Q & A: A Collapsed Lung: Was this Due to Anorexia Nervosa?

Q: A patient with anorexia nervosa with whom I recently consulted had a past medical history of a collapsed lung, which her physician called spontaneous pneumothorax. Is this a recognized complication of anorexia nervosa?

(A.L., Tallahassee, FL)

A: Spontaneous pneumothorax occurs when a subpleural pulmonary bleb (basically a structural bubble) bursts and air rushes into the pleural space between the lung and chest wall. The lung then collapses in response to this sudden build-up in air pressure where no air previously existed. Spontaneous pneumothorax most often occurs in young adult individuals with lean bodies, typically males. They usually present with acute chest pain and progressive shortness of breath. In instances where small amounts of air have leaked into the chest wall cavity, treatment can be conservative, and the air may be reabsorbed spontaneously. However, in pronounced cases, chest tubes must be inserted to help the air escape and to enable the lung to reinflate. One case has been reported with anorexia nervosa, and the authors assume that others have occurred as well (Psychosomatics 1998;39:162). However, a larger number of patients with anorexia nervosa have developed “spontaneous pneumomediastinum.” In this situation, high intrathoracic pressure, sometimes associated with vomiting, leads to high intra-alveolar pressure, rupture of perivascular alveoli, and escape of air into connective tissues and dissection of air into the mediastinum. Symptoms include acute pleuritic chest pain, shortness of breath, and neck pain, and several specific signs on physical examination of the chest. The important point here is that patients who are vomiters and who develop this syndrome require an immediate contrast esophagogram to rule out perforation of the esophagus (Booerhaave’s syndrome). If untreated, this condition may lead to peritonitis and result in death, and must be attended to surgically as rapidly as possible.

— J.Y.