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Summary Two patients with paraseptal (peri-acinar) emphysema are described. Bilateral spontaneous pneumothorax occurred in one patient and rapid enlargement of a bulla in the other, in each case causing severe acute dyspnœa: neither had complained of dyspnœa before. The radiographic features were the combination of hair-line ring and polygonal shadows with avascular areas distributed under the pleura, characteristic of the condition. Pulmonary function studies showed remarkably little airway obstruction and the lungs were evenly ventilated: the minor degree of impairment was consistent with a cushioning effect of the peripheral bull˦. One of the patients died after operation, enabling detailed pathological studies of this unusual condition to be made.

In a series of 160 male shipyard workers with radiographic evidence of pleural plaque formation 14% were found to have circulating rheumatoid factor or antinuclear antibodies. Twenty of the 160 men showed pulmonary fibrosis in addition to pleural plaque formation and circulating antibodies were present in 7 of the 20 (35%). When these 20 subjects are excluded, the incidence of circulating antibodies in the remaining 140 men with pleural plaques alone is reduced to 11 %, a figure only marginally above that found in the general population. This indicates that, as measured by these tests, pleural plaques are immunologically inert.