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All Out of Breath - Onset and Progression of Primary Spontaneous Pneumothorax


Prof. Shelley Wall¹, Dr. John Wong² (content expert)


Educated lay-audience

Completed on:

Dec. 2017

Tools used:

Adobe Illustrator, Adobe Photoshop

This pathology illustration was conceptualized in order to describe and clarify on the microscopic, histological and organ-level effects of primary spontaneous pneumothorax - a serious, often life-threatening lung condition which can occur in young individuals who are otherwise healthy. Lung tissue cubes were integrated into the design in order to illustrate the etiology (causative factor) of this condition. The layout was designed for the finished piece to be printed as a double-page tabloid spread.

¹Biomedical Communications, University of Toronto, ²Anatomic Pathology, Sunnybrook Health Science Centre

Process Work

1. Rationale

The pathological condition (PSP, Primary Spontaneous Pneumothorax) portrayed in this project was fascinating, as it affected otherwise healthy young adults, and the morphological changes spanned cellular, tissue, and organ levels. With that, I aimed to showcase various aspects of this condition to an educated lay audience.

2. Research and Reproduction

Background research was done from pathology literature and disease information resources on PSP. Preliminary sketches and "tissue cube" illustrations were done to explore how cellular and tissue level pathomorphology would be portrayed.

3. Layout Design

The final deliverable piece for this project was to be printable as a tabloid double-page spread, 11'' x 17''. For establishing layout, factors like ease of narrative flow and partitioning of major content clusters were taken into consideration. To add visual impact, certain graphic elements were laid out past page margins into full bleed. Thumbnails and rough sketches were done to create and refine the general layout. Textual elements were implemented and adjusted to retain salience on visuals.

4. Colour and Style

The colour swatch was established through colour studies and consulting tissue references. A realistic, painterly finish was chosen for the graphics in this piece to portray the tissue types convincingly while maintaining an interesting, illustrative quality.

5. Rendering

To provide total control over detail and colour, the entire piece was first digitally painted in grayscale within Photoshop. Each element (e.g. "tissue cube 1") was painted in independent layer-sets with incremental details. Colouration was digitally glazed using Hue/Saturation adjustment layer-sets, each set targeting individual element; multiple adjustment layers allowed for complex colour-mixing.


Augur, A.M.R., and A.F. Dalley. Grant’s Atlas of Anatomy 14e. Page 218-227: Thorax. Philadelphia: Lippincott Williams & Wilkins Company.

Hill, M.A. 2017 Embryology Respiratory histology 07.jpg. Retrieved November 29, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/File:Respiratory_histology_07.jpg

Lichter, I., and J. F. Gwynne. “Spontaneous pneumothorax in young subjects: A clinical and pathological study.” Thorax 26, no. 4 (1971): 409-17.

Tschopp, J.M., Bintcliffe, O., Astoul, P., Canalis, E., Driesen, P., Janssen J., Krasnik M., Maskell, N., Schil, P.V., Tonia, T., Waller, D.A., Marquette, C.H., and G. Cardillo. “ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.” European Respiratory Journal 46 (2015): 321-335.