|Year : 2022 | Volume
| Issue : 1 | Page : 50-51
Chest image: bilateral pneumothorax
Rohit Bansal1, Priya Bansal2
1 Department of Medicine, Dr RML Hospital and ABVIMS, New Delhi, India
2 Department of Medicine, LHMC and SSK Hospital, New Delhi, India
|Date of Submission||12-Jan-2021|
|Date of Decision||29-Sep-2021|
|Date of Acceptance||20-Nov-2021|
|Date of Web Publication||19-Apr-2022|
Dr. Priya Bansal
Department of Medicine, R-4/44, Raj Nagar, Ghaziabad 201002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Patients presenting with spontaneous pneumothorax usually have an underlying lung disease. We present a case of bilateral pneumothoraces in a patient with no known co-morbidity or risk factors, except a recent history of lower respiratory tract infection. We wish to highlight post-infective cysts as a cause of this presentation.
Keywords: Bilateral pneumothorax, infective cysts, pneumothorax
|How to cite this article:|
Bansal R, Bansal P. Chest image: bilateral pneumothorax. J Assoc Chest Physicians 2022;10:50-1
| Chest image|| |
A 41-year-old nonsmoker well-built male patient presented to the medical emergency department in January 2020, with progressive dyspnea for 3 days. He had no known comorbid illness and medical history was unremarkable, except for a mild respiratory illness 2 months back. On examination, he was tachypneic and had bilateral diminished breath sounds. The total leukocyte count was 16,000/mm3. Chest X-ray showed bilateral pneumothorax [Figure 1]. Computed tomography of chest revealed bilateral pneumothorax with well-defined cystic lesions of varying sizes and wall thickness, distributed in bilateral lung fields [Figure 2]. Bronchoalveolar lavage indicated dense inflammation comprising predominantly polymorphs. Fungal culture, reverse-transcription polymerase chain reaction for tuberculosis, and HIV tests were negative. Workup for malignancy and anti-nuclear antibody (ANA) were also negative. In the absence of any risk factors for primary spontaneous pneumothorax such as thin built, tall height, and cigarette smoking, patient was diagnosed with postinfective cystic disease of lung in the wake of recent history of respiratory illness. The patient underwent bilateral intercostal drainage, was started on broad spectrum antibiotics, and discharged in satisfactory condition. Patient has been asymptomatic on follow-up.
|Figure 2 Computed tomography of the chest confirming bilateral pneumothorax.|
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Simultaneous bilateral pneumothorax accounts for 1.3% of all spontaneous pneumothoraces. Patients may present with mild dyspnea and chest pain or severe shortness of breath with respiratory failure. Early diagnosis and treatment by bilateral chest drainage are imperative to avoid life-threatening progression to tension pneumothorax. Patients presenting with spontaneous pneumothoraces usually have an underlying lung disease such as lymphangioleiomyomatosis, congenital disease (cystic fibrosis), malignancy, chronic obstructive pulmonary disease with emphysema, or infection. A rare condition is the Birt–Hogg–Dubè syndrome, an autosomal dominant disorder characterized by multiple fibrofolliculomas, lung cysts, pneumothorax, and renal tumors. Postinfective cysts are usually reported with pneumonia (Staphylococcus aureus), pneumocystosis, or other fungal infection. Airway inflammation leads to the development of blebs, bullae, and areas of pleural porosity which may rupture spontaneously or in the presence of precipitating factors such as surgery or changes in atmospheric pressure.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]