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Topics in Companion Animal Medicine Nov 2021Spontaneous pneumothorax, which may have an acute or insidious onset in dogs and cats, results in respiratory difficulty and has the potential to be life threatening.... (Review)
Review
Spontaneous pneumothorax, which may have an acute or insidious onset in dogs and cats, results in respiratory difficulty and has the potential to be life threatening. Dogs commonly develop spontaneous pneumothorax due to bullae or blebs, while cats typically have underlying inflammatory disease, like feline allergic airway disease. Urgent therapeutic intervention is essential in animals with respiratory distress. The recommended therapeutic strategies are typically different in each of these species due to underlying etiology. The first part of this review article will focus on physiology, clinical presentation, and diagnosis of spontaneous pneumothorax in dogs and cats. Advances in diagnostics, especially the recent utility of point of care ultrasound, will be discussed. The second part of the series will provide an overview of therapeutic options and management of patients with spontaneous pneumothorax, as well as information on prognosis.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Pneumothorax
PubMed: 34303864
DOI: 10.1016/j.tcam.2021.100563 -
Topics in Companion Animal Medicine Nov 2021This review article will review treatment and prognosis of spontaneous pneumothorax in dogs and cats. The advantages of surgical and medical management in dogs and cats,... (Review)
Review
This review article will review treatment and prognosis of spontaneous pneumothorax in dogs and cats. The advantages of surgical and medical management in dogs and cats, as well as current treatment practices, including autologous blood pleurodesis and small-bore chest tubes, will be discussed.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Pneumothorax; Prognosis
PubMed: 34509664
DOI: 10.1016/j.tcam.2021.100582 -
Lakartidningen Feb 2022A couple of decades ago, most large pneumothoraces were managed initially through the insertion of large-bore chest tubes, active suction and in hospital admission.... (Review)
Review
A couple of decades ago, most large pneumothoraces were managed initially through the insertion of large-bore chest tubes, active suction and in hospital admission. Mounting evidence has since established that the patient's symptoms, not the size of the pneumothorax, should guide whether invasive management is required for spontaneous pneumothoraces. There is also mounting evidence that small traumatic and iatrogenic pneumothoraces can be managed conservatively. Small-bore chest tubes are just as effective as large-bore chest tubes for all types of pneumothoraces and likely associated with fewer complications. Passive drainage allows for out-of-hospital follow-up for selected patients. This article presents a stepwise approach to the management of pneumothoraces in the emergency department based on a review of the current literature.
Topics: Chest Tubes; Drainage; Emergency Service, Hospital; Humans; Pneumothorax; Treatment Outcome
PubMed: 35226352
DOI: No ID Found -
Clinical Medicine (London, England) Jun 2018Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing... (Review)
Review
Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing acutely unwell adult patients. However, it currently remains the domain of a relatively small handful of physicians within the UK. There are numerous reasons for this, notably a lack of training pathways and supervisors but also a lack of understanding of the evidence base behind this imaging modality. This review article aims to explore some of the evidence base behind POCUS for a number of medical pathologies, and where possible compare it to evidenced traditional examination techniques. We discuss the issues around training in bedside ultrasound and recommend a push to integrate POCUS training into internal medicine curricula and support trainers to comprehensively deliver this.
Topics: Abdominal Injuries; Echocardiography; Evidence-Based Medicine; Heart Arrest; Humans; Pneumothorax; Point-of-Care Testing; Respiratory Insufficiency; Shock; Surgery, Computer-Assisted; Ultrasonography; United Kingdom
PubMed: 29858431
DOI: 10.7861/clinmedicine.18-3-219 -
Annals of the Royal College of Surgeons... Apr 2022Thoracic endometriosis syndrome is an under-recognised manifestation of endometriosis and includes catamenial pneumothorax, catamenial haemothorax, catamenial...
Thoracic endometriosis syndrome is an under-recognised manifestation of endometriosis and includes catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules. Catamenial pneumothorax presents as recurrent spontaneous pneumothorax with a temporal relationship to the onset of menses, affecting mostly the right lung. A 48-year-old woman presented with an eight-year history of right-sided catamenial pneumothorax, during which time she had three episodes of pneumothorax. Serial chest imaging revealed an enlarging mass overlying the right hemi-diaphragm. She was referred to our trust where she underwent video-assisted thoracoscopic surgery for right pleurectomy. Intraoperatively, defects were found in the right hemidiaphragm, through which parts of the liver had herniated. We describe the presenting features and management of catamenial pneumothorax.
Topics: Diaphragm; Endometriosis; Female; Humans; Middle Aged; Pneumothorax; Thoracic Surgery, Video-Assisted
PubMed: 34825583
DOI: 10.1308/rcsann.2021.0164 -
Interactive Cardiovascular and Thoracic... Mar 2020Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the...
UNLABELLED
Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients.
CLINICAL TRIAL REGISTRATION NUMBER
International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.
Topics: Chest Tubes; Global Health; Humans; Incidence; Pleurodesis; Pneumothorax; Talc; Thoracic Surgery, Video-Assisted
PubMed: 31858124
DOI: 10.1093/icvts/ivz290 -
The European Respiratory Journal Aug 2015Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in... (Review)
Review
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.
Topics: Advisory Committees; Antiperspirants; Humans; Pleurodesis; Pneumothorax; Practice Guidelines as Topic; Recurrence; Smoking; Societies, Medical; Talc; Thoracic Surgery, Video-Assisted; Thoracotomy
PubMed: 26113675
DOI: 10.1183/09031936.00219214 -
European Respiratory Review : An... Sep 2020Birt-Hogg-Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene , encoding the protein...
Birt-Hogg-Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene , encoding the protein folliculin. Its clinical expression typically includes multiple pulmonary cysts, recurrent spontaneous pneumothoraces, cutaneous fibrofolliculomas and renal tumours of various histological types. BHD has no sex predilection and tends to manifest in the third or fourth decade of life. Multiple bilateral pulmonary cysts are found on chest computed tomography in >80% of patients and more than half experience one or more episodes of pneumothorax. A family history of pneumothorax is an important clue, which suggests the diagnosis of BHD. Unlike other cystic lung diseases such as lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis, BHD does not lead to progressive loss of lung function and chronic respiratory insufficiency. Renal tumours affect about 30% of patients during their lifetime, and can be multiple and recurrent. The diagnosis of BHD is based on a combination of genetic, clinical and/or skin histopathological criteria. Management mainly consists of early pleurodesis in the case of pneumothorax, periodic renal imaging for tumour detection, and diagnostic work-up in search of BHD in relatives of the index patient.
Topics: Birt-Hogg-Dube Syndrome; Cysts; Humans; Lung Diseases; Pneumothorax; Tomography, X-Ray Computed
PubMed: 32943413
DOI: 10.1183/16000617.0042-2020 -
Medicina 2022Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical...
Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spontaneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.
Topics: Adult; Diaphragm; Endometriosis; Female; Humans; Pneumothorax; Thoracic Surgery, Video-Assisted
PubMed: 35037874
DOI: No ID Found -
The Journal of the American Osteopathic... Jan 2019Dry needling is a widely used alternative therapy for musculoskeletal disorders, such as myofascial pain. The procedure involves placing a solid monofilament needle into...
Dry needling is a widely used alternative therapy for musculoskeletal disorders, such as myofascial pain. The procedure involves placing a solid monofilament needle into myofascial trigger points or connective tissue to relieve pain. Some of the complications secondary to this procedure include cardiac tamponade, hematoma, infection, nerve injury, and pneumothorax. Although the incidence is low, the complications can be potentially life threatening. We present the case of a 44-year-old man who had dry needling of the infraspinatus, supraspinatus, rhomboid, and paraspinal muscles with subsequent development of a left apical pneumothorax. Given that the pneumothorax was small, the patient had good recovery with supplemental oxygen. Although the incidence of pneumothorax is very low, it is an important diagnosis to consider for a patient presenting with dry cough, malaise, chest pain, or shortness of breath after a dry needling procedure. Patients should be made aware of these potential complications as part of an informed consent.
Topics: Adult; Humans; Male; Myofascial Pain Syndromes; Needles; Pneumothorax; Radiography; Tomography, X-Ray Computed; Trigger Points
PubMed: 30615043
DOI: 10.7556/jaoa.2019.009