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dc.contributor.authorCasha, Aaron-
dc.contributor.authorGatt, Ruben-
dc.contributor.authorWolak, Wiktor-
dc.contributor.authorDudek, Krzysztof-
dc.contributor.authorGauci, Marilyn-
dc.contributor.authorSchembri-Wismayer, Pierre-
dc.contributor.authorCamilleri-Podesta, Marie Therese-
dc.contributor.authorGrima, Joseph N.-
dc.contributor.authorManche, Alexander-
dc.identifier.citationCasha, A., Gatt, R., Wolak, W., Dudek, K., Gauci, M., Schembri Wismayer, P., ... Manche, A. (2014). Is there a biomechanical cause for spontaneous pneumothorax? European Journal of Cardio-Thoracic Surgery, 45(6), 1011-1016.en_GB
dc.description.abstractOBJECTIVES: Primary spontaneous pneumothorax has long been explained as being without apparent cause. This paper deals with the effect of chest wall shape and explains how this may lead to the pathogenesis of primary spontaneous pneumothorax. METHODS: Rib cage measurements were taken from chest radiographs in 12 male pneumothorax patients and 12 age-matched controls. Another group of 15 consecutive male thoracic computerised tomography (CT) were investigated using paramedian coronal and sagittal CT reconstructions to assess apical lung shape. A finite element analysis (FEA) model of a lung apex was constructed, including indentations for the first rib guided by CT scan data, to assess pleural stress. This model was tested using different anteroposterior diameter ratios, producing a range of thoracic indexes. RESULTS: The pneumothorax patients had a taller chest (P = 0.03), wider transversely (P = 0.009) and flatter (P = 0.03) when compared with controls, resulting in a low thoracic index. Prominent rib indentations were found anteriorly and posteriorly on the lung surface, especially on the first rib on CT. FEA of the lung revealed significantly higher stress (×5-×10) in the apex than in the rest of the lung. This was accentuated (×4) in low thoracic index chests, resulting in 20-fold higher stress levels in their apex. CONCLUSIONS: The FEA model demonstrates a 20-fold increase in pleural stress in the apex of chests with low thoracic index typical of spontaneous pneumothorax patients. Mild changes in thoracic index, as occurring in females or with aging, reduce pleural stress. Spontaneous pneumothorax occurring in young male adults may have a biomechanical cause.en_GB
dc.publisherOxford University Pressen_GB
dc.subjectFinite element methoden_GB
dc.subjectBiological modelsen_GB
dc.titleIs there a biomechanical cause for spontaneous pneumothorax?en_GB
dc.rights.holderThe copyright of this work belongs to the author(s)/publisher. The rights of this work are as defined by the appropriate Copyright Legislation or as modified by any successive legislation. Users may access this work and can make use of the information contained in accordance with the Copyright Legislation provided that the author must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder.en_GB
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