1
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Scott S, Morrison B, Young K, Clark L, Li Y, Walter C, Rohr A, Alli A. Re-expansion Pulmonary Edema (REPE) Following Thoracentesis: Is Large-Volume Thoracentesis Associated with Increased Incidence of REPE? Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03773-2. [PMID: 38858252 DOI: 10.1007/s00270-024-03773-2] [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: 02/12/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE To determine the safety and efficacy associated with drainage volumes greater than 1,500 mL in a single, unilateral thoracentesis without pleural manometry measurements. MATERIALS AND METHODS This retrospective, single-institution study included 872 patients (18 years and older) who underwent ultrasound-guided thoracentesis. Patient and procedures data were collected including demographics, number of and laterality of thoracenteses, volume and consistency of fluid removed, and whether clinical or radiologic evidence of re-expansion pulmonary edema (REPE) developed within 24 h of thoracentesis. Fisher's exact test was used to test the significance of the relationship between volume of fluid removed and evidence of REPE. RESULTS A total of 1376 thoracenteses were performed among the patients included in the study. The mean volume of fluid removed among all procedures was 901.1 mL (SD = 641.7 mL), with 194 (14.1%) procedures involving the removal of ≥ 1,500 mL of fluid. In total, six (0.7%) patients developed signs of REPE following thoracentesis, five of which were a first-time thoracentesis. No statistically significant difference in incidence of REPE was observed between those with ≥ 1,500 mL of fluid removed compared to those with < 1,500 mL of fluid removed (p-value = 0.599). CONCLUSIONS Large-volume thoracentesis may safely improve patients' symptoms while preventing the need for repeat procedures.
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Affiliation(s)
- Sandon Scott
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Brennan Morrison
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kate Young
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lauren Clark
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Yanming Li
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Carissa Walter
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Aaron Rohr
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Adam Alli
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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2
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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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3
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Chopra A, Doelken P, Hu K, Huggins JT, Judson MA. Pressure-Dependent Pneumothorax and Air Leak: Physiology and Clinical Implications. Chest 2023; 164:796-805. [PMID: 37187435 DOI: 10.1016/j.chest.2023.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection, or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stay. This review suggests that identification of pressure-dependent pneumothorax is clinically important because the air leak that results is not related to a lung injury that requires repair but rather to a physiological consequence of a pressure gradient. A pressure-dependent pneumothorax occurs during pleural drainage in patients with lung-thoracic cavity shape/size mismatch. It is caused by an air leak related to a pressure gradient between the subpleural lung parenchyma and the pleural space. Pressure-dependent pneumothorax and air leak do not need any further pleural interventions.
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Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Peter Doelken
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Kurt Hu
- Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - John T Huggins
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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4
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Venkitakrishnan R, Augustine J, Ramachandran D, Cleetus M. Pneumothorax ex vacuo: Three cases of an uncommon entity. Lung India 2023; 40:169-172. [PMID: 37006103 PMCID: PMC10174644 DOI: 10.4103/lungindia.lungindia_517_22] [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: 11/06/2022] [Revised: 12/18/2022] [Accepted: 01/07/2023] [Indexed: 03/05/2023] Open
Abstract
Pneumothorax is a frequently encountered entity in pulmonary practice and can be primary or secondary. Traumatic and iatrogenic causes also account for a minority of cases presenting to the chest physician. The most common therapeutic intervention done is a tube thoracostomy in all but the mildest of cases. Pneumothorax ex vacuo is a distinctly uncommon entity that differs considerably from the rest of the pneumothorax cases in its pathogenesis, clinical manifestations, radiological findings, and management. Pneumothorax in this entity results from the sucking in of air into the pleural space caused by an exaggerated negative intrapleural pressure, which is most frequently secondary to acute lobar collapse. Symptoms attributable to pneumothorax per se are distinctly mild and the vital aspect of treatment is to relieve the bronchial obstruction. Tube thoracostomy fails to relieve the pneumothorax in such cases and should be avoided. We share three cases of pneumothorax ex vacuo encountered in our institution and alert clinicians of the presentation, radiology, and management of this uncommon condition.
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Affiliation(s)
| | - Jolsana Augustine
- Department of Pulmonary Medicine, Rajagiri Hospital, Aluva, Kochi, Kerala, India
| | - Divya Ramachandran
- Department of Pulmonary Medicine, Rajagiri Hospital, Aluva, Kochi, Kerala, India
| | - Melcy Cleetus
- Department of Pulmonary Medicine, Rajagiri Hospital, Aluva, Kochi, Kerala, India
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5
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Hara D, Kondo R, Shomura T, Agatsuma T, Saito G. Impact of pneumothorax-like pulmonary collapse caused by rapid bronchial obstruction: A case report of pneumothorax ex vacuo. Respir Med Case Rep 2023; 42:101817. [PMID: 36712478 PMCID: PMC9880389 DOI: 10.1016/j.rmcr.2023.101817] [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: 12/13/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
We report two cases of pulmonary collapse that simulated pneumothorax on computed tomographic images and were caused by rapid complete bronchial obstruction. One patient was a 77-year-old woman with sudden dyspnea, and the other was an 83-year-old woman with sudden dyspnea who was infected with influenza A virus. Chest computed tomography revealed lobular complete atelectasis with an almost complete expansion of the other lobes of the right lung. Some air space in the right pleural cavity was also observed. Both cases were diagnosed as "pneumothorax" by primary doctors. We noted the disappearance of air density in the lumen of the right bronchus in both cases. We performed bronchoscopy before thoracic drainage and removed the obstruction. Immediately, the obstructed pulmonary lobes expanded, and the air space in the pleural cavity disappeared without thoracic drainage. In the literature, this pneumothorax-like pulmonary collapse is called as "pneumothorax ex vacuo."
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Affiliation(s)
- Daisuke Hara
- Department of Thoracic Surgery, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan.,Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Ryoichi Kondo
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, Nagano, Japan
| | - Toshitaka Shomura
- Department of Respiratory Medicine, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
| | - Toshihiko Agatsuma
- Department of Respiratory Medicine, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
| | - Gaku Saito
- Department of Thoracic Surgery, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
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6
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The Tale of Two Pneumothoraces after Bronchoscopic Lung Volume Reduction. Ann Am Thorac Soc 2022; 19:1596-1601. [PMID: 36048120 DOI: 10.1513/annalsats.202201-006cc] [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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7
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Taton O, Heinen V, Bondue B, Slebos DJ, Shah PL, Carron K, Moens O, Leduc D. Long-Term Follow-Up of Intralobar Bullae After Endobronchial Valve Treatment for Emphysema. Int J Chron Obstruct Pulmon Dis 2022; 17:1735-1742. [PMID: 35941900 PMCID: PMC9356607 DOI: 10.2147/copd.s363490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Endoscopic lung volume reduction using unidirectional endobronchial valves is a new technique in the treatment of patients with severe emphysema. However, the movements of the thoracic structures after endobronchial valves insertion are still unpredictable We report the unusual outcome of six patients after valves insertion in the left upper lobe. They all developed a complete atelectasis of the target lobe, a pneumothorax and sequential genuine bullae in the treated left lung of unknown etiology. The chest CT scan prior to the valves insertion was unremarkable. Three patients developed an air–liquid level in the bullae the day before a bacterial infection of their left lower lobe. The three other patients had an uneventful spontaneous resolution of their bullae at long-term follow-up. Therefore, a conservative attitude should be followed in this particular setting.
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Affiliation(s)
- Olivier Taton
- Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Correspondence: Olivier Taton, Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, Brussels, 1070, Belgium, Tel +3225553943, Email
| | - Vincent Heinen
- Department of Pneumology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Benjamin Bondue
- Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- The Netherlands and GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pallav L Shah
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kris Carron
- Department of Pneumology, AZ Delta, Menen, Belgium
| | - Olivia Moens
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Leduc
- Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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8
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Shimada T, Okuzumi S, Kakimoto T, Yamamoto T, Iwamaru A, Nakanishi K, Minematsu N. Pneumothorax as a rare presentation of bronchial schwannoma. Respir Med Case Rep 2022; 36:101590. [PMID: 35198367 PMCID: PMC8844907 DOI: 10.1016/j.rmcr.2022.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 10/31/2022] Open
Abstract
Tracheobronchial schwannomas are rare diseases. Common signs and symptoms of this tumor include cough, wheezing, and dyspnea. In contrast, pneumothorax is an exceptional presentation. This study reports the first case of bronchial schwannoma presenting with pneumothorax. A 79-year-old woman was diagnosed with pneumothorax by chest radiography. Chest computed tomography unexpectedly revealed a tumor occluding the right main bronchus. Following the pathological diagnosis of bronchial schwannoma, the patient underwent thoracoscopic tumor enucleation. The airway lumens are consequently secured postoperatively. We reviewed the literature and discussed the mechanisms and treatment options for bronchial benign tumor-associated pneumothorax. Pneumothorax should be aware of a rare presentation of non-malignant tracheobronchial tumors.
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9
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van Dijk M, Sue R, Criner GJ, Gompelmann D, Herth FJ, Hogarth DK, Klooster K, Kocks JW, de Oliveira HG, Shah PL, Valipour A, Slebos DJ. Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update. Respiration 2021; 100:969-978. [PMID: 34062550 PMCID: PMC8619763 DOI: 10.1159/000516326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
For selected patients with advanced emphysema, bronchoscopic lung volume reduction with one-way valves can lead to clinically relevant improvements of airflow obstruction, hyperinflation, exercise capacity, and quality of life. The most common complication of this procedure is pneumothorax with a prevalence of up to ±34% of the treated patients. Patients who develop a pneumothorax also experience meaningful clinical benefits once the pneumothorax is resolved. Timely resolution of a post-valve treatment pneumothorax requires skilled and adequate pneumothorax management. This expert panel statement is an updated recommendation of the 2014 statement developed to help guide pneumothorax management after valve placement. Additionally, mechanisms for pneumothorax development, risk assessment, prevention of pneumothorax, and outcomes after pneumothorax are addressed. This recommendation is based on a combination of the current scientific literature and expert opinion, which was obtained through a modified Delphi method.
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Affiliation(s)
- Marlies van Dijk
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rick Sue
- Advanced Lung Institute, Banner University Phoenix, Phoenix, Arizona, USA
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Felix J.F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - D. Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janwillem W.H. Kocks
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- General practitioners Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Hugo G. de Oliveira
- Serviço de Pneumologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pallav L. Shah
- Royal Brompton Hospital, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, Vienna, Austria
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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Koster TD, Klooster K, Ten Hacken NHT, van Dijk M, Slebos DJ. Endobronchial valve therapy for severe emphysema: an overview of valve-related complications and its management. Expert Rev Respir Med 2020; 14:1235-1247. [PMID: 32842819 DOI: 10.1080/17476348.2020.1813571] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bronchoscopic lung volume reduction treatment with one-way valves is an effective guideline treatment option for patients with severe emphysema. However, important challenges and adverse reactions may occur after treatment. AREAS COVERED This review summarizes the complications after endobronchial and intrabronchial valve treatment that have been described by the currently published randomized controlled trials and other relevant papers regarding the complications and its management. In case there was no relevant literature regarding these subjects, recommendations are based on expert opinion. Complications include pneumothorax, post-obstruction pneumonia and hemoptysis. Also, the treatment may not be effective due to the presence of collateral ventilation or misplaced valves. Furthermore, an initial beneficial effect may vanish due to granulation tissue formation, valve dysfunction or valve migration. Careful follow-up after treatment with valves is important. Evaluation with a CT-scan and/or bronchoscopy is needed if there is no improvement after treatment, loss of benefit, or occurrence of important adverse events during follow-up. EXPERT OPINION Treating severe emphysema patients with one-way valves requires continuous dedication and expertise, especially to achieve an optimal outcome and elegantly deal with the various complications after treatment.
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Affiliation(s)
- T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Marlies van Dijk
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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11
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Van Der Molen MC, Klooster K, Hartman JE, Slebos DJ. Lung volume reduction with endobronchial valves in patients with emphysema. Expert Rev Med Devices 2018; 15:847-857. [DOI: 10.1080/17434440.2018.1538780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marieke C. Van Der Molen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jorine E. Hartman
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Demystifying the persistent pneumothorax: role of imaging. Insights Imaging 2016; 7:411-29. [PMID: 27100907 PMCID: PMC4877351 DOI: 10.1007/s13244-016-0486-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/21/2016] [Accepted: 03/15/2016] [Indexed: 01/21/2023] Open
Abstract
Evaluation for pneumothorax is an important indication for obtaining chest radiographs in patients who have had trauma, recent cardiothoracic surgery or are on ventilator support. By definition, a persistent pneumothorax constitutes ongoing bubbling of air from an in situ chest drain, 48 h after its insertion. Persistent pneumothorax remains a diagnostic dilemma and identification of potentially treatable aetiologies is important. These may be chest tube related (kinks or malposition), lung parenchymal disease, bronchopleural fistula, or rarely, oesophageal-pleural fistula. Although radiographs remain the mainstay for diagnosis and follow up of pneumothorax, computed tomography (CT) is increasingly being used for problem solving. Aetiology of persistent air leak determines the optimal treatment. For some, a simple repositioning of the chest tube/drain may suffice; others may require surgery. In this pictorial review, we will briefly describe the physiology of pneumothorax, discuss imaging features of identifiable causes for persistent pneumothorax and provide a brief overview of treatment options. Specific aetiology of a persistent air leak may often not be immediately discernible, and will need to be carefully sought. Accurate interpretation of imaging studies can expedite diagnosis and facilitate prompt treatment. Key points • Persistent pneumothorax is defined as a leak persisting for more than 2 days. • Radiographs can identify chest-tube-related causes of pneumothorax. • CT is the most useful test to identify other causes. • Penetrating thoracic injury can cause fistulous communication resulting in a persistent pneumothorax. • Discontinuity of visceral pleura identified by CT may indicate a bronchopleural fistula.
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13
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Han W, Huh D, Kim B, Kwak E, Lee S. Endobronchial Primitive Neuroectodermal Tumor With Pneumothorax Ex Vacuo. Ann Thorac Surg 2015; 100:1455-8. [PMID: 26434446 DOI: 10.1016/j.athoracsur.2014.11.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Abstract
We experienced a rare case of an endobronchial primitive neuroectodermal tumor of the left main bronchus. Initially we suspected pneumothorax caused by a collapsed left upper lobe and an air-entrapped lower lobe. After tube thoracostomy, the pneumothorax persisted without air leakage. A tumor was detected at the left main bronchus on computed tomography and bronchoscopy, and diagnosed pathologically as small cell lung cancer. Under the presumed diagnosis of limited-stage small cell lung cancer, we performed a left pneumonectomy. The tumor was eventually identified pathologically as a primitive neuroectodermal tumor. Although adjuvant chemoradiotherapy was not performed, no recurrence was observed.
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Affiliation(s)
- Wongyeong Han
- Department of Thoracic and Cardiovascular Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Dongmyung Huh
- Department of Thoracic and Cardiovascular Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
| | - Byoungho Kim
- Department of Thoracic and Cardiovascular Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Eunkyoung Kwak
- Department of Histopathology, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Sunah Lee
- Department of Oncology, Daegu Fatima Hospital, Daegu, Republic of Korea
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14
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Valipour A, Burghuber OC. An update on the efficacy of endobronchial valve therapy in the management of hyperinflation in patients with chronic obstructive pulmonary disease. Ther Adv Respir Dis 2015; 9:294-301. [PMID: 26294417 DOI: 10.1177/1753465815599693] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140 Wien, Vienna, Austria
| | - Otto Chris Burghuber
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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15
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Valipour A, Slebos DJ, de Oliveira HG, Eberhardt R, Freitag L, Criner GJ, Herth FJ. Expert Statement: Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples. Respiration 2014; 87:513-21. [DOI: 10.1159/000360642] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/14/2014] [Indexed: 11/19/2022] Open
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16
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Cho YK, Shin JH, Oh YM, Kim TH, Kim EY, Shin DH, Song HY. Experimental lung collapse following deployment of a self-expandable bronchial occluder in a rabbit model. Br J Radiol 2011; 85:e146-52. [PMID: 21385911 DOI: 10.1259/bjr/40247893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Closure of a bronchopleural fistula is required to prevent fatal empyema or aspiration pneumonia. The purpose of this study was to determine the feasibility and efficacy of bronchial occlusion with a self-expandable occluder to induce experimental lung collapse in a rabbit model. METHODS 10 bronchial occluders (wine glass appearance; 8 mm in diameter and 15 mm in length) were implanted in the native left main bronchi of 10 rabbits via an endotracheal route. We analysed the following: (1) diameters and morphological changes of the bronchial occluders during follow-up; (2) percentage volume of the collapsed lung during follow-up; and (3) complications and gross pathology. 1-day and 2-week follow-up CT scans were routinely obtained. Rabbits were sacrificed 4 weeks after the experiment. RESULTS In all 10 rabbits, the bronchial occluders were successfully implanted and were completely expanded within 2 weeks. Complete collapse of the left lung occurred in three rabbits on day 1 and in an additional two rabbits 2 weeks following implantation. Two other rabbits maintained the percentage volume of the collapsed lung between 51% and 99% during follow-up; the other three rabbits had <50% during follow-up. Pneumothoraces occurred in nine rabbits, but completely resolved at the 2-week follow-up. Right lung herniation across the midline progressed 2 weeks after occluder implantation. CONCLUSION Placement of self-expandable occluders in a rabbit bronchus model was feasible and showed a potential to induce artificial lung collapse. While pneumothoraces were common, they resolved during follow-up.
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Affiliation(s)
- Y-K Cho
- Department of Radiology, Eulji Medical Center, University of Eulji College of Medicine, Seoul, Republic of Korea
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Wan IYP, Toma TP, Geddes DM, Snell G, Williams T, Venuta F, Yim APC. Bronchoscopic Lung Volume Reduction for End-Stage Emphysema. Chest 2006; 129:518-26. [PMID: 16537847 DOI: 10.1378/chest.129.3.518] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To report the first multicenter experience on the treatment of end-stage emphysema using an endobronchial valve (EBV) [Emphasys EBV; Emphasys Medical; Redwood City, CA]. DESIGN Retrospective analysis from prospective multicenter registry. PATIENTS AND INTERVENTIONS This is a study of the use of EBVs in the treatment of end-stage emphysema at nine centers in seven countries. Ninety-eight patients with mean FEV(1) of 0.9 +/- 0.3 L (30.1 +/- 10.7% of predicted) [+/- SD] and residual volume (RV) of 5.1 +/- 1.3 L (244.3 +/- 0.3% of predicted) were treated over a period of 20 months. Spirometry, plethysmography, and diffusing capacity of the lung for carbon monoxide (Dlco) and exercise tolerance testing were performed at 30 days and 90 days after the procedure. RESULTS RV decreased by 4.9 +/- 17.4% (p = 0.025), FEV(1) increased by 10.7 +/- 26.2% (p = 0.007), FVC increased by 9.0 +/- 23.9% (p = 0.024), and 6-min walk distance increased by 23.0 + 55.3% (p = 0.001). There was a trend toward improvement in Dlco, but this did not reach statistical significance (17.2 +/- 52.0%, p = 0.063). Patients treated unilaterally showed a trend toward greater improvement than those treated bilaterally. A similar trend toward improvement was observed in patients who had one entire lobe treated compared to those with just one or two bronchopulmonary segments treated. Eight patients (8.2%) had serious complications in the first 90 days, including one death (1.0%). CONCLUSION This multicenter analysis confirms that improvement in pulmonary function and exercise tolerance can be achieved in emphysematous patients using EBVs. Future efforts should be directed to determining how to select those patients who would benefit most from this procedure and the best endobronchial treatment strategy.
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Affiliation(s)
- Innes Y P Wan
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Ponrartana S, Laberge JM, Kerlan RK, Wilson MW, Gordon RL. Management of patients with "ex vacuo" pneumothorax after thoracentesis. Acad Radiol 2005; 12:980-6. [PMID: 16087092 DOI: 10.1016/j.acra.2005.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Revised: 04/30/2005] [Accepted: 04/30/2005] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine clinical outcome in patients who developed "ex vacuo" pneumothorax following thoracentesis and to assess the benefit of chest tube placement for this complication. MATERIALS AND METHODS We retrospectively reviewed records of 282 patients who underwent 437 thoracenteses at a single institution during a 6-year period. We identified 34 patients (12.1%) who developed a pneumothorax following 39 thoracenteses (8.8%) and then identified a subset of patients with pneumothorax "ex vacuo" defined as a moderate to large hydropneumothorax or small pneumothorax persisting for more than 3 days. Patient charts were reviewed to document the treatment strategy employed and subsequent clinical outcome, which included length of hospital stay, resolution of pneumothorax, reaccumulation of pleural effusion, and overall survival. RESULTS Ten patients developed "ex vacuo" pneumothroax following thoracentesis. None complained of significant worsening of symptoms following thoracentesis. Seven patients were treated by observation alone and 3 patients underwent tube thorocostomy. A decrease in size of the pneumothorax was observed in only 3 patients, none of whom had a chest tube placed. Effusion completely reaccumulated in 7 patients. All 10 patients died during the follow-up period; the mean survival was 157 days (range: 13-402 days). Survival among patients treated by observation was 191.4 days versus 71.7 days for patients receiving chest tubes. CONCLUSION Life expectancy for most patients who develop "ex vacuo" pneumothorax following therapeutic thoracentesis is short (<6 months). Chest tube placement is not necessary in asymptomatic patients and is unlikely to provide clinical benefit.
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Affiliation(s)
- Skorn Ponrartana
- Department of Radiology, Division of Interventional Radiology, University of California, San Francisco, 94143, USA
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Affiliation(s)
- Riyad Karmy-Jones
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Abstract
Pneumothorax can be spontaneous, traumatic or iatrogenic. Pneumothorax ex vacuo, sports-related pneumothorax and barotrauma unrelated to mechanical ventilation are interesting and newer entities. Management consists of getting rid of the air and prevention of recurrence of pneumothorax.
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Affiliation(s)
- A M Karnik
- State University of New York at Stony Brook, NY, USA
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Hazouard E, Koninck JC, Attucci S, Fauchier-Rolland F, Brunereau L, Diot P. Pneumorachis and pneumomediastinum caused by repeated Müller's maneuvers: complications of marijuana smoking. Ann Emerg Med 2001; 38:694-7. [PMID: 11719752 DOI: 10.1067/mem.2001.118016] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pneumomediastinum may occur during marijuana inhalation but only rarely has pneumorachis (epidural pneumatosis or aerorachia) been reported. The usual mechanisms that produce pneumomediastinum include severe acute asthma, toxic-induced bronchial hyperreactivity, and barotrauma caused by Valsalva's maneuver (expiration through resistance). We report a case in which barotrauma resulted from repeated deep inspiration through a device with airflow resistance equivalent to Müller's maneuver. Inspiration occurred through a homemade apparatus resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum combined with subcutaneous emphysema and pneumorachis occurred, without identified pneumothorax. There were no neurologic complications. Because of the absence of bronchospasm, expiration either through the apparatus or actively against a closed glottis, or apnea, this phenomenon is likely a result of repeated Müller's maneuvers. Successive inhalation through resistance could have resulted in extreme negative intrathoracic pressure, which would have caused a transmural pressure gradient inducing barotrauma and release of extrarespiratory air. High-concentration oxygen therapy to achieve nitrogen washout was used.
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Affiliation(s)
- E Hazouard
- Department of Pneumology, INSERM EMI-U 00-10, Bretonneau University Hospital, Tours, France.
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Florman S, Young B, Allmon JC, Diethelm L, Raafat A. Traumatic pneumothorax ex vacuo. THE JOURNAL OF TRAUMA 2001; 50:147-8. [PMID: 11231686 DOI: 10.1097/00005373-200101000-00031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Florman
- Department of Surgery, Tulane University, SL-22, 1430 Tulane Avenue, New Orleans, Louisiana 70111, USA
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