EARLY SECONDARY SPONTANEOUS PNEUMOTHORAX IN A CAUCASIAN FEMALE WITH PAST PRIMARY SPONTANEOUS PNEUMOTHORAX

Abstract

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pneumothorax is the trapping of air between the visceral and parietal pleura of the lungs.it is a well-established condition associated with smoking, vaping, Marfans syndrome, tall build and familial diseases like alpha 1 antitrypsin deficiency. CASE PRESENTATION: 45 y/o Caucasian lady who presented to the ER with sudden left sided pleuritic chest pain and Shortness of breath She denied palpitations, nausea or vomiting Past medical history was significant for right spontaneous pneumothorax for which she Video-assisted thoracoscopic surgery at the age of 31 and COPD She has smoked about 1.5 packs per day for over 20 years, 3-year history of vaping.She had no family history of similar symptoms On presentation, Her vitals were unremarkable except for O2 Saturation of 92 on room air which increased to 98 with 2L of O2Physical examination was remarkable for a tall, slender appearing lady with diminished breath sounds on the left lung base. Her laboratory investigations were unremarkable including troponin and EKG. Chest Xray showed bullous changes bilaterally with compressive atelectasis in both lungs with 20% left-sided pneumothorax, follow up CT scan of the chest showed Severe lung parenchymal disease with multiple cystic spaces all over the lungs and approximately 40% left-sided pneumothorax. Cardio-thoracic surgery was consulted following which she had Pig tail catheter inserted and connected to an underwater seal, however her pneumothorax was not resolving hence she had thoracotomy with blebectomy. Lung biopsy showed severe bullous emphysema with blebs, chronic inflammation, perilesional fibrosis and dystrophic calcificationPatient was strongly advised against smoking and she was scheduled to follow up in pulmonology clinic to rule out alpha 1 anti-trypsin deficiency, results of which were pending DISCUSSION: Secondary Spontaneous Pneumothorax is defined as pneumothorax that occurs in the presence of lung disease as with this patient who had underlying bullous disease.It is commonly found in male patients with an age preponderance of greater than 55 years, our patient however is a lady and less than 50 years Primary Spontaneous pneumothorax is pneumothorax occurring in the absence of lung disease. It is commonly found in males usually between ages 10-30 years It is very likely our patient initially had a primary spontaneous pneumothorax given her slender tall build which then progressed to secondary pneumothorax given her significant smoking, vaping history and severe bullous lung disease raising suspicious for underlying Alpha 1 antitrypsin deficiency. CONCLUSIONS: It is important to investigate further for individuals like this who present which such severe lung disease with unusual demographics REFERENCE #1: 1. Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Thorax. 2000 Aug;55(8):666-71. doi: 10.1136/thorax.55.8.666. PMID: 10899243; PMCID: PMC1745823. REFERENCE #2: Melton LJ 3rd, Hepper NG, Offord KP. Influence of height on the risk of spontaneous pneumothorax. Mayo Clin Proc. 1981 Nov;56(11):678-82. PMID: 7300447 DISCLOSURES: No relevant relationships by Karishma Kadariya, source=Web Response No relevant relationships by Evans Kyei-Nimako, source=Admin input No relevant relationships by Utibe Ndebbio, source=Web Response No relevant relationships by Demilade Soji-Ayoade, source=Web Response