Abstract
Bilateral pneumothoraces are extremely rare. Patients with pleuroparenchymal fibroelastosis are frequently complicated by pneumothorax, which is sometimes bilateral. Pleuroparenchymal fibroelastosis should be considered a cause of bilateral pneumothoraces with apical fibrosis.
Keywords: apical fibrosis, bilateral pneumothoraces, pleuroparenchymal fibroelastosis, secondary pneumothorax
Bilateral pneumothoraces are extremely rare. We present a fatal case of a patient diagnosed with secondary pneumothorax associated with idiopathic pleuroparenchymal fibroelastosis (PPFE) who died of type II respiratory failure one year after the onset of pneumothorax. PPFE should be considered a cause of bilateral pneumothoraces with apical fibrosis.
CLINICAL IMAGE
A slender 78‐year‐old man with no history of smoking or dust exposure presented with persistent dyspnea for several years. A physical examination revealed decreased bilateral breath sounds. Chest radiography showed bilateral pneumothoraces and apical infiltrates (Figure 1A). Chest computed tomography obtained 1 year before showed subpleural consolidation at the bilateral lung apexes (Figure 1B). The patient was diagnosed with secondary pneumothorax associated with idiopathic pleuroparenchymal fibroelastosis (PPFE) and followed without treatment. However, the pneumothoraces did not improve, and the patient died of type II respiratory failure 1 year after the onset of pneumothorax.
FIGURE 1.
Chest radiography showed bilateral pneumothoraces (arrowheads) and subpleural band‐like infiltrates at the apex of the lungs (A). Coronal chest computed tomography before the onset of pneumothorax showed wedge‐shaped consolidation at the bilateral lung apexes (B).
Bilateral pneumothoraces are extremely unusual and represent only 1.5% of all pneumothorax cases. 1 PPFE is rare interstitial pneumonia with upper‐lobe predominance. 2 PPFE patients were frequently complicated by pneumothorax with a three‐year cumulative incidence of 53.9%. 2 Notably, pneumothoraces were bilateral in 15.8% of PPFE patients because pneumothorax in PPFE is often refractory, and contralateral pneumothorax may develop before the pneumothorax heals. 2 Pneumothorax in PPFE is caused by progressive contraction of the upper lung lobe and is usually untreated due to the small space of pneumothorax and its resistance to thoracic drainage. 2 Based on our findings, PPFE should be considered a cause of bilateral pneumothoraces with apical fibrosis.
AUTHOR CONTRIBUTIONS
Yoshiaki Kinoshita: Investigation, writing–original draft, writing–review and editing, and final approval of the manuscript. Takuhide Utsunomiya: Investigation, writing–review and editing and visualization, and final approval of the manuscript. Hisako Kushima: Writing–review and editing, and final approval of the manuscript. Hiroshi Ishii: Writing–review and editing, and final approval of the manuscript.
CONFLICT OF INTEREST
None declared.
ETHICS STATEMENT
The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.
Kinoshita Y, Utsunomiya T, Kushima H, Ishii H. Bilateral pneumothoraces with apical consolidations. Respirology Case Reports. 2022;10:e01066. 10.1002/rcr2.1066
Associate Editor: Jennifer Ann Wi
Funding information JSPS KAKENHI, Grant/Award Number: JP21K16153.
DATA AVAILABILITY STATEMENT
No data are available.
REFERENCES
- 1. Akcam TI, Kavurmaci O, Ergonul AG, Aydin S, Turhan K, Cakan A, et al. Analysis of the patients with simultaneous bilateral spontaneous pneumothorax. Clin Respir J. 2018;12:1207–11. [DOI] [PubMed] [Google Scholar]
- 2. Kono M, Nakamura Y, Enomoto Y, Yasui H, Hozumi H, Karayama M, et al. Pneumothorax in patients with idiopathic pleuroparenchymal fibroelastosis: incidence, clinical features, and risk factors. Respiration. 2021;100:19–26. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No data are available.