Spontaneous Pneumothorax in Flight as First Manifestation of Alpha-1 Antitrypsin Deficiency

Lin Y-C, Chiu W-K, Chang H, Cheng Y-L, Chen J-C. Spontaneous pneumothorax in flight as first manifestation of alpha-1 antitrypsin deficiency. Aviat Space Environ Med 2008; 79:704–6.Alpha-1 antitrypsin deficiency is a genetic condition that increases the risk of a variety of conditions including pulmonary emphysema and chronic liver disease. We report on a 33-yr-old male fighter pilot with early-onset pulmonary emphysema with bullae who developed spontaneous pneumothorax during in-flight combat training. A CT scan of his chest after removal of the chest tube showed multiple variably sized bullae and pulmonary cysts scattered throughout both lungs. Serum levels of alpha-1 antitrypsin were markedly decreased. Genetic analyses showed a PI ZZ genotype. Alpha-1 antitrypsin deficiency often goes undiagnosed by flight surgeons, which is a risk to flight safety.