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PubMed1995

Spontaneous pneumothorax complicating chemotherapy for metastatic seminoma. A case report and a review of the literature.

BACKGROUND: Spontaneous pneumothorax complicating chemotherapy has been reported mainly in metastatic sarcoma, particularly of the osteogenic type. The main factor in the etiology of spontaneous pneumothorax could be related to tumor lysis and/or rapid rupture of chemosensitive peripheral or subpleural metastasis into the pleural cavity, thus leading to a bronchopleural fistula. METHODS AND RESULTS: A 49-year-old patient in whom spontaneous pneumothorax developed after successful chemotherapy for metastatic seminoma is described. On chest tube drainage, the lung reexpanded rapidly and the patient became clinically and radiographically symptom free. CONCLUSION: To the authors' knowledge, this is only the second case of spontaneous pneumothorax complicating chemotherapy-induced rapid regression of lung and mediastinal metastases in patients with seminoma. Spontaneous pneumothorax should be included in the spectrum of chemotherapy-related side effects in chemosensitive solid tumors with lung metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Sonographically guided thoracentesis and rate of pneumothorax.

PURPOSE: To assess whether thoracenteses performed with sonographic guidance are associated with a lower rater of pneumothorax and tube thoracostomy than those performed without sonographic guidance. METHODS: We reviewed the medical records of 523 subjects undergoing their initial diagnostic thoracentesis at our institution from July 1, 2001, to June 30, 2002. We excluded 73 subjects in whom no chest imaging had been performed within 5 days of thoracentesis or who had pre-existing chronic hydropneumothorax. RESULTS: Of the 450 thoracenteses performed, 305 (67.8%) were performed with sonographic guidance and 145 (32.2%) were performed without. On postthoracentesis imaging in all subjects, 30 pneumothoraces (6.7%) were found (23 inpatients, 7 out-patients). Eight patients required a tube thoracostomy for their pneumothorax. Pneumothorax occurred in 15 of 305 procedures (4.9%) performed with sonographic guidance and 15 of 145 procedures (10.3%) performed without (p < 0.05). Tube thoracostomy was performed in 0.7% of patients whose thoracentesis was performed with sonographic guidance and in 4.1% in those that were not (p < 0.05). We found no correlation between pneumothorax after thoracentesis and age, inpatient status, loculation of effusion, or volume of pleural fluid removed. CONCLUSIONS: The routine use of sonography during diagnostic thoracentesis is associated with a reduced rate of pneumothorax and tube thoracostomy.

Adolescent↗
PubMed2002

Pneumothorax detection using pulmonary acoustic transmission measurements.

Pneumothorax is a common clinical condition that can be life threatening. The current standard of diagnosis includes radiographic procedures that can be costly and may not always be readily available or reliable. The objective of this study was to investigate the hypothesis that pneumothorax causes detectable pathognomonic changes in pulmonary acoustic transmission. An animal model was developed whereby 15 mongrel dogs were anaesthetised, intubated and mechanically ventilated. A thoracoscopic trocar was placed into the pleural space for the introduction of air and confirmation of a approximately 30% pneumothorax by direct visualisation. Broadband acoustic signals were introduced into the endotracheal tube, while transmitted waves were measured at the chest surface. Pneumothorax was found consistently to lower the pulmonary acoustic transmission in the 200-1200 Hz frequency band, whereas smaller transmission changes occurred at lower frequencies (p< 0.0001, sign test). The ratio of acoustic energy between low-(< 220 Hz) and high-(550-770 Hz) frequency bands was significantly different in the control and pneumothorax states (p < 0.0001, sign test). This implies that pneumothoraces can be reliably detected using pulmonary acoustic transmission measurements in the current animal model. Further studies are needed to investigate the feasibility of using this technique in humans.

Acoustics↗
PubMed2004

[Pulmonary lymphangioleiomyomatosis as a rare cause of recurrent spontaneous pneumothorax].

BACKGROUND: Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. The clinical characteristics include recurrent spontaneous pneumothorax and progressive dyspnea. The features of chest computed tomography are nearly pathognomonic with the detection of bilateral thin-walled cysts. CASE REPORT: A 32-year-old female presented with sudden-onset right-sided chest pain, which aggravated during inspiration, dyspnea at exertion, and cough. She had a history of bilateral recurrent spontaneous pneumothorax. Physical examination showed reduced pulmonary sounds on the right side. Chest X-ray confirmed the diagnosis of recurrent right-sided pneumothorax. Computed tomography showed multiple bilateral bullae. Video-assisted pleurectomy, bulla resection, and bulla coagulation were performed. The diagnosis of pulmonary lymphangioleiomyomatosis was confirmed by pulmonary biopsy. After pleurectomy, the patient remained symptom-free without recurrent pneumothorax. CONCLUSION: Pulmonary lymphangioleiomyomatosis is a rare cause of recurrent pneumothorax and should be considered a differential diagnosis, especially in young women with diffuse bilateral bullous emphysema or tuberous sclerosis.

Adult↗
PubMed1999

Thoracoscopic surgery for spontaneous pneumothorax.

Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n = 165), recurrence (n = 325), radiologically demonstrated huge bulla (n = 12), spontaneous hemopneumothorax (n = 13), incomplete expansion of the lung (n = 212), and bilateral involvement (n = 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n = 312), argon beam coagulation (n = 6), endoscopic suturing (n = 52), and endoloop ligation (n = 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n = 16), localized empyema (n = 2), chest wall bleeding (n = 1), and persistent air leaks (bulla type III) (n = 31). The median duration of the operation was 55 minutes (15-160 minutes), and the average postoperative hospital stay was 4.5 days (range 0-27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1-60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.

Adolescent↗
PubMed2004

Value of high-resolution ultrasound in detecting a pneumothorax.

This study was designed to compare the detectability of high-resolution ultrasound (HRUS) and bedside chest radiography (CR) for a pneumothorax. During the last 14 months, 97 consecutive patients who were admitted to our institute to undergo a transthoracic needle aspiration and biopsy (TNAB) of the lung were included. Both HRUS and CR were performed immediately after the TNAB procedure. The HRUS images were saved in sequence using the cine-review mode and displayed as an animation on a workstation. Four radiologists independently analyzed both HRUS images and a soft copy of the CR on a diagnostic monitor and identified the pneumothorax. With CT as the reference standard, statistical parameters were calculated. From 97 patients, 35 pneumothorax cases were found on CT after the TNAB. The sensitivities in detecting the pneumothorax were 80 and 47% in HRUS and CR, respectively. The specificities were 94 and 94%. The diagnostic accuracies were 89 and 77%. The inter-observer agreement was excellent (kappa=0.85) in the HRUS images and moderate (kappa=0.49) in the CR. The results of this study suggest that HRUS is a more sensitive and confident method for diagnosing a pneumothorax when compared to bedside chest radiography.

Biopsy, Needle↗
PubMed2006

Should 3K zoom function be used for detection of pneumothorax in cesium iodide/amorphous silicon flat-panel detector radiographs presented on 1K-matrix soft copies?

The purpose of the study was to evaluate observer performance in the detection of pneumothorax with cesium iodide and amorphous silicon flat-panel detector radiography (CsI/a-Si FDR) presented as 1K and 3K soft-copy images. Forty patients with and 40 patients without pneumothorax diagnosed on previous and subsequent digital storage phosphor radiography (SPR, gold standard) had follow-up chest radiographs with CsI/a-Si FDR. Four observers confirmed or excluded the diagnosis of pneumothorax according to a five-point scale first on the 1K soft-copy image and then with help of 3K zoom function (1K monitor). Receiver operating characteristic (ROC) analysis was performed for each modality (1K and 3K). The area under the curve (AUC) values for each observer were 0.7815, 0.7779, 0.7946 and 0.7066 with 1K-matrix soft copies and 0.8123, 0.7997, 0.8078 and 0.7522 with 3K zoom. Overall detection of pneumothorax was better with 3K zoom. Differences between the two display methods were not statistically significant in 3 of 4 observers (p-values between 0.13 and 0.44; observer 4: p = 0.02). The detection of pneumothorax with 3K zoom is better than with 1K soft copy but not at a statistically significant level. Differences between both display methods may be subtle. Still, our results indicate that 3K zoom should be employed in clinical practice.

Adult↗
PubMed2002

Pneumothorax and transient pseudohypoaldosteronism in an infant with hydronephrosis.

Pneumothorax and transient pseudohypoaldosteronism have been noted as complications of obstructive uropathy in infancy. However, they are rare complications, and there have been no reports of a patient with both pneumothorax and pseudohypoaldosteronism in obstructive uropathy. Here we describe a case of pneumothorax and transient pseudohypoaldosteronism in an infant with bilateral hydronephrosis due to ureteropelvic junction obstruction. Nephrostomy improved the patient's condition and laboratory findings rapidly. While the exact pathogenic mechanism of pneumothorax in patients with obstructive uropathy is unclear, some biochemical defects due to obstructive uropathy might impair fetal lung maturation, which results in pneumothorax.

Female↗
PubMed1994

Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax.

In a prospective comparison, 60 patients suffering from complicated spontaneous pneumothorax were randomly allocated to receive treatment by a video-assisted thoracoscopic surgery (VATS) technique or by thoracotomy. Thirty patients underwent bullectomy and apical pleurectomy by VATS performed through three 2-cm incisions (group V) and 30 patients underwent a similar surgical procedure through a posterolateral thoracotomy (group T). The median operating time was significantly longer in group V (45 versus 37.5 minutes; p < 0.05), but the postoperative analgesic requirement and hospital stay were less than those in group T. On the third postoperative day, the reductions in the forced expiratory volume in 1 second and forced vital capacity were significantly lower in group V than in group T (p < 0.05 and p < 0.01, respectively). Initial treatment of the spontaneous pneumothorax was effective in 27 patients (90%) in group V and in 29 patients (97%) in group T. There have been two late recurrences in group V and one in group T at a median follow-up of 15.1 months and 16.3 months, respectively. Within the study group, 30 consecutive patients presented with primary spontaneous pneumothorax. In this subgroup there was no significant difference in the operating time between VATS and thoracotomy, but postoperative pain, hospital stay, and pulmonary dysfunction were all less for those undergoing VATS. All treatment failures were in the subgroup of 30 consecutive patients who presented with secondary spontaneous pneumothorax, and the hospital stay in this group was prolonged by the use of VATS. We conclude from our findings that VATS is superior to thoracotomy in the treatment of primary spontaneous pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax.

BACKGROUND: Although management of spontaneous pneumothorax by video-assisted thoracic surgery (VATS) has generally shown superior clinical results to thoracotomy, management of spontaneous pneumothorax by transaxillary minithoracotomy (TAMT) has also shown good clinical results. The objective of this study was to compare the clinical results of VATS and TAMT in treating spontaneous pneumothorax. METHODS: Sixty-six patients, aged 13 to 81 years, with recurrent, persistent or contralateral spontaneous pneumothorax were involved in this study. Thirty-six patients were treated by VATS and 30 by TAMT. The operating time, the amount of analgesics used on the first postoperative day, the duration of the indwelling chest tube, and the number of recurrences after operation were compared. The follow-up periods of both procedures were from 6 to 24 months. RESULTS: Of the 66 patients, 64 were male and 2 were female. The duration of operation, from start of skin incision to insertion of chest tube, was 91.2 +/- 36.8 minutes in VATS and 86.3 +/- 40.9 minutes in TAMT (p = 0.6061). The amount of analgesics (keptoprofen) used was 1.9 +/- 2.3 ampules in VATS and 2.1 +/- 2.9 ampules in TAMT (p = 0.0883). The duration of indwelling chest tube was 5.0 +/- 4.0 days in VATS and 4.3 +/- 2.1 days in TAMT (p = 0.3707). The number of recurrences after operation was 4 in VATS and none in TAMT. CONCLUSIONS: There were no advantages of VATS over TAMT for management of recurrent, persistent, or contralateral spontaneous pneumothorax in regard to the operating time, the amount of analgesics used on the first postoperative day, the duration of the indwelling chest tube, and the number of postoperative recurrences in patients with apical bullae.

Adolescent↗
PubMed1996

Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS.

BACKGROUND: Video-assisted thoracic surgery has recently evolved as a viable alternative to thoracotomy for spontaneous pneumothorax. METHODS: A series of 163 patients with primary spontaneous pneumothorax were treated by video-assisted thoracic surgery. Seventy patients were treated for a recurrent episode, 64 patients for a persistent primary spontaneous pneumothorax, 24 patients for a contralateral episode, and 5 patients for a bilateral primary spontaneous pneumothorax. Stapling of bullae with an Endo-GIA stapler (Auto-Suture, Elencourt, France) was performed in 90% of the cases and parietal pleural abrasion was performed in each case. RESULTS: One revisional lateral limited thoracotomy was required for bleeding. Six patients had a prolonged air leak; 2 of them were reoperated on by lateral limited thoracotomy. Two patients have had an incomplete reexpansion of the lung and required a reoperation. The duration of hospitalization was 6.9 +/- 3 days. With a mean follow-up of 24.5 months, three recurrences requiring a reoperation occurred; 3 other patients had a partial recurrence and healed by rest without drainage. The mean time to return to the occupational activity of the patients was 42 +/- 34 days. These results were compared with those of a previous series of 87 patients operated on by lateral limited thoracotomy. CONCLUSIONS: With the development of surgical technique and video equipment, video-assisted thoracic surgery will probably become the treatment of choice of primary spontaneous pneumothorax.

Absenteeism↗
PubMed1991

Tension pneumothorax associated with hyperbaric oxygen therapy.

The authors present three patients who developed a tension pneumothorax while receiving emergent hyperbaric oxygen therapy for acute carbon monoxide poisoning. Each patient was intubated and received closed chest compressions for cardiac arrest prior to hyperbaric oxygenation. Despite the apparent absence of pneumothorax prior to hyperbaric therapy, tension pneumothorax was detected soon after decompression. These cases illustrate the need for vigilance in detecting and addressing pneumothorax prior to hyperbaric decompression in obtunded patients. Serial physical examinations, arterial blood gas determinations, properly positioned chest radiographs, and a high index of suspicion for pneumothorax in the setting of emergent hyperbaric therapy are recommended.

Adolescent↗
PubMed1986

Catheter aspiration for simple pneumothorax.

A prospective study was conducted in the emergency setting to determine the efficacy of treatment of simple pneumothorax by catheter aspiration. Patients who were successfully treated were discharged to home. Sixty-one patients with a total of 76 pneumothoraces were involved in the study. The overall success rate was 75.6%, with an 82% success rate for needle-induced, 75% for traumatic, and 45% for spontaneous pneumothorax. The duration of symptoms, the size of the pneumothorax, the patient's age, and a prior history of pneumothorax did not affect the outcome. The poorest results were noted with spontaneous pneumothoraces, as would be expected since a majority of these patients have preexistent lung disease. Catheter aspiration of simple pneumothorax offers a cost-effective approach to this clinical problem.

Adult↗
PubMedDate not supplied

CT detection of occult pneumothorax in multiple trauma patients.

Chest injuries are the cause of death in 25% of trauma fatalities, and a major contributing factor in an additional 50%. Pneumothorax, the second most common chest injury, may often be initially overlooked. Administration of anesthesia and mechanical ventilation may produce enlargement of a pneumothorax and clinical deterioration. We reviewed 90 trauma patients who had been admitted with a diagnosis of pneumothorax or who had developed pneumothoraces after hospital admission. In 35 cases (38.8%), initial supine chest x-ray study failed to detect a pneumothorax, and the diagnosis was made on CT scan of the chest or abdomen performed within 2 hours of admission. In 15 of these cases (42.8%), identification of the pneumothorax on CT scan resulted in alterations in management, including chest tube placement in 10 patients and intensified monitoring in 5 patients. Failure to identify pneumothoraces in trauma patients may lead to deterioration and significant complications in patients requiring anesthesia or mechanical ventilation. CT scan may facilitate identification in these cases.

Adolescent↗
PubMed1993

Spontaneous pneumothorax in paediatric patients.

To obtain information to guide the management of children and early adolescents with apparent spontaneous pneumothorax the medical records of all patients over the age of 5 years presenting with this condition over a 25-yr period were reviewed. Twelve patients had a pneumothorax not associated with an acute episode of asthma. Six of these underwent thoracotomy at first presentation. Of the six who were initially treated conservatively five had a recurrence on the ipsilateral side. Seven patients developed a pneumothorax during an acute episode of asthma and none had a recurrence. Early intervention by either thoracotomy or some form of closed pleurodesis should be considered in paediatric patients presenting with an apparent spontaneous pneumothorax not associated with an acute episode of asthma. Pneumothorax complicating an acute episode of asthma is rare in the paediatric age group and is unlikely to recur.

Acute Disease↗
PubMed2004

Video-assisted thoracoscopic management of recurrent primary spontaneous pneumothorax after prior talc pleurodesis: a feasible, safe and efficient treatment option.

OBJECTIVE: To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis. METHODS: From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as long-term outcome were reported. RESULTS: We collected 39 patients (28 male) with a median age of 25 years (15-41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days-13 years]. Size of recurrence involved 10-80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n=6, 22%). Median follow-up was 26 months [10-38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery. CONCLUSIONS: Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.

Adolescent↗
PubMed2005

Catamenial pneumothorax: optimal hormonal and surgical management.

OBJECTIVE: To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP). METHODS: We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002. RESULTS: In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively. All six patients taking estrogen/progesterone replacement had recurrences pre-operatively and two of three had recurrences post-operatively while on these medications. No patient suffered a pneumothorax either pre- or post-operatively while taking a gonadotropin releasing hormone agonist (two and three patients, respectively). Intraoperative findings included diaphragmatic implants [5] diaphragmatic fenestrations [4], apical blebs [2] and visceral pleural implants [2]. All pathology was specifically addressed at the time of surgery. Pleural space management included mechanical pleurodesis in seven and pleurectomy with talc insufflation in 1. Follow-up ranged from 27 to 63 months with a mean of 48 months. Three patients developed post-operative recurrences. One was managed without intervention and two required additional procedures. CONCLUSION: Catamenial pneumothorax is under appreciated, representing up to one-third of women with spontaneous pneumothorax. Hormonal agents that allow for menses are ineffective. Gonadotropin releasing hormone agonists should be considered as part of the pre-operative or post-operative management in high risk patients. Our findings suggest that an additional intervention to augment pleural symphysis at the level of the diaphragm should be performed.

Adult↗
PubMed2005

Thoracoscopic parietal pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax.

OBJECTIVE: The obliteration of pleural space is useful to prevent recurrences of spontaneous pneumothorax. We retrospectively compared the results of pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax. METHODS: Between 1996 and 2004, 136 patients underwent surgery for primary spontaneous pneumothorax, with 143 surgical procedures, all performed by VATS. Indications were recurrent pneumothorax in 107 patients, a complicated first episode in 29 and occupational activity in 7. Six patients were excluded because of postoperative histopathological diagnosis other than pulmonary emphysema. In 70 cases pleurodesis was performed with argon beam coagulation and in 67 by Marlex degrees mesh abrasion. These techniques were employed during two different periods. Median follow-up was 68 months in the Marlex degrees group and 41 in the argon group. The two groups resulted as being homogeneous for gender, age, smoking attitude and surgical indication. Statistical analysis was done with chi2 and Fisher's test. RESULTS: No postoperative mortality was observed. Mean recovery time was 5 days. There were three patients with postoperative bleeding who underwent re-operation. There were nine cases of prolonged air-leak, one needing surgical exploration. Nine recurrences were noted, all requiring surgery. Two recurrences were observed in the group treated by pleural abrasion (3.4%) and seven in the group treated by argon coagulation (10.7%). The Fisher's test failed to demonstrate a statistical significance between the two procedures in terms of recurrence rate (p=0.18). Multivariate analysis yielded no risk factors for recurrences. Postoperative complications resulted as being equally distributed in both groups. CONCLUSION: After primary spontaneous pneumothorax, pleurodesis induced by argon beam parietal pleural coagulation resulted as being no better than that obtained by pleural abrasion in the prevention of recurrences. No benefits in terms of postoperative complications resulted by use argon beam coagulation.

Adolescent↗