title: Vascular-penetration defect detected in parietal pleura of primary spontaneous pneumothorax.
abstract: Primary spontaneous pneumothorax (PSP) is one of the most frequent diseases that thoracic surgeons handle, but the aetiology is not really known. We prospectively examined intraoperative images and collected the data of PSP patients who received bullectomy and mechanical pleurodesis with the thoracoscope at the Department of Thoracic Surgery at our hospital. Vascular-penetration defects (VPDs) were 2-6 mm vessel-converged holes that we found on the apex of the parietal pleura of PSP patients exclusively. The VPDs were solely located in the apex of the parietal pleura on the chest wall above the first rib. As many as up to four in number could be present. The VPDs were sometimes complementary to blebs and were not found in any of the other thoracoscopic surgeries for diseases other than PSP. We postulate that the presence of VPDs may be a contributing factor to the formation of a subgroup of emphysematous-like changes and the recurrence of PSP.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Frank Cheau-Feng
authors.initials: FC
authors.lastname: Lin
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chou
authors.affiliation: Department of Medical Research, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan.
authors.forename: Kee-Ching
authors.initials: KC
authors.lastname: Jeng
authors.affiliation: Department of Medical Research, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan Department of Food and Nutrition, Providence University, Taichung, Taiwan tsaistella111@gmail.com.
authors.forename: Stella Chin-Shaw
authors.initials: SC
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010994:Pleura / Q000098:blood supply* / Q000601:surgery; D018700:Pleurodesis / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000175:diagnosis* / Q000209:etiology
keywords: Anatomy; Pleura; Pneumothorax