Approach to lung biopsies from patients with pneumothorax

Frank Schneider, Rajmohan Murali, Kristen L. Veraldi, Henry D. Tazelaar, Kevin O. Leslie

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Context.-Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of "spontaneous," or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment. Objective.-To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair. Data Sources.-Literature review and consultation experience of the authors. Conclusions.-Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.

Original languageEnglish (US)
Pages (from-to)257-265
Number of pages9
JournalArchives of Pathology and Laboratory Medicine
Volume138
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Pneumothorax
Biopsy
Lung
Lung Diseases
Blister
Information Storage and Retrieval
Interstitial Lung Diseases
Wounds and Injuries
Lung Injury
Rupture
Referral and Consultation
Air
Therapeutics
Pathologists

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Schneider, F., Murali, R., Veraldi, K. L., Tazelaar, H. D., & Leslie, K. O. (2014). Approach to lung biopsies from patients with pneumothorax. Archives of Pathology and Laboratory Medicine, 138(2), 257-265. https://doi.org/10.5858/arpa.2013-0091-RA

Approach to lung biopsies from patients with pneumothorax. / Schneider, Frank; Murali, Rajmohan; Veraldi, Kristen L.; Tazelaar, Henry D.; Leslie, Kevin O.

In: Archives of Pathology and Laboratory Medicine, Vol. 138, No. 2, 02.2014, p. 257-265.

Research output: Contribution to journalArticle

Schneider, F, Murali, R, Veraldi, KL, Tazelaar, HD & Leslie, KO 2014, 'Approach to lung biopsies from patients with pneumothorax', Archives of Pathology and Laboratory Medicine, vol. 138, no. 2, pp. 257-265. https://doi.org/10.5858/arpa.2013-0091-RA
Schneider, Frank ; Murali, Rajmohan ; Veraldi, Kristen L. ; Tazelaar, Henry D. ; Leslie, Kevin O. / Approach to lung biopsies from patients with pneumothorax. In: Archives of Pathology and Laboratory Medicine. 2014 ; Vol. 138, No. 2. pp. 257-265.
@article{c7c075e6240d4afea67026273e6c5fe2,
title = "Approach to lung biopsies from patients with pneumothorax",
abstract = "Context.-Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of {"}spontaneous,{"} or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment. Objective.-To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair. Data Sources.-Literature review and consultation experience of the authors. Conclusions.-Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.",
author = "Frank Schneider and Rajmohan Murali and Veraldi, {Kristen L.} and Tazelaar, {Henry D.} and Leslie, {Kevin O.}",
year = "2014",
month = "2",
doi = "10.5858/arpa.2013-0091-RA",
language = "English (US)",
volume = "138",
pages = "257--265",
journal = "Archives of Pathology and Laboratory Medicine",
issn = "0003-9985",
publisher = "College of American Pathologists",
number = "2",

}

TY - JOUR

T1 - Approach to lung biopsies from patients with pneumothorax

AU - Schneider, Frank

AU - Murali, Rajmohan

AU - Veraldi, Kristen L.

AU - Tazelaar, Henry D.

AU - Leslie, Kevin O.

PY - 2014/2

Y1 - 2014/2

N2 - Context.-Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of "spontaneous," or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment. Objective.-To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair. Data Sources.-Literature review and consultation experience of the authors. Conclusions.-Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.

AB - Context.-Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of "spontaneous," or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment. Objective.-To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair. Data Sources.-Literature review and consultation experience of the authors. Conclusions.-Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.

UR - http://www.scopus.com/inward/record.url?scp=84893683854&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893683854&partnerID=8YFLogxK

U2 - 10.5858/arpa.2013-0091-RA

DO - 10.5858/arpa.2013-0091-RA

M3 - Article

C2 - 24476522

AN - SCOPUS:84893683854

VL - 138

SP - 257

EP - 265

JO - Archives of Pathology and Laboratory Medicine

JF - Archives of Pathology and Laboratory Medicine

SN - 0003-9985

IS - 2

ER -