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"Ex Vacuo" Pneumothorax

University of California, San Francisco San Francisco, CA 94143-0628

Newborn infants who have undergone surgical repair of congenital diaphragmatic hernias manifest an ipsilateral hypoplastic lung surrounded by a potential space above the neo-diaphragm. Sometimes in the literature, this finding is described as a pneumothorax [1, 2].

However, we believe that a more appropriate term would be "ex vacuo" pneumothorax by analogy to the condition in the brain called "ex vacuo hydrocephalus." The use of the term "ex vacuo pneumothorax" would make it clear that the space around the infant's hypoplastic lung is a potential space that exists because the hypoplastic lung has not yet expanded. The space is more accurately described as ex vacuo rather than pneumothorax, which has a much different implication to most people. Certainly, the phrase "ex vacuo pneumothorax" would describe a temporary phenomenon because in a short time, gradual expansion of the hypoplastic lung and fluid would fill this space.

References

1. Saifuddin A, Arthur RJ. Congenital diaphragmatic hernia: a review of pre- and postoperative chest radiology. Clin Radiol1993; 47:104 -110[Medline]
2. Skarsgard ED, Harrison MR. Congenital diaphragmatic hernia: the surgeon's perspective. Pediatr Rev1999; 20:71 -78

Reply

Cincinnati Children's Hospital Medical Center Cincinnati, OH 45229-3039

Medical terminology is often complex and cumbersome and can detract from rather than enhance medical education, communication, and understanding. Half of the battle in medicine is understanding the language. Because of such issues, I am always leery of newly proposed terms, particularly when they contain words that might be of Latin origin. We have so many as it is. In my opinion, for a proposed term to be considered, it should be simple and clear and enhance communication between health care providers.

Drs. Aiken and Gooding have proposed the term "ex vacuo pneumothorax" to describe the air-filled space created when a congenital diaphragmatic hernia is repaired. This air-filled space certainly does not have the same significance as a typical pneumothorax and is in no way an indication for chest tube placement. Although most pediatric surgeons and pediatric radiologists who care for such infants recognize this difference, I have personally witnessed confusion concerning this issue among rotating radiology residents and pediatric house staff. It is conceivable that such confusion could result in suboptimal patient care. The term "ex vacuo pneumothorax" may foster better communication and understanding in this particular scenario and therefore improve patient care. The term is descriptive and implies and helps explain the mechanism by which the space exists. Therefore, I think the proposed term is reasonable and its use should be entertained.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aiken, A. Articles by Donnelly, L. F. Search for Related Content PubMed PubMed Citation Articles by Aiken, A. Articles by Donnelly, L. F. Social Bookmarking                      What's this?