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The European Respiratory Journal Jun 1997Although spontaneous pneumothoraces have been recognized and treated for almost 180 yrs, new aspects have emerged concerning pathogenesis, diagnostic procedures and... (Review)
Review
Although spontaneous pneumothoraces have been recognized and treated for almost 180 yrs, new aspects have emerged concerning pathogenesis, diagnostic procedures and treatment modalities. In spite of the fact that blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they seldom seem to be the actual cause of the pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the pneumothorax during transpulmonary pressure changes. The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary spontaneous pneumothorax.
Topics: Humans; Pneumothorax; Recurrence; Respiratory Function Tests
PubMed: 9192946
DOI: 10.1183/09031936.97.10061372 -
Medicine Jan 2023Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical...
Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical ventilation. Here, we report 9 patients who developed spontaneous intrathoracic gas effusions in the absence of mechanical ventilation. The incidence of spontaneous intrathoracic gas effusions is low at 0.5% in hospitalized COVID-19 patients in the absence of respiratory support. Two patients (22.2%) had spontaneous pneumomediastinum, with or without subcutaneous emphysema. Three patients (33.3%) had pneumomediastinum associated with pneumothorax, with or without subcutaneous emphysema, and 4 patients (44.4%) had spontaneous pneumothorax. The Pneumothorax was unilateral in 66.6% of cases (6/9) but without location preference. Five of our patients were smokers, of whom 80% had isolated spontaneous pneumothorax. Other comorbidities included pulmonary tuberculosis in a single patient, diabetes in 2 patients and arterial hypertension in 1 patient. None of the patients had respiratory comorbidities. All of our patients were male. The average duration of hospital stay was 10 days (±6.63). All patients required oxygen therapy. Three patients (33.3%) with spontaneous pneumothorax required chest drainage. The evolution was favorable in 6 patients (66.7%) and worse in 3 cases (33.3%). The respiratory manifestations of COVID-19 have been stereotyped. Intrathoracic effusions may also be signs of COVID-19 with varying prognoses, or even the only presentation of the disease. This should be considered in clinical practice, and doctors are encouraged to request a SARS-CoV-2 test in this situation. Further investigations with a larger sample size are needed to identify the prognostic factors in COVID-19 patients with gas effusions.
Topics: Humans; Male; Female; COVID-19; SARS-CoV-2; Pneumothorax; Mediastinal Emphysema; Subcutaneous Emphysema
PubMed: 36607883
DOI: 10.1097/MD.0000000000032605 -
Interactive Cardiovascular and Thoracic... Jun 2022The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more...
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality.
METHODS
We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases.
RESULTS
Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups.
CONCLUSIONS
The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.
Topics: COVID-19; Chest Tubes; Female; Humans; Male; Oxygen; Pandemics; Pneumothorax; Thoracostomy
PubMed: 34661670
DOI: 10.1093/icvts/ivab280 -
Pathologica Aug 2022The thoracic district is the most frequent visceral location of synovial sarcoma, generally involving lung and pleura as a large solid mass. We present herein a...
The thoracic district is the most frequent visceral location of synovial sarcoma, generally involving lung and pleura as a large solid mass. We present herein a 57-year-old man with recurrent pneumothorax and a localized bulla at the lingula. The lesion was excised by a Video-Assisted-Thoracoscopic-Surgery (VATS) wedge resection and surprisingly consisted of a unilocular cyst with fibrous wall intermingled by a longitudinal proliferation of bland-looking, dense, monomorphic spindle cells diffusely expressing EMA, CD99, CD56 and focally staining with cytokeratins. Fluorescent in situ hybridization demonstrated the presence of SYT rearrangement and a diagnosis of pulmonary cystic monophasic synovial sarcoma was made. Only few similar cases have been reported in literature, mainly occurring in young male adults. A meticulous examination of all resected tissue from pneumothorax is the prerequisite to suspect this extremely challenging condition, while immuno-molecular studies are mandatory to achieve the correct diagnosis.
Topics: Adult; Humans; In Situ Hybridization, Fluorescence; Lung; Male; Middle Aged; Pneumothorax; Sarcoma, Synovial; Thoracic Surgery, Video-Assisted
PubMed: 36136899
DOI: 10.32074/1591-951X-377 -
British Medical Journal Dec 1976
Topics: Adult; Humans; Intubation; Male; Pneumothorax
PubMed: 1009354
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... Feb 2022In this study, we evaluated the clinical characteristics and seasonal distribution of patients with primary spontaneous pneumothorax and examined the relationships...
OBJECTIVE
In this study, we evaluated the clinical characteristics and seasonal distribution of patients with primary spontaneous pneumothorax and examined the relationships between meteorological factors and pneumothorax development overall and in terms of first episode and recurrence.
METHODS
The hospital records of 168 pneumothorax patients treated in our clinic between January 2016 and December 2020 were reviewed retrospectively. A cluster was defined as two or more patients with pneumothorax presenting within three consecutive days. Meteorological factors were compared between days with and without pneumothorax patients. This comparison was based on meteorological data from the day of symptom onset (D), the day before symptom onset (D1), and the difference between those days (D-D1). Meteorological data from the index day (D) were also compared between patients with first episode and recurrence of pneumothorax.
RESULTS
The study included 149 (88.7%) men and 19 (11.3%) women. The mean age was 25.02±6.97 (range, 17-35; median, 26) years. Of note, 73 (43.4%) patients underwent surgery. The highest number of patients presented in November (n=19, 11.3%). In terms of season, most presentations occurred in autumn. Humidity was significantly lower on recurrence days compared with first episode (p=0.041).
CONCLUSION
Our results indicated that meteorological factors (i.e., atmospheric pressure, humidity, wind speed, temperature, and precipitation) were not associated with pneumothorax development. By comparing the patients with first episode and recurrence, the humidity was significantly lower in the recurrence group.
Topics: Adolescent; Adult; Atmospheric Pressure; Female; Humans; Male; Meteorological Concepts; Pneumothorax; Recurrence; Retrospective Studies; Weather; Young Adult
PubMed: 35239876
DOI: 10.1590/1806-9282.20210821 -
The Malaysian Journal of Pathology Dec 2023Information on incidence and risk factors associated with different types of neonatal pneumothorax were lacking globally. (Observational Study)
Observational Study
BACKGROUND
Information on incidence and risk factors associated with different types of neonatal pneumothorax were lacking globally.
OBJECTIVES
To determine incidences of pneumothorax developed spontaneously and during different modes of respiratory support, and risk factors associated with each type of pneumothorax.
STUDY DESIGN
Retrospective observational study of neonates in the Malaysian National Neonatal Registry.
SETTING
44 Malaysian neonatal intensive care units (NICUs).
PARTICIPANTS
All neonates born in 2015-2020 and admitted to NICUs.
RESULTS
Pneumothorax developed in 3265 neonates: 37.5% occurred spontaneously, 62.5% during respiratory support. The incidence of all types of pneumothorax was 1.75 per 1000 livebirths, and of spontaneous pneumothorax was 0.58 per 1000 livebirths. Pneumothorax developed in 0.6% (450/70512) of neonates during continuous positive air way pressure therapy (nCPAPt), 1.8% (990/54994) of neonates during conventional mechanical ventilation (CMV), and 7.0% (599/8557) of neonates during high frequency ventilation (HFV). Term neonates had significantly higher pneumothorax rate than preterms (p<0.001). Multiple logistic regression analyses show that exposure to intermittent positive pressure ventilation and chest compression at birth were significant independent factors associated with increased risk of spontaneous pneumothorax and CMV, and persistent pulmonary hypertension was associated with increased risk of spontaneous pneumothorax and pneumothorax during CMV and HFV.
CONCLUSIONS
The most common type of pneumothorax was spontaneous in-onset. Neonates on HFV had the highest and those on nCPAPt the lowest rate of pneumothorax. Improving training of resuscitation techniques at birth and strategies of use of invasive modes of respiratory support may reduce incidences of all types of pneumothorax.
Topics: Infant, Newborn; Humans; Child; Pneumothorax; Intensive Care Units, Neonatal; Respiration, Artificial; Retrospective Studies; Cytomegalovirus Infections
PubMed: 38155385
DOI: No ID Found -
Respiratory Research Feb 2022Spontaneous pneumothorax is a common pathology but optimal initial treatment regime is not well defined. Treatment options including conservative management, needle...
BACKGROUND AND OBJECTIVE
Spontaneous pneumothorax is a common pathology but optimal initial treatment regime is not well defined. Treatment options including conservative management, needle aspiration (NA) or insertion of a small-bore chest drain. Recent large randomised controlled trials may change the treatment paradigm: comparing conservative and ambulatory management to standard care, but current guidelines need to be updated. The aim of this study was to assess the current "state of play" in the management of pneumothorax in the UK.
METHODS
Physicians and respiratory healthcare staff were invited to complete an online survey on the initial and subsequent management of pneumothorax.
RESULTS
This study is the first survey of pneumothorax practice across the UK, which highlights variation in practice: 50% would manage a large primary pneumothorax with minimal symptoms conservatively, compared to only 3% if there were significant symptoms; 64% use suction if the pneumothorax had not resolved after > 2 days, 15% always clamp the chest drain prior to removal; whereas 30% never do. NICE guidance recommends the use of digital suction but this has not translated into widespread usage: only 23% use digital suction to check for resolution of air leak).
CONCLUSION
Whilst there has always been allowance for individual clinician preference in guidelines, there needs to be consensus on the optimum management strategy. The challenge the new guidelines face is to design a simple and pragmatic approach, using this new evidence base.
Topics: Chest Tubes; Drainage; Humans; Incidence; Pneumothorax; United Kingdom
PubMed: 35130917
DOI: 10.1186/s12931-022-01943-9 -
Anesthesiology Aug 2022
Topics: Child; Humans; Iatrogenic Disease; Pneumothorax
PubMed: 35666979
DOI: 10.1097/ALN.0000000000004270 -
Anesthesiology Aug 2022
Topics: Humans; Child; Pneumothorax; Iatrogenic Disease
PubMed: 35666961
DOI: 10.1097/ALN.0000000000004271