Beers M F, Sohn M, Swartz M
Cardiovascular Pulmonary Division, Hospital, University of Pennsylvania, Philadelphia 19104.
Chest. 1990 Aug;98(2):266-70. doi: 10.1378/chest.98.2.266.
Spontaneous pneumothorax associated with Pneumocystis carinii pneumonia (PCP) in AIDS patients has been reported with increasing frequency; however, little is known about the causative histopathology. In the past year, we treated three patients with documented PCP subsequently complicated by multiple spontaneous pneumothoraces. All patients underwent open surgical repair. In contrast to traditional pathologic findings of PCP in AIDS, histologic sections of lung from each patient consistently demonstrated an extensive interstitial inflammatory process with destruction of lung tissue primarily involving the periphery of the lung. Subpleural necrosis with bleb formation as well as bullous changes persisted even in the absence of an alveolar filling process. We conclude that the mechanism for pneumothorax in PCP is spontaneous rupture of necrotic lung tissue occurring in a subgroup of AIDS patients in which the interstitial inflammatory response to Pneumocystis has been accelerated.
艾滋病患者中与卡氏肺孢子虫肺炎（PCP）相关的自发性气胸报告频率日益增加；然而，关于其致病组织病理学却知之甚少。在过去一年里，我们治疗了3例确诊为PCP且随后并发多处自发性气胸的患者。所有患者均接受了开放性手术修复。与艾滋病患者PCP的传统病理表现不同，每位患者的肺组织学切片均持续显示广泛的间质性炎症过程，肺组织破坏主要累及肺周边。即使没有肺泡填充过程，胸膜下坏死伴肺大疱形成以及肺大泡改变依然存在。我们得出结论，PCP患者发生气胸的机制是在一小部分对肺孢子虫的间质性炎症反应加速的艾滋病患者中，坏死肺组织的自发性破裂。
