Fibrothorax in a Patient with Social Withdrawal

A 65-year-old man was referred to our hospital because of oxygen desaturation and decreased lung sounds in the left hemithorax. He was diagnosed with left-sided pneumothorax. The pneumothorax had been noted 20 years ago at another hospital and left untreated, as the patient refused any treatment owing to prolonged social withdrawal. His aerodermectasia did not improve despite some fluctuations. Chest radiography and computed tomography revealed left-sided pneumothorax surrounded by pleural fibrosis, contralateral mediastinal shift, and aerodermectasia (Picture a, b). Although the patient was recommended to be admitted to our hospital, he again refused treatment. Long-standing pneumothorax might have been the direct cause of fibrothorax in this case; however, most cases of spontaneous pneumothorax usually improve without treatment (1). Thus, in this patient, it is possible that pleurisy (e.g., parapneumonic effusion) occurred repeatedly during the course of the disease. The inflammation may have injured the parietal pleura, resulting in chronic aerodermectasia. In addition, mesothelial cells in the pleura likely contribute to the chronic pleural fibrotic process (2). Therefore, chest radiography in the present case showed a strange appearance, as if lung markings were present outside the collapsed lung.

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The author states that he has no Conflict of Interest (COI).

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