste ensaio pictórico foi melhorar o entendimento do pneumotórax espontâneo primário e propor uma descrição das principais lesões anatômicas encontradas durante a cirurgia.

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Figures

Figure 1
Figure 1. Schematic illustration of the anatomy of emphysematous lung lesions, representing a bleb and a bulla.
Figure 2
Figure 2. Coronal CT scan of the chest showing a bulla located in the right lung apex and accompanied by pleural adhesion.
Figure 3
Figure 3. Video-assisted thoracoscopic surgery image of a bulla showing extreme thinning in the left lung apex and accompanied by pleural adhesion.
Figure 4
Figure 4. Schematic illustration of the types of emphysematous lung lesions. A: normal lung; B: apical lung scarring; C: small bleb; D: bulla; E: giant bulla; F: multiple bullae; G: multiple bilateral bullae; H: lobar emphysema; I: recurrent pneumothorax with multiform membranous pleuropulmonary adhesions; J: multiloculated membranous chronic pneumothorax; and K: spontaneous hemopneumothorax (the last three being accompanied by pleural adhesions).
Figure 5
Figure 5. Lung specimen obtained by video-assisted surgery and showing bullae.
Figure 6
Figure 6. In A, schematic illustration of a cross-sectional CT scan used in the preoperative identification of emphysematous bullae. In B, the positioning of the required equipment for video-assisted thoracic surgery.
See this image and copyright information in PMC

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