What is a spontaneous pneumothorax?

priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Please include a cover letter with a complete list of authors (including full first and last names and highest degree), corresponding author's address, phone number, fax number, and email address (if applicable). An electronic version of the communication should be included on a 3.5-inch diskette. Specific permission to publish should be cited in the cover letter or appended as a postscript. CHEST reserves the right to edit letters for length and clarity. In their report on tracheal injury caused by paraquat, Ruiz-Bailen and colleagues 1 stated, in the " Abstract, " that the patient presented with acute respiratory insufficiency and a spontaneous (sic!) pneumothorax. In the " Discussion " section they wrote again that " very rarely, spontaneous (!) extraalveolar air appears. .. " etc. What does spontaneous mean? According to Webster's New Universal Unabridged Dictionary 2 (definition 1), spontaneous means " coming or resulting from a natural impulse or tendency. " Dorland's Medical Dictionary defines spontaneous as " occurring without external influence. " 3 In the reported case, the pneumothorax caused by ingestion of paraquat was anything but spontaneous, and by referring to it as such, the authors did not really mean it. Medical terminology is important and should be used with precision. We are grateful for the opportunity to respond to the interesting comments made by Drs. Weissberg and Weissberg on our article in CHEST (June 2001). 1 Spontaneous pneumothorax, defined as that which occurs without previous trauma or other evident cause, can be categorized as primary or secondary according to the existence or not of a previous initial lesion of the lung parenchyma. 2,3 Our patient arrived at the emergency department with a pneumothorax of unknown origin and with no known history of lung disease, so that he initially received a diagnosis of primary spontaneous pneumothorax. Nevertheless, if the origin of the pneumothorax was not the tracheal lesion alone, but also a subsequent ARDS induced by paraquat poisoning, we could describe it as a secondary spontaneous pneumothorax, considering it to be induced by the acute lung injury, with the possible formation of subpleural bullae followed by rupture. Moreover, …