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Liao KM, Chiu CC, Lu HY. The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan. Respir Med 2024; 228:107672. [PMID: 38763446 DOI: 10.1016/j.rmed.2024.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. METHODS In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. RESULTS We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. CONCLUSION Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yun-Lin, Taiwan.
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Kanne JP, Rother MDM. Pneumothorax: Imaging Diagnosis and Etiology. Semin Roentgenol 2023; 58:440-453. [PMID: 37973273 DOI: 10.1053/j.ro.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Nishizawa S, Tobino K, Murakami Y, Uchida K, Kawabata T, Ota H, Hiramatsu Y, Sueyasu T, Tsuruno K. Mortality and prognostic factors for spontaneous pneumothorax in older adults. PLoS One 2023; 18:e0291233. [PMID: 37682952 PMCID: PMC10490947 DOI: 10.1371/journal.pone.0291233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.
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Affiliation(s)
- Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Yousuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Takafumi Kawabata
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Hiroyuki Ota
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
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Pressure-dependent persistent air leak in a patient with secondary spontaneous pneumothorax. Am J Med Sci 2022; 364:782-788. [PMID: 35787363 DOI: 10.1016/j.amjms.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/03/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
An air leak lasting more than 5-7 days (persistent air leak, PAL) can complicate up to 40% of patients with secondary spontaneous pneumothorax. Chronic obstructive pulmonary disease is the most common cause of secondary spontaneous pneumothorax, and early surgical intervention has been recommended for patients with PAL. Bullectomy or blebectomy with concomitant mechanical pleurodesis by medical thoracoscopy or video assisted thoracoscopic surgery is considered definitive therapy. Unfortunately, the perioperative course following lung resection can also be complicated by air leaks leading to worse clinical outcomes. Post lung resection air leak can be pressure independent or pressure dependent (also known as drainage-related air leak). The distinction between these two entities is crucial as the management varies drastically. Pleural manometry may play an important role in the early diagnosis of pressure-dependent PAL preventing further unnecessary surgical procedures from being performed.
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Paul SS, Mohan Lal B, Ray A, Meena VP, Garg RK, Tiwari P, Sirohiya P, Vig S, Bhatnagar S, Mohan A, Vyas S, Wig N. Pneumothorax and pneumomediastinum in patients with COVID-19: A retrospective study from tertiary care institute in India. Drug Discov Ther 2022; 15:310-316. [PMID: 35034924 DOI: 10.5582/ddt.2021.01105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.
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Affiliation(s)
- Saurav Sekhar Paul
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavesh Mohan Lal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Sirohiya
- Department of Oncoanesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, India
| | - Saurabh Vig
- Department of Oncoanesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, India
| | - Sushma Bhatnagar
- Department of Oncoanesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, India
| | - Anant Mohan
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis and Intervention Radiology All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
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Affiliation(s)
- Nai-Chien Huan
- Department of Pulmonology, Serdang Hospital, Kajang, Malaysia
| | - Calvin Sidhu
- Edith Cowan University, Perth, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
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Pneumothorax, More Than Meets the Eye. A Woman with Acute Intermittent Pleuritic Pain Associated with Dyspnea and a Dry Cough after a Flight. Ann Am Thorac Soc 2021; 18:347-352. [PMID: 33522868 DOI: 10.1513/annalsats.202006-705cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chauvin P, Sohier L, Rochas Y, Kerjouan M, Salé A, Lederlin M, Jouneau S. [Ambulatory management of bilateral secondary spontaneous pneumothorax in palliative care]. Rev Mal Respir 2021; 38:773-779. [PMID: 34045087 DOI: 10.1016/j.rmr.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Secondary spontaneous pneumothoraces account for 35% of all pneumothoraces after the age of 50. Their management is still debated and can be challenging due to the underlying respiratory condition. In our observation, the use of small-bore chest tubes allowed prolonged ambulatory care in a palliative setting. CASE REPORT We report the case of a 54-year-old woman suffering from a leiomyosarcoma with multiple pulmonary metastases who had repeated episodes of pneumothorax, one of which was bilateral. Treatment involved the bilateral insertion of 8.5F pigtail catheters connected to Heimlich valves that allowed management as an outpatient. Recurrences were treated similarly, in association with oncological management, providing great additional benefits for patient comfort in this palliative context. CONCLUSION Altogether, this case report confirms the applicability of outpatient management for drained spontaneous secondary pneumothoraces, even bilateral, especially in a palliative-care setting.
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Affiliation(s)
- P Chauvin
- Service de pneumologie, Hôpital Pontchaillou, CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes cedex 9, France.
| | - L Sohier
- Service de pneumologie, Groupe hospitalier de Bretagne Sud, 56322 Lorient, France
| | - Y Rochas
- Service de pneumologie, Groupe hospitalier de Bretagne Sud, 56322 Lorient, France
| | - M Kerjouan
- Service de pneumologie, Hôpital Pontchaillou, CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes cedex 9, France
| | - A Salé
- Service de pneumologie, Hôpital Pontchaillou, CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes cedex 9, France
| | - M Lederlin
- Service de radiologie et d'imagerie médicale, Hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - S Jouneau
- Service de pneumologie, Hôpital Pontchaillou, CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes cedex 9, France; IRSET UMR 1085, université de Rennes 1, 35000 Rennes, France
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Yamazaki R, Nishiyama O, Gose K, Saeki S, Sano H, Iwanaga T, Tohda Y. Pneumothorax in patients with idiopathic pulmonary fibrosis: a real-world experience. BMC Pulm Med 2021; 21:5. [PMID: 33407311 PMCID: PMC7789641 DOI: 10.1186/s12890-020-01370-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background Some patients with idiopathic pulmonary fibrosis (IPF) develop pneumothorax. However, the characteristics of pneumothorax in patients with IPF have not been elucidated. The purpose of this study was to clarify the clinical course, actual management, and treatment outcomes of pneumothorax in patients with IPF. Methods Consecutive patients with IPF who were admitted for pneumothorax between January 2008 and December 2018 were included. The success rates of treatment for pneumothorax, hospital mortality, and recurrence rate after discharge were examined. Results During the study period, 36 patients with IPF were admitted with pneumothorax a total of 58 times. During the first admission, 15 patients (41.7%) did not receive chest tube drainage, but 21 (58.3%) did. Of the 21 patients, 8 (38.1%) received additional therapy after chest drainage. The respective treatment success rates were 86.6% and 66.7% in patients who underwent observation only vs chest tube drainage. The respective hospital mortality rates were 13.3% and 38.0%. The total pneumothorax recurrence rate after hospital discharge was 34.6% (n = 9). Conclusions Pneumothorax in patients with IPF was difficult to treat successfully, had a relatively poor prognosis, and showed a high recurrence rate.
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Affiliation(s)
- Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
| | - Kyuya Gose
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Sho Saeki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
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Zhang L, Xie T, Fu Y, Wu H. Assessment and review of treatment for secondary spontaneous pneumothorax using medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis. Ther Adv Respir Dis 2021; 15:1753466620986390. [PMID: 33573519 PMCID: PMC7887667 DOI: 10.1177/1753466620986390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS To evaluate the efficacy of medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis in spontaneous pneumothorax. PATIENTS AND METHODS Three male patients with spontaneous pneumothorax were treated; medical thoracoscopy-assisted argon plasma coagulation combined with autologous blood pleurodesis was conducted for all patients whose duration of the air leak exceeded 7 days. We systematically reviewed all of the relevant literature to analyze and sum up the treatments of secondary spontaneous pneumothorax. RESULTS The air leaks were all sealed and no recurrence of pneumothorax was reported. No complications of fever, bleeding, or signs of infection were observed during the process. CONCLUSION The authors believe that the combination of medical thoracoscopy-assisted argon plasma coagulation and autologous blood pleurodesis is safe and effective. However, due to the number of patients included in this uncontrolled case study, more cases will be collected in the future.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, China
| | - Tian Xie
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yihui Fu
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Haihong Wu
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Flora AS, Aragaki-Nakahodo A, Benzaquen S. Endobronchial Valve Placement for Persistent Air Leaks Secondary to Pulmonary Infections. J Bronchology Interv Pulmonol 2021; 28:47-52. [PMID: 32452981 DOI: 10.1097/lbr.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumothoraces associated with infectious diseases have a higher rate of treatment failure and longer length of hospital stay than those associated with obstructive lung diseases and malignancy. Little is mentioned in the medical literature concerning the use of endobronchial 1-way valves in treating alveolar-pleural fistulae (APF) caused by pulmonary infections. METHODS A 7-year, single-center, retrospective analysis of patients consented for exempted off-label use of the Olympus Spiration Implantable Endobronchial Valve system to control prolonged air leaks at the University of Cincinnati Medical Center. RESULTS Nineteen consecutive patients had 22 separate APF events from pulmonary infections during which a total of 101 valves were placed over 23 procedures (average 4.4±2.8 valves per procedure). The average time from the first chest tube placement to valve placement was 23.4±20.8 days (range, 2 to 84 d). Chest tubes were successfully removed in 19 (86.4%) of 22 APF events without further intervention. In events not including chest tubes remaining solely for empyema treatment after cessation of air leak (n=14), the average time from valve placement to the removal of all chest tubes was 12.8±20.2 days (1 to 81 d). Thirty and ninety day all-cause mortality was 15.8%. On average, valves were removed 64.1±27.1 days (range, 38 to 135 d) after placement. CONCLUSION Based on our institutional experience, endobronchial valves may be a treatment option for select patients with persistent air leaks caused by pulmonary infections. Further standardized and comparative studies are required to fully understand the risks and benefits of this treatment.
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Affiliation(s)
- Arjan S Flora
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Alejandro Aragaki-Nakahodo
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Einstein Medical Center, Philadelphia, PA
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Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberetchs EJ, Jacob J, Alquézar-Arbé A, Mòdol JM, López-Díez MP, Guardiola JM, Cardozo C, Lucas Imbernón FJ, Aguirre Tejedo A, García García Á, Ruiz Grinspan M, Llopis Roca F, González Del Castillo J. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study. Chest 2020; 159:1241-1255. [PMID: 33227276 PMCID: PMC7678420 DOI: 10.1016/j.chest.2020.11.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined. RESEARCH QUESTION Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP? STUDY DESIGN AND METHODS This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes. RESULTS We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups. INTERPRETATION SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pascual Piñera
- Emergency Department, Hospital Reina Sofía, Murcia, Spain
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
| | - Alfonso Martín
- Emergency Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | | | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Maria Mòdol
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Carlos Cardozo
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Emergency Department, Hospital Austral, Buenos Aires, Argentina
| | | | | | | | | | - Ferran Llopis Roca
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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Cho HE, Byun J, Choi WA, Kim M, Kim KY, Kang SW. Analysis of Pneumothorax in Noninvasive Ventilator Users With Duchenne Muscular Dystrophy. Chest 2020; 159:1540-1547. [PMID: 32956714 DOI: 10.1016/j.chest.2020.09.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND With the advancement of cardiorespiratory interventions, the survival rate among patients with Duchenne muscular dystrophy (DMD) has increased. Subsequently, pneumothorax has become a significant problem in patients with prolonged ventilatory support. RESEARCH QUESTION What are the frequency, recurrence rate, risk factors, and prognosis of pneumothorax in patients with DMD requiring noninvasive ventilation (NIV)? Also, are there known risk factors of pneumothorax on chest CT scans? STUDY DESIGN AND METHODS This retrospective longitudinal cohort study included 176 patients treated between 2006 and 2019. We collected information regarding location, severity, treatment methods, recurrence frequency, abnormal findings on CT scanning, and date of death. We compared the pneumothorax and nonpneumothorax groups. We calculated the estimated survival probabilities from the age at NIV application according to pneumothorax occurrence. RESULTS Sixteen of the 176 patients (9.0%) experienced pneumothorax (median age at diagnosis, 24.6 years; range, 20.7-33.7 years). Among the 16 patients, 15 demonstrated pneumothorax after NIV application (median time between diagnosis and initial NIV application, 5.6 years; range, 3 days-9.6 years). Sixteen patients experienced 31 episodes of pneumothoraces (range, one-five episodes); among them, seven episodes (22.6%) were asymptomatic. Known risk factors not clearly visible by radiography scans were found in chest CT scan in 11 patients (68.8%). Seven of 16 patients (43.8%) eventually sustained severe lung damage with pulmonary fibrosis. No significant between-group differences were found in body weight, BMI, and age at NIV application; however, the pneumothorax group showed a significantly higher mortality rate after NIV application. INTERPRETATION On pneumothorax occurrence in patients with DMD, recurrences and severe lung damage are common; moreover, these patients show higher mortality rates than patients without pneumothorax. Chest CT scans should be performed to identify risk factors, and treatment should be initiated accordingly. In addition, physicians should consider chest CT scanning in the case of suspected pneumothorax, even if no radiographic abnormality is found.
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Affiliation(s)
- Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Justin Byun
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsang Kim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Yeol Kim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
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Aljehani Y, Alshamekh A, AlQatari AA. Radiologically Guided Management of Secondary Spontaneous Pneumothorax. Radiol Case Rep 2020; 15:1115-1118. [PMID: 32547671 PMCID: PMC7283950 DOI: 10.1016/j.radcr.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Secondary spontaneous pneumothorax is a serious medical condition that typically occurs in patients with an underlying lung pathology such as chronic obstructive pulmonary disease. Those patients are usually compromised and more amenable to higher morbidity and mortality rates. Moreover, they are poor candidates for general anesthesia and mechanical ventilation due to their poor health condition. We report a case of an 86-year-old male, who presented with a non-ST-elevation myocardial infarction and was incidentally found to have secondary spontaneous pneumothorax on a routine chest x-ray. The results of his blood work, international normalized ratio and liver function test were abnormal. Therefore, a novel intervention was introduced to control the air-leak by injecting a sealant material (Progel™, Warwick, Rhode Island, USA) through a thoracostomy tube guided by computed tomography fluoroscopy. The procedure was demonstrated to be a successful method of air-leak repair with minimal complications; as the patient was followed for two and a half years without any evidence of recurrence.
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Affiliation(s)
- Yasser Aljehani
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alshamekh
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A AlQatari
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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15
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Hanley B, Chambers D. Significant and potentially overlooked causes of unexpected death outside the cardiovascular and central nervous system. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Fang M, Liu G, Luo G, Wu T. Does pigtail catheters relieve pneumothorax?: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13255. [PMID: 30461628 PMCID: PMC6392921 DOI: 10.1097/md.0000000000013255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pigtail catheter drainage has been usually applied for the treatment of pleural effusion and pneumothorax. Our aim was to investigate the application and efficacy of pigtail catheters for pneumothorax. METHODS We carried out a meta-analysis of retro- or pro-spective studies addressing the effect of pigtail catheters for pneumothorax. We presented success rates of pigtail catheter drainage as primary outcomes, and considered the duration of drainage, and complication rates as secondary outcomes. Pooled data were available using the fixed or random effects model. Heterogeneity, sensitivity, and subgroup analyses were performed. RESULTS The meta-analysis was based on 16 articles with a total of 1067 patients. Our analyses showed that pooled success rates were 0.77 (0.71-0.82), )furthermore, duration of drainage was 5.61 (3.99-7.23), and complication rates 0.18 (0.09-0.27). Subgroup results according to causes of pneumothorax and patient characteristics were robust and all consistent with overall outcomes. CONCLUSION These suggested that pigtail catheter insertion within radiological guidance may provide a safe and effective way for the treatment of pneumothorax. More large-scale and prospective studies were required to determine these findings.
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17
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Chang SH, Kang YN, Chiu HY, Chiu YH. A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax. Chest 2018; 153:1201-1212. [PMID: 29452099 DOI: 10.1016/j.chest.2018.01.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/05/2018] [Accepted: 01/26/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The optimal initial treatment approach for pneumothorax remains controversial. This systemic review and meta-analysis investigated the effectiveness of small-bore pigtail catheter (PC) drainage compared with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax. METHODS PubMed and Embase were systematically searched for observational studies and randomized controlled trials published up to October 9, 2017, that compared PC and LBCT as the initial treatment for pneumothorax. The investigative outcomes included success rates, recurrence rates, complication rates, drainage duration, and hospital stay. RESULTS Of the 11 included studies (875 patients), the success rate was similar in the PC (79.84%) and LBCT (82.87%) groups, with a risk ratio of 0.99 (95% CI, 0.93 to 1.05; I2 = 0%). Specifically, PC drainage was associated with a significantly lower complication rate following spontaneous pneumothorax than LBCT drainage (Peto odds ratio: 0.49 [95% CI, 0.28 to 0.85]; I2 = 29%). In the spontaneous subgroup, PC drainage was associated with a significantly shorter drainage duration (mean difference, -1.51 [95% CI, -2.93 to -0.09]) and hospital stay (mean difference: -2.54 [95% CI, -3.16 to -1.92]; P < .001) than the LBCT group. CONCLUSIONS Collectively, results of the meta-analysis suggest PC drainage may be considered as the initial treatment option for patients with primary or secondary spontaneous pneumothorax. Ideally, randomized controlled trials are needed to compare PC vs LBCT among different subgroups of patients with pneumothorax, which may ultimately improve clinical care and management for these patients. TRIAL REGISTRY PROSPERO; No.: CRD42017078481; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Su-Huan Chang
- Center for Evidence-Based Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin-Yi Chiu
- Center for Evidence-Based Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education and Humanities in Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan.
| | - Yu-Han Chiu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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18
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Elsayed HH. Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax? J Thorac Dis 2017; 9:3518-3522. [PMID: 29268330 DOI: 10.21037/jtd.2017.08.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hany Hasan Elsayed
- Thoracic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
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19
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A deep azygoesophageal recess may increase the risk of secondary spontaneous pneumothorax. Surg Today 2017; 47:1147-1152. [DOI: 10.1007/s00595-017-1482-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/18/2017] [Indexed: 12/11/2022]
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20
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Hussein RM, Elshahat HM, Shaker A, Hashem AZA. Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Yang SS, Kardash K, Sirois C. Intraoperative Pneumothorax Presenting as Abdominal Distention. Ann Thorac Surg 2015; 101:336-8. [PMID: 26694270 DOI: 10.1016/j.athoracsur.2015.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/08/2014] [Accepted: 01/16/2015] [Indexed: 11/20/2022]
Abstract
A 74-year-old man with a history of lung cancer presented for right upper lobectomy. After induction of anesthesia, it was noted that the abdomen became progressively more distended. Soon afterward, there was a significant decrease in tidal volume. Ultrasonography of the lung showed no sign of pneumothorax at the anterior second intercostal space. However, the roentgenograms showed a massive right-sided pneumothorax and extensive pneumoperitoneum. Both the pneumothorax and the pneumoperitoneum were decompressed in the operating room, and the elective lobectomy proceeded as previously planned. The patient was extubated at the end of the operation, and there were no sequelae postoperatively.
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Affiliation(s)
- Stephen Su Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Kenneth Kardash
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Christian Sirois
- Department of Thoracic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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22
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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23
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Kim HJ, Cho YH, Suh GY, Yang JH, Jeon K. Subclavian Artery Laceration Caused by Pigtail Catheter Removal in a Patient with Pneumothorax. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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Rawal G, Yadav S, Garg N, Wani UR. Secondary Spontaneous Pneumothorax (SSP) with Bronchopleural Fistula in A Patient with COPD. J Clin Diagn Res 2015; 9:PD07-8. [PMID: 26023593 DOI: 10.7860/jcdr/2015/13265.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/10/2015] [Indexed: 11/24/2022]
Abstract
The aim of this article is to report a case of secondary spontaneous pneumothorax (SSP) with bronchopleural fistula in a patient with chronic obstructive pulmonary disease (COPD). SSP is a common life threatening complication in a patient with COPD and usually creates confusion in the mind of the treating physician during an episode of acute exacerbation of COPD. A 52-year-old male presented with a three day history of dry cough and breathing difficulty. He had a history of COPD. A large pneumothorax on the left side was confirmed after chest X-ray. Tube thoracostomy was performed which showed a persistent air-leak suggesting a bronchopleural fistula. The patient was treated conservatively with patience and the leak sealed spontaneously. The patient recovered uneventfully. This case emphasizes that SSP should be considered in the differential diagnosis of patients having a history of long-term COPD who are in a relatively stable condition with non- critical respiratory distress and the importance of conducting a chest X-ray along with repeated clinical examination in a patient of COPD who does not improve with adequate therapy.
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Affiliation(s)
- Gautam Rawal
- Attending Consultant-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Chest Clinic Moti Nagar, New Delhi, India
| | - Nitin Garg
- Senior Consultant and Head-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
| | - Umar Rasool Wani
- Senior Resident-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
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25
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Tseng YC, Dai MS. Vanished lung metastases. QJM 2015; 108:81-2. [PMID: 24996767 DOI: 10.1093/qjmed/hcu143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y-C Tseng
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - M-S Dai
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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26
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Sebastian R, Ghanem O, Diroma F, Milner SM, Gerold KB, Price LA. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature. Burns 2014; 41:e24-7. [PMID: 25363602 DOI: 10.1016/j.burns.2014.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients.
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Affiliation(s)
- Raul Sebastian
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Omar Ghanem
- Union Memorial Hospital, Medstar, Baltimore, MD 21218, USA
| | - Frank Diroma
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Stephen M Milner
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Kevin B Gerold
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Leigh A Price
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA.
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27
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Huang Y, Huang H, Li Q, Browning RF, Parrish S, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Courcoutsakis N, Madesis A, Diplaris K, Karaiskos T, Zarogoulidis P. Approach of the treatment for pneumothorax. J Thorac Dis 2014; 6:S416-20. [PMID: 25337397 DOI: 10.3978/j.issn.2072-1439.2014.08.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 11/14/2022]
Abstract
Pneumothorax can occur in several situations such as; chronic obstructive pulmonary disease (COPD) where emphysema is observed or due to a biopsy for malignancy suspicion. In any case it is a dangerous situation that requires immediate attention and treatment. Pneumothorax can be divided in primary and secondary. Staging of pneumothorax is also very important. In our current editorial we summarize etiology and treatment of pneumothorax from a panel of pulmonary physicians, oncologists and thoracic surgeons.
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Affiliation(s)
- Yong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haidong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Qiang Li
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Scott Parrish
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Courcoutsakis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Diplaris
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Parrish S, Browning RF, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Tsiouda T, Madesis A, Karaiskos T, Zarogoulidis P. The role for medical thoracoscopy in pneumothorax. J Thorac Dis 2014; 6:S383-91. [PMID: 25337393 DOI: 10.3978/j.issn.2072-1439.2014.08.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/06/2014] [Indexed: 02/02/2023]
Abstract
Pneumothorax is a life threatening situation that requires fast treatment. There are two major classifications: Primary and Secondary. Staging of pneumothorax is also very important for treatment. Treatment of pneumont can be performed either from thoracic surgeons, or pulmonary physicians. In our current work we provide up-to-date information regarding pneumothorax classification, staging and treatment from the point of view of expert pulmonary physicians.
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Affiliation(s)
- Scott Parrish
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis 2014; 6:271-84. [PMID: 24624291 DOI: 10.3978/j.issn.2072-1439.2013.11.29] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/27/2013] [Indexed: 11/14/2022]
Abstract
The incidence of any kind of air leaks after lung resections is reportedly around 50% of patients. The majority of these leaks doesn't require any specific intervention and ceases within a few hours or days. The recent literature defines a prolonged air leak (PAL) as an air leak lasting beyond postoperative day 5. PAL is associated with a generally worse outcome with a more complicated postoperative course anxd prolonged hospital stay and increased costs. Some authors therefore consider any PAL as surgical complication. PAL is the most prevalent postoperative complication following lung resection and the most important determinant of postoperative length of hospital stay. A low predicted postoperative forced expiratory volume in 1 second (ppoFEV1) and upper lobe disease have been identified as significant risk factors involved in developing air leaks. Infectious conditions have also been reported to increase the risk of PAL. In contrast to the problem of PAL, there is only limited information from the literature regarding apical spaces after lung resection, probably because this common finding rarely leads to clinical consequences. This article addresses the pathogenesis of PAL and apical spaces, their prediction, prevention and treatment with a special focus on surgery for infectious conditions. Different predictive models to identify patients at higher risk for the development of PAL are provided. The discussion of surgical treatment options includes the use of pneumoperitoneum, blood patch, intrabronchial valves (IBV) and the flutter valve, and addresses the old question, whether or not to apply suction to chest tubes. The discussed prophylactic armentarium comprises of pleural tenting, prophylactic intraoperative pneumoperitoneum, sealing of the lung, buttressing of staple lines, capitonnage after resection of hydatid cysts, and plastic surgical options.
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Affiliation(s)
- Michael Rolf Mueller
- Otto Wagner Hospital, Department of Thoracic Surgery, Baumgartner Hoehe 1, A-1145 Vienna, Austria
| | - Beatrice A Marzluf
- Otto Wagner Hospital, Department of Thoracic Surgery, Baumgartner Hoehe 1, A-1145 Vienna, Austria
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30
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Low LL, Vasanwala FF. A Unique Case of Spontaneous Secondary Pneumothorax (SSP) Occurring during an Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD). PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spontaneous secondary pneumothorax (SSP) is a known complication and can occur during an acute exacerbation of chronic obstructive pulmonary disease (COPD) to confuse an unsuspecting physician. These patients have limited cardiopulmonary reserve, so can deteriorate quickly and require urgent management. We describe a unique case of SSP that occurred during an acute exacerbation of COPD, to remind physicians of this possibility and to re-examine their patients who are not improving as expected with nebulisation therapy.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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31
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Huynh RK, Ross AS. Delayed pneumothorax after laparoscopic sigmoid colectomy in a patient without underlying lung disease. SAGE Open Med Case Rep 2014; 2:2050313X14554940. [PMID: 27489661 PMCID: PMC4857342 DOI: 10.1177/2050313x14554940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/10/2014] [Indexed: 11/15/2022] Open
Abstract
We present an unusual case of a delayed pneumothorax occurring approximately 72 h post-operatively in a patient without any underlying lung disease who had undergone laparoscopic sigmoid colon resection. The patient was in her mid-40s with a body mass index of 28.0 and had no history of smoking. Her spontaneous pneumothorax manifested without any precipitating events or complications during recovery. There was no evidence of any infectious process. There were no central line attempts and all ports were placed intra-peritoneally, and there was no evidence of any subcutaneous emphysema. One possible mechanism of injury that we propose is barotrauma from an extended period of time in Trendelenburg position. Notably, the only abnormal finding throughout the entire post-operative period preceding the delayed pneumothorax was a PO2 desaturation the day before. This case highlights the necessity to examine and investigate any desaturation post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying lung disease or risk factors, spontaneous pneumothorax could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure.
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Affiliation(s)
- Richie K Huynh
- Division of Surgery, Integrated Medical Science Department, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Andrew S Ross
- Division of Surgery, Integrated Medical Science Department, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; Department of Colon and Rectal Surgery, Boca Raton Regional Hospital, Boca Raton, FL, USA
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Abstract
Many diagnostic and therapeutic options exist for the evaluation and treatment of patients with pneumothorax. Guidelines from US and European professional societies and individual expert opinions differ in the approach to patient care. Advances in diagnostic techniques, such as real-time thoracic ultrasound, have added to the evaluation strategy. It is important for medical trainees and providers to become familiar with techniques utilized worldwide as they may be encountered in clinical practice. We review current evidence, expert recommendations, and compare professional society guidelines discussing the various diagnostic and management options for patients with pneumothorax to assist physicians and trainees involved in the care of hospitalized and outpatient adults who have primary, secondary, and traumatic iatrogenic pneumothorax. Management of traumatic non-iatrogenic pneumothorax is beyond the scope of this article, thus, not reviewed here.
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Affiliation(s)
- Matthew Trump
- Pulmonary and Critical Care Fellow, University of Missouri-Kansas City, School of Medicine, Kansas City, MO.
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Emergencies in pleural diseases. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Although chest tube placement is one of the most common procedures in managing patients with pleural disease, it is not clear what size and type of chest tube is indicated for various conditions. Chest tubes can be divided into small- (≤14 French [Fr]) and large-bore (>14 Fr) and can be placed by blunt dissection, guidewire (Seldinger), or trocar guidance. Recently a trend has been seen toward using smaller chest tubes for most indications, given their relative ease and patient comfort. This article summarizes the rationale for using different chest tubes depending on the clinical scenario.
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Porcel JM, García-Gil D. Emergencies in pleural diseases. Rev Clin Esp 2012; 213:242-50. [PMID: 23261842 DOI: 10.1016/j.rce.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/16/2012] [Accepted: 11/04/2012] [Indexed: 11/26/2022]
Abstract
A parapneumonic effusion should be drained if it is large (≥ 1/2 of the hemithorax), loculated, frank pus is obtained, if the fluid is non-purulent fluid but has a low pH (< 7.20) or if the culture is positive. Instillation of fibrinolytics and DNase thorough the chest catheter in locutated effusions and empyemas is currently recommended. Management of spontaneous pneumothorax is fundamentally influenced by the patient's symptoms. Insertion of a chest catheter is mandatory if there is significant dyspnea, hemodynamic instability or large pneumothoraces (≥ 2 cm). Pleural ultrasonography confirms the presence of air or fluid in the pleural space and serves to guide any pleural procedure (e.g., thoracentesis, chest tubes). The use of small-bore 12F catheters inserted via the percutaneous Seldinger technique under ultrasonography guidance is a safe and effective procedure in complicated parapneumonic effusions/empyema and most pneumothoraces.
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Affiliation(s)
- J M Porcel
- Unidad de Patología Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
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Desmettre T, Meurice JC, Tapponnier R, Pretalli JB, Dalphin JC. [The EXPRED study: where are we?]. Rev Mal Respir 2012; 30:18-21. [PMID: 23318185 DOI: 10.1016/j.rmr.2012.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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