Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax

Currently, the incidence of hemopneumothorax is high in China, and with the continuous improvement of modern medical standards, video-assisted thoracoscopic surgery (VATS) has gradually become the main method of clinical treatment of hemopneumothorax. The aim of this study was to investigate the minimally invasive mechanism and the clinical value of television thoracoscopy in the diagnosis and treatment of traumatic hemopneumothorax and to provide a relevant theoretical basis for the superiority of television thoracoscopy. In this study, total of 98 patients with traumatic hemopneumothorax admitted to three hospitals from January 2017 to December 2019 were selected and divided into 49 cases each in the thoracotomy group and VATS group according to the differences of the surgical method. The surgical situation such as operation time, intraoperative bleeding, and incision length, postoperative recovery such as duration of painkiller use, chest tube retention time, volume of drainage, and hospital stay, levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and other inflammatory factors at different times after admission to hospital, postoperative complications such as pulmonary infection, enveloped effusion, incisional infection, and pressureulcers, and recurrence rate at 12-month follow-up were used as the evaluation indexes to analyze the effect of different surgical treatment modalities in patients with hemopneumothorax and the impact on patient prognosis. The results showed that the operative time, intraoperative bleeding, duration of painkiller use, chest tube retention time, and hospital stay were shorter in the VATS group than in the thoracotomy group. The length of the surgical incision, volume of drainage, and inflammatory factor levels at different postoperative periods were lower in the VATS group than in the thoracotomy group. The incidence of postoperative complications was lower in both groups, and the difference was not statistically significant. The follow-up results showed that there were no recurrent cases in both groups 12 months after discharge. This indicates that VATS is an effective treatment option for hemopneumothorax, which can achieve the same exploration and treatment effect as thoracotomy, and has the advantages of less trauma, less bleeding, shorter operation time, and faster postoperative recovery compared with thoracotomy. The prognosis of patients treated by VTAS is good, which provides a new treatment route for patients who cannot tolerate thoracotomy and are poorly tolerated.

[Pneumothorax]

A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.

Spontaneous hemopneumothorax after laparoscopy: a case report and literature review

BACKGROUND

Spontaneous hemopneumothorax (SHP) is defined as the accumulation of >400 mL of blood in the pleural cavity in association with spontaneous pneumothorax. This rare clinical disorder may be life-threatening.

CASE PRESENTATION

A 71-year-old woman presented with a 1-month history of recurrent bloody stool, and electronic colonoscopy suggested a rectal mass. Laparoscopic radical resection of rectal cancer was performed. Two days later, she developed chest tightness, shortness of breath, and slight pain in the left chest. Emergency chest radiography revealed mild left pneumothorax and pleural effusion. SHP was suspected and a thoracic drain was inserted. However, the patient developed hemorrhagic shock 3 hours after drainage. She underwent emergency video-assisted thoracic surgery (VATS), which revealed left lung tip rupture with bleeding and adhesive band fracture at the top of the left thoracic cavity. The ruptured lung tissue was removed and electrocoagulation at the adhesion band was performed for hemostasis. The patient was discharged on postoperative day 11. At the time of this writing, she had developed no SHP recurrence or any other complications.

CONCLUSIONS

This case shows that conservative treatment may have serious consequences in patients with SHP. Thus, chest X-ray examination and VATS should be performed in patients with SHP.

Spontaneous Hemopneumothorax: A Rare Cause of Unexplained Hemodynamic Instability in a Young Patient

Spontaneous hemopneumothorax is a rare and potentially life-threatening disorder which complicates about 1-12% of patients presenting with spontaneous pneumothorax and has a remarkable predilection for male patients. It may present with signs of hypovolemic shock without apparent cause. While there are no specific guidelines for the management of patients diagnosed with such condition, wide debate in the literature relating to patient selection for surgery remains unresolved, and recently there seems to be a trend increasingly favorable towards early surgical intervention. Video-assisted thoracic surgery emerges as an excellent option for stable patients and has now been considered the gold standard treatment for spontaneous hemopneumothorax. We report the case of a 17-year-old male patient who presented to the emergency department with a history of sudden chest pain and dyspnea, with no previous evidence of trauma. On admission, the patient presented with hypotension, tachycardia, and cutaneous pallor. Chest X-ray showed hydropneumothorax on the left hemithorax; then, chest tube was placed with an initial drainage of 2000 ml of blood.

Challenges in the diagnosis of Boerhaave syndrome: A case report

RATIONALE

Acute chest pain remains one of the most challenging complaints of patients presenting to emergency departments (EDs). The diverse etiologies of chest pain frequently lead to diagnostic and therapeutic challenges. Esophageal perforation is a rare but potentially life-threatening disease. It results in delayed diagnosis and an estimated mortality risk of 20% to 40%. Prompt diagnosis and immediate therapeutic interventions are key factors for a good prognosis.

PATIENT CONCERNS

Case 1 involved a 66-year-old man who presented to the ED with acute chest pain radiating to the back and hematemesis. Emergent contrast thoracic computerized tomography (CT) indicated the presence of a massive pneumothorax with pleural effusion. The continuous drainage of a dark-red bloody fluid following emergent thoracic intubation led to the discovery that the patient had experienced severe vomiting after whiskey consumption before admission to the hospital. Re-evaluation of the CT indicated spontaneous pneumomediastinum, whereas barium esophagography confirmed the presence of an esophageal perforation. Case 2 involved an 18-year-old Vietnamese man admitted to our ED with acute chest pain and swelling of the neck after vomiting due to beer consumption. A chest x-ray indicated diffuse subcutaneous emphysema of the neck and upper thorax. Contrast CT indicated pneumomediastinum with extensive emphysema and air in the paraspinal region and spinal canal.

DIAGNOSES

Both of the 2 cases were diagnosed as spontaneous perforation of the esophagus (Boerhaave syndrome [BS]).

INTERVENTIONS

Case 1 received surgical interventions, whereas case 2 decided not to avail our medical services.

OUTCOMES

Case 1 was discharged after a good recovery. Case 2 lost to follow-up.

LESSONS

We recommend all physicians in the ED to raise their index of suspicion for BS when dealing with patients having acute chest pain, dyspnea, confirmed pneumothorax, or newly-developed pleural effusion.