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Heart & Lung : the Journal of Critical... 2021Pneumothorax has been frequently described as a complication of COVID-19 infections.
BACKGROUND
Pneumothorax has been frequently described as a complication of COVID-19 infections.
OBJECTIVE
In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax.
METHODS
Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of "COVID-19," "SARS-CoV-2," "pneumothorax," "pneumomediastinum," and "barotrauma" from January 1st, 2020 to January 30th, 2021.
RESULTS
Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8-23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0-19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly.
CONCLUSION
COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.
Topics: Aged; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Respiration, Artificial; SARS-CoV-2
PubMed: 34087677
DOI: 10.1016/j.hrtlng.2021.04.005 -
Cureus Feb 2024Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung...
Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung tissue. The elusive etiology of VLS mandates a diagnosis based on radiographic evidence showcasing giant bullae occupying at least one-third of the hemithorax in one or both lungs. This report presents a case of VLS in a 36-year-old female smoker devoid of any prior medical history. Additionally, we conducted a systematic review to discern the demographics, risk factors, and treatment modalities for individuals diagnosed with VLS.
PubMed: 38314388
DOI: 10.7759/cureus.53443 -
Medicine Aug 2020Previous literature on epidural pneumatosis (pneumorrhachis, or air in epidural cavity) associated with forceful vomiting in a patient with diabetic ketoacidosis (DKA)...
Proposed characterization of the syndrome of epidural pneumatosis (pneumorrhachis) in patients with forceful vomiting from diabetic ketoacidosis as a clinico-radiologic pentad based on systematic literature review & an illustrative case report.
BACKGROUND
Previous literature on epidural pneumatosis (pneumorrhachis, or air in epidural cavity) associated with forceful vomiting in a patient with diabetic ketoacidosis (DKA) has consisted of individual case reports without comprehensive syndrome characterization due to syndromic rarity, with the largest previous literature review comprising 6 cases. Presumed pathophysiology is air escaping from alveolar rupture from forceful vomiting via tissue planes to cause epidural pneumatosis.
AIM
Systematically review literature to facilitate syndromic diagnosis, evaluation, and treatment. A new illustrative case is reported.
METHODS
Systematic review of literature using 2 independent readers, 2 computerized databases, and the following medical terms/keywords: ["epidural pneumatosis" OR "pneumorrhachis"] AND ["diabetes" OR "diabetic ketoacidosis" or "DKA"]. Discrepancies between 2 readers were resolved by consensus using prospectively developed study inclusion criteria. Two readers independently abstracted case report. Prospective review protocol and patients, problems, intervene, comparison group, outcomes discussed in Methods section of paper.
RESULTS-SYSTEMATIC-LITERATURE-REVIEW
Revealed 10 previously reported cases plus 1 new case (see below) that shows this syndrome presents rather stereotypically with the tentatively proposed following pentad (% of patients fulfilling individual criterion): 1-forceful vomiting (100%), 2-during DKA (100%), 3-pneumomediastinum from forceful alveolar rupture (100%), 4-epidural pneumatosis from air escape from pneumomediastinum (100%), and 5-no complications of Boerhaave syndrome or of focal neurological deficits (100%). Pentad is pathophysiologically reasonable because forceful vomiting can cause alveolar rupture, pneumomediastinum, and air entry into epidural space.
RESULTS-ILLUSTRATIVE-CASE-REPORT
Epidural pneumatosis occurred in a 33-year-old-male with poorly controlled diabetes mellitus type 1 who presented with forceful vomiting while in DKA. Radiologic findings also included subcutaneous emphysema, pneumomediastinum, and small pneumothorax. The patient rapidly improved while receiving acute therapy for DKA, and was discharged after 2 hospital days.
STUDY LIMITATIONS
Limited number of analyzed, retrospectively reported cases. Case reports subject to reporting bias. Specificity, positive predictive value, and negative predictive value not meaningfully analyzed in this homogeneous population.
CONCLUSIONS
Based on systematic review, syndrome is tentatively proposed as a pentad with: 1-forceful vomiting, 2-during DKA, 3- pneumomediastinum, 4-epidural pneumatosis, and 5-no complications of Boerhaave syndrome or focal neurological deficits. Proposed pentad should be prospectively tested in a larger population including patients with this versus closely related syndromes.
Topics: Adolescent; Adult; Conservative Treatment; Diabetic Ketoacidosis; Esophageal Perforation; Female; Humans; Male; Mediastinal Diseases; Mediastinal Emphysema; Nervous System Diseases; Pneumorrhachis; Pneumothorax; Predictive Value of Tests; Prospective Studies; Pulmonary Alveoli; Radiography, Thoracic; Retrospective Studies; Rupture; Subcutaneous Emphysema; Syndrome; Treatment Outcome; Vomiting; Young Adult
PubMed: 32871860
DOI: 10.1097/MD.0000000000021001