Anorexia nervosa presenting as diffuse spontaneous air leaks

In the context of AN, malnourishment has been closely linked to reduced lung surfactant production and emphysematous-like changes which increases susceptibility to tissue injury and poor healing.1 AN is also associated with induced vomiting, which may cause oesophageal rupture and raised intrathoracic pressure, predisposing to developing pneumomediastinum, pneumothorax and pneumorrhachis. Other risk factors for developing spontaneous air leaks include male gender and vigorous exercise.2 The development of emphysematous-like lung changes without underlying pulmonary disease has also been reported in the HIV population, where bronchial dilation and premature bullous disease were seen in affected patients, predisposing to air leaks.3 When air leaks are identified, visceral organ injuries should be excluded as this would require surgical intervention. Depending on severity, the management of patients with AN-associated air leaks usually involves a medically conservative and multidisciplinary team approach until the source of the air leak heals.1 2 Currently, the duration required for restoration of normal pulmonary physiology and whether emphysematous-like changes will improve with refeeding are yet to be determined.1 However, patients generally recover well with spontaneous resolution of the air leaks without any significant sequelae.