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Rare lung collapse hits 2 teens

By Sheryl Kay
10/13/2010 © Health News Florida

Jonathan Katz seemed healthy enough. But when the 16-year-old Tampa high-school student started having trouble breathing in chemistry class last month, he was rushed to the St. Joseph's Hospital emergency room.

Five months earlier, another Hillsborough County high-school student went to the same emergency room with almost-identical symptoms. Alex Pantelis, 16, of Brandon, was at lunch with friends when he felt a sharp pain in his back, followed by a tightening in the chest.

"I thought I was probably having a heart attack," Pantelis said. "It did cross my mind that I might die."

Chest pains and shortness of breath aren't supposed to happen to young, healthy teens. But Katz and Patelis suffered from a rare condition that causes lungs to collapse for no apparent reason.

They are two of thousands of patients --- many of them young, taller, slender men --- who suffer from the condition known as Primary Spontaneous Pneumothorax each year in the United States.

"I was just shocked," said Robin Katz, Jonathan's mother. "I'd never heard of such a thing, and when I told the doctor that, he said even though it's not common he had just had another teenage boy come through the emergency room within the past few months with the exact same thing."

The condition is an unpredictable lung collapse that is most often caused by a tearing of a small air blister --- called a "bleb" --- or a group of blisters on the top of the lung. Problems occur when a bleb tears and releases air into the pleural space, pushing against the lung and causing it to collapse.

Similar conditions, such as one known as Traumatic Pneumothorax, are caused by more dramatic events, like a lung rupturing during a medical procedure or a broken rib puncturing a lung.

Katz, a sophomore at Tampa Preparatory School, had no warning signs.

"I was sitting in chemistry class watching a movie about pollution in the Hillsborough River," he recalled. "Then all of a sudden I felt this weird pain go down my back, and my chest started to get tight, and it was getting harder and harder to breath."

Katz said nothing at first, hoping it would just go away. But the symptoms got worse, with every breath causing more tightness in his chest.

School administrators were baffled and consulted with the school's sports trainer, who also could not identify the problem. Even after Katz's parents took him to the ER, the first technician assessing the teen did not recognize a potential lung collapse. The diagnosis was made after hospital workers monitored his oxygen levels and took a chest x-ray.

The overall incidence of primary spontaneous pneumothorax is low, with about eight to 18 cases per 100,000 men each year, and one to six cases per 100,000 women annually, according to Dr. Michael Baumann, Professor Of Medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at the University of Mississippi Medical Center, and a renowned specialist in the syndrome.

But that still translates to about 10,000 cases a year in the United States. Pantelis, a sophomore at Tampa Jesuit High School, was rushed to St. Joseph's in April after feeling the pain.

Pantelis was more fortunate than Katz: His lung collapse was only 12 percent, while Katz's collapse was 60 percent. Within hours, Pantelis' lung re-inflated on its own; Katz needed surgery to implant a plastic tube that would allow air out of the chest cavity and enable the lung to re-inflate.

Both, however, were in the hospital several days before returning to school.

Experts agree that the condition is triggered by a rupture at some location on the lung, which allows air to escape into the chest cavity. That puts pressure on the lung and causes it deflate.

Most investigators point to a tearing in the blebs as the reason for the change in pressure. Numerous studies also have confirmed that taller, skinnier teenage men are more at risk.

But many unanswered questions remain, such as why some people have blebs but never suffer Primary Spontaneous Pneumothorax. Also, in some cases, people are stricken with the condition but show no evidence of blebs. Another question centers on why blebs tear.

Dr. Veena Antony, Professor of Medicine, Molecular Genetics and Microbiology at the University of Florida, has found evidence that the condition occurs when a person has a loss of cells covering the pleura. The pleura is a membrane that shields and cushions the lung. With the cell covering missing, the blebs are at much higher risk of tearing.

"Imagine a soap bubble that has no shield, no covering," Antony said. "With any kind of change in pressure, that soap bubble is going to pop."

Even with just normal breathing, she said, the forces and pressures that occur are enough to cause a rupture. But the likelihood rises for those who smoke or inhale any unusual materials, because those activities cause even greater changes in air pressure.

Dr. Daniel Haim, president of Central Florida Pulmonary Group in Orlando, said he warns patients they are at much greater risk if they smoke or inhale foreign substances such as marijuana or ‘crack’ cocaine. He also advises against scuba diving because of the dramatic pressure changes, but said flying in an airplane is generally allowed because cabins are pressurized.

Also, Primary Spontaneous Pneumothorax can reoccur. Haim said patients have a 30 to 40 percent change of another collapse, with reoccurrences as random as the initial episodes.

Both Katz and Pantelis have had one reoccurrence each, about a week after the initial pneumothorax. Neither, however, said they worry too much about reoccurrences.

"You know, when I roughhouse a little with the guys there might be that one fleeting moment that I think about it, but then it's gone," said Pantelis.

Katz said if he's learned anything from this episode, it's to not hold back if there's an unusual pain that doesn't go away.

"I'm always the healthy one, I'm always feeling fine, and then instantly all this happened," he said. "If you feel like you're having trouble breathing, don't tough it out. Don't risk it. Get it checked out right away."

--Sheryl Kay is an independent journalist in Tampa. Questions, comments can be sent to Editor Carol Gentry.