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PubMed1994

[Treatment of spontaneous pneumothorax: survey among Dutch pneumonologists].

OBJECTIVE: To gain insight into the treatment of spontaneous pneumothorax in the Netherlands. DESIGN: Questionnaire. SETTING: Nationwide in the Netherlands. METHOD: A questionnaire was sent to all 286 practising pulmonologists in the Netherlands to inquire about the mode of treatment used for spontaneous pneumothorax. Answers were sorted by size of practice. University hospital, non-university hospitals qualified for residency training and offices with at least 4 pulmonologists were classified as large practices. Other practices were classified as small. RESULTS: 89% of all pulmonologists responded. In small practices, a first spontaneous pneumothorax was treated by chest tube drainage; in large practices, thoracoscopy was usually performed. In recurrent pneumothorax, thoracoscopy was the first choice in both small and large practices. The role of interventional thoracoscopy and surgery was not established. CONCLUSION: Worldwide, including in the Netherlands, there is no consensus about the treatment of spontaneous pneumothorax. Randomised studies with cost-effect analysis are necessary.

Chest Tubes↗
PubMed1994

Three years' experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax.

In a prospective study (June 1990 to June 1993), 79 patients were treated for spontaneous pneumothorax by video-assisted thoracoscopic methods with regular follow-up. The observation time was from 3 to 36 months (mean 19.6 months) and was more than 24 months in 27 patients. In 57 patients spontaneous pneumothorax was primary and in 22 secondary. The 53 male and 26 female patients were aged between 17 and 87 years (mean 37 years). Twenty-one patients were treated thoracoscopically for first episode, 22 for persistent pneumothorax (> 7 days), and 36 for a recurrence. Endoscopic examination failed to reveal any lung alteration in four patients (5.1%), and treatment then consisted of simple drainage. Leaks were sealed 26 times by means of a Roeder loop with local anesthesia and 14 times by wedge resection with endotracheal anesthesia and one-lung ventilation; 34 patients were treated by pleurectomy. No deaths occurred. Surgical morbidity was 3.8%, and the postoperative complication rate was 5.1%. One patient was excluded from the follow-up study after conversion to a thoracotomy for control of arterial bleeding. We noted six recurrences; four occurred in the first 21 days and three after ligation of the leak with a Roeder loop. We conclude that video-assisted thoracoscopic treatment of spontaneous pneumothorax by wedge resection and pleurectomy has a recurrence-free rate of 93.8% (45/48) and is therefore an effective treatment for all forms of spontaneous pneumothorax.

Adolescent↗
PubMed1993

Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use.

Occult pneumothorax is defined as a pneumothorax that is detected by abdominal computed tomographic (CT) scanning, but not routine supine screening chest roentgenograms. Forty trauma patients with occult pneumothorax were prospectively randomized to management with tube thoracostomy (n = 19) or observation (n = 21) without regard to the possible need for positive pressure ventilation, to test the hypothesis that tube thoracostomy is unnecessary in this entity. Eight of the 21 patients observed had progression of their pneumothoraces on positive pressure ventilation, with three developing tension pneumothorax. None of the patients with tube thoracostomy suffered major complications as a result of the procedure. Hospital and ICU lengths of stay were not increased by tube thoracostomy. Patients with occult pneumothorax who require positive pressure ventilation should undergo tube thoracostomy.

Adolescent↗
PubMed1993

Spontaneous pneumothorax in patients with the human immunodeficiency virus: study of eight cases.

OBJECTIVE: To evaluate the risk factors and the natural history of spontaneous pneumothorax in patients with human immunodeficiency virus infection (HIV). METHODS: We studied eight HIV infected patients with spontaneous pneumothorax. Variables assessed included sex, age, risk factor for HIV infection, use of Pneumocystis carinii pneumonia prophylaxis, total and CD4 positive lymphocyte count, previous history of Pneumocystis carinii pneumonia or pulmonary tuberculosis, chest X-ray film, presence of simultaneous opportunistic infection, partial pressure of oxygen in arterial blood gas determination and clinical outcome. RESULTS: The patients were predominantly male and intravenous drug abusers. Mean age was 28 years (range: 21-44). Five patients had acquired immunodeficiency syndrome, 2 oral candidiasis and one asymptomatic HIV infection. Three had previously had Pneumocystis carinii pneumonia and six a concurrent opportunistic infection. No one was receiving aerosolized pentamidine prophylaxis. The pneumothorax was bilateral in two cases. Chest tube evacuation was required in seven, and six patients died. Only two patients without opportunistic infection were discharged. CONCLUSIONS: We conclude that spontaneous pneumothorax is a serious problem with high mortality in patients with advanced human immunodeficiency virus infection. Previous or active Pneumocystis carinii pneumonia appear to be a risk factor for developing pneumothorax. It seems to be independent of aerosolized pentamidine use.

AIDS-Related Opportunistic Infections↗
PubMed1993

Medical therapy for recurring catamenial pneumothorax following pleurodesis.

BACKGROUND: Catamenial pneumothorax, a rare complication of systemic endometriosis, has been difficult to treat successfully. Successful medical therapy is associated with amenorrhea. CASE: A 44-year-old white woman with recurring catamenial pneumothorax underwent thoracotomy and abrasive pleurodesis. Following the procedures, pneumothorax occurred again and she was treated with the GnRH analogue leuprolide acetate, 3.75 mg monthly intramuscularly. After 6 months, her therapy was changed to continuous hormonal suppression with norethindrone, 0.7 mg/day. After 6 months of this therapy and into the third episode of vaginal bleeding, the patient had another recurrent pneumothorax. CONCLUSION: Leuprolide acetate followed by continuous hormonal suppression with norethindrone was successful for 1 year in resolving recurring postsurgical catamenial pneumothorax, but the problem recurred with the resumption of vaginal bleeding during progestin therapy. Successful medical therapy requires amenorrhea.

Adult↗
PubMed1993

Videothoracoscopy in the treatment of spontaneous pneumothorax: an initial experience.

We report an initial experience with the new and potentially advantageous technique of videothoracoscopy in the treatment of pneumothorax. A series of 18 consecutive patients (14 male, 4 female) presenting with spontaneous pneumothorax over a 4-month period underwent surgical treatment by this method. The indication for surgery was recurrent pneumothorax in nine patients and persistent air leak in the remainder (median duration 15 days, range 5-28 days). Stapled apical bullectomy with apical parietal pleurectomy was performed in 14 patients, bullectomy alone was performed in one patient and pleurectomy alone in three patients. Additional talc pleurodesis was carried out in three of these patients. Median duration of operation was 53.5 min (range 35-120 min). The median postoperative drainage was 300 ml in 24 h (range 50-580 ml). The median duration of intercostal drainage was 48 h (range 24-384 h) and of postoperative hospital stay 4 days (range 3-18 days). The mean postoperative analgesic requirement was 1.3 mg morphine/h. Three complications required reoperation. In two patients a large air leak persisted after operation; one proceeded to thoracotomy for suturing of the air leak and in the other this was accomplished by videothoracoscopy. A further patient re-presented at 2 weeks with recurrent pneumothorax which was treated at thoracotomy. At a median follow-up of 68.5 days (range 10-124 days) this is the only recurrence. These complications were caused by errors in surgical technique early in our series. This initial experience of videothoracoscopic pleurectomy suggests it is an effective, well-tolerated treatment of spontaneous pneumothorax.

Adolescent↗
PubMed1995

[Thoracoscopy in persistent or recurrent spontaneous pneumothorax].

To assess the value of thoracoscopy in spontaneous pneumothorax, the procedure and results of thoracoscopy by using fiberoptic bronchoscope and rigid cold-light thoracoscope in 50 patients with persistent or recurrent pneumothorax were reported. We found subpleural blebs or bullae in 35 cases and adhesions preventing lung expansion in 10 cases. The histologic diagnosis following thoracoscopic biopsy in 13 patients showed non-specific inflammation in 12 cases and tuberculosis in one case. The overall diagnostic rate was 92% (46/50). 5 cases were cured with transendoscopical Nd-YAG laser cauterisation of the blebs or bullae not exceeding 1 cm in diameter. There were no side effects after the procedure, and no recurrence was observed in a follow-up of 24 months. 40 patients were treated with intrapleural talcum power under thoracoscopic control. The postoperative complications were transient fever and chest pain and recurrence was observed in two cases only (5%) during 2-7 years of follow-up. It is concluded that thoracoscopy enables accurate assessment of the causes of pneumothorax, talc pleurodesis is a very effective method of controlling recurrent and persistent pneumothorax, and laser therapy can play an important role in selected patients with spontaneous pneumothorax.

Adolescent↗
PubMed1997

[A case of non-smoking female with peripheral small lung squamous cell carcinoma discovered after operation of spontaneous pneumothorax].

We have experienced a lung cancer patient discovered after operation of pneumothorax by chance. The patient was 44-year-old female who had been followed up for right pneumothorax in menstruation. She got pneumothorax in menstruation recurrently complained of chest pain. Chest X-p revealed right pneumothorax. We never discovered views of catamenial pneumothorax by thoracoscopy. Partial resection of hypertrophic pleura of right S1 was performed by video assist thoracoscopic surgery. Histological diagnosis was bulla formation with a tiny focus of squamous cell carcinoma in situ. In addition, right upper lobectomy and lymph node dissection were performed. Metastasis was not recognized any lymph node. No recurrence has been observed for 17 months.

Adult↗
PubMed1997

[Spontaneous pneumothorax].

Pneumothorax corresponds to the extravasation of air in the pleural cavity. This produces a partial or complete collapse of the adjacent lung. This is a common thorax disease resulting from a leak between the broncho-pulmonary gas compartment and the usually virtual pleural space. Pneumothorax is called spontaneous when no traumatic or iatrogenic factors are present. Spontaneous pneumothorax can be primary (when no radiographic or clinical injuries can be detected) or secondary to an underlying pulmonary disorder. Evolution of spontaneous pneumothorax is usually benign. However, recurrence is frequent. Preventing recurrences is the basis of all the therapeutic controversies which, after drainage, are based on pleurodesia indications. Vital prognosis may be compromised when pneumothorax is compressive, bilateral, or when it results in respiratory failure in patients with chronic respiratory insufficiency.

Humans↗
PubMed1997

[Contralateral pneumothorax after lung resection].

Nine hundred and seventy-three consecutive patients were referred to our hospital for thoracotomy to treat chest diseases between January 1, 1981, and December 31, 1995. Of these patients, 20 males were readmitted within a mean of 20 months with a diagnosis of contralateral pneumothorax. Sixteen of the patients with a mean age of 28.5 years (range 16-76 years of age) had been operated on for bullous lung disease. The remaining four, with a mean age of 60.8 years (range 54-71), had been operated on for lung cancer. All of the 20 patients had received unilateral thoracotomy for lung resection. One patient had undergone pneumonectomy for lung cancer; three had undergone lobectomy; and 16 had been treated by partial lung resection. The patient who had undergone pneumonectomy was found to have contralateral pulmonary metastasis of lung cancer. In the other 19 patients, emphysematous bulla was the origin of the contralateral pneumothorax. The mean value of body mass index (BMI) of the group was 18.4 as compared to 21.7 in the patients who did not go on to develop contralateral pneumothorax, a significant difference (p < 0.05). In conclusion, postoperative contralateral pneumothorax was correlated to the existence of emphysematous changes of the lung and a significantly lower BMI. We conclude that patients with BMIs less than 20 may be at increased risk of developing postoperative contralateral pneumothorax.

Adolescent↗
PubMed1998

[A case of primary lung cancer presenting as pneumothorax].

A 62-year-old man presented pneumothorax as a first manifestation of lung cancer was described. The patient complained right side chest pain and dry cough of 6 days duration. On the day of admission, a chest radiograph showed a large pneumothorax on the right. After 3 days of tube drainage, the lung was re-expanded and a chest radiograph showed a mass density above the right hilum. A chest CT revealed a cavitating tumor of the right upper lobe with a fistula to the pleural space. Right upper lobectomy was performed, and the histology was squamous cell carcinoma. The cause of pneumothorax was bronchopleural fistula secondary to rapid growth of the cancer. Pneumothorax due to primary lung cancer is rare and the prognosis is poor because the cancer was advanced stage or diagnosis of cancer was delayed in the literature review. Lung cancer should always be considered as a possible cause of pneumothorax, and it is important to diagnose lung cancer as soon as possible.

Carcinoma, Squamous Cell↗
PubMed1998

[Catamenial pneumothorax under video-assisted thoracoscopic surgery: a case report].

A 46-year-old woman complained four times of chest pains due to repeated right pneumothorax. This was improved by the right thoracic drainage each time. She was diagnosed as having catamenial pneumothorax from the fact that each episode of pneumothorax began with the first day of her menstrual cycle. She was admitted to our hospital in Jan. 1996 and operated on by the obliteration of pleuro-peritoneal fistulas on right diaphragm under video-assisted thoracoscopic surgery (VATS). No other abnormal lesions were found in the right pleural cavity and right lung. In this case, the pathophysiological mechanisms of pneumothorax might have been caused by the air influx from the peritoneal cavity to the right pleural cavity through the fistulas on the right diaphragm. VATS is minimally invasive surgery and very useful for the treatment of pleuro-peritoneal fistulas on the diaphragm. It should be emphasized that hormonal therapy is necessary after VATS of catamenial pneumothorax.

Endoscopy↗
PubMed2004

Spontaneous pneumothorax in scleroderma.

We present an illustrative case of a patient with advanced scleroderma who presented with a spontaneous pneumothorax, a condition that has only rarely been reported previously in association with scleroderma. Our patient and those previously reported had advanced pulmonary fibrosis with honeycombing and subpleural cysts, with spontaneous pneumothorax occurring secondary to cyst rupture. Our patient was treated with chest tube thoracostomy, but her spontaneous pneumothorax later recurred. She was then treated with talc pleurodesis and has not had a recurrence in 18 months of follow-up.Spontaneous pneumothorax remains a rare pulmonary manifestation of scleroderma, occurring only in patients with advanced pulmonary fibrosis associated with cyst formation and rupture. Initial management consists of chest tube insertion, but recurrence is high and may require pleurodesis or partial lobectomy. Physicians managing patients with scleroderma should be aware of spontaneous pneumothorax, especially in those with advanced pulmonary fibrosis and subpleural cysts.

Journal Article↗
PubMed1989

[Treatment of spontaneous pneumothorax].

Experience with 300 episodes of spontaneous pneumothorax in 209 patients is reported. The treatment results of two time periods 1980-1983 (A) and 1985-1987 (B) are compared. During the second period the diagnostic work-up was much more extensive and included pleurography, CT-scan and thoracoscopy. This resulted in a more differentiated therapy and a reduction in the recurrence rate from 41% to 22%. Among the different modes of treatment chest-tube drainage alone had the worst results with a 44% rate of early and late recurrence. Better results were obtained with pleurodesis using fibrin adhesive either through a pleural catheter (24%) or thoracoscopically (13%). Operative treatment had the lowest recurrence rate (4%). In the primary treatment of spontaneous pneumothorax chest-tube drainage had a recurrence rate of 33% and catheter-pleurodesis with fibrin adhesive of 18% while no relapse could be observed in the group treated by thoracoscopy or operation. In the treatment of recurrent pneumothorax chest-tube drainage alone is unsuitable because of a failure rate of 64%. Catheter pleurodesis also had a high rate of recurrence (30%). The best results were again obtained by thoracoscopic (19%) and operative treatment (4%). On the basis of the described experience an individualized approach to the treatment of spontaneous pneumothorax is recommended.

Adolescent↗
PubMed1995

Localized pneumothorax with lobar collapse and diffuse obstructive airway disease.

Localized pneumothorax adjacent to a collapsed lobe has been reported in children with bronchial obstruction. We present our findings in seven children with a similar phenomenon occurring in association with diffuse obstructive airway disease. The children, aged from 3 weeks to 17 years, were admitted for diffuse obstructive airway disease and, subsequently, developed lobar collapse with adjacent localized pneumothorax. In five of the seven patients there was a paradoxical shift of the mediastinum toward the side of the pneumothorax. In six cases, the pneumothorax resolved spontaneously with lobar reexpansion. A conservative treatment approach to patients with this constellation of radiographic findings appears justified.

Adolescent↗
PubMed2003

Familial spontaneous pneumothorax in three generations and its HLA.

We experienced a case of familial spontaneous pneumothorax in three generations. Six of 13 family members had episodes of spontaneous pneumothorax. It is well established that there are some diseases associated with human leukocyte antigen (HLA). We performed HLA phenotyping for HLA of A, B and C. In our study, we detected the HLA haplotype A2, B61 in three of 4 who had episodes of spontaneous pneumothorax. The HLA haplotype A2, B70 were also detected in three of 4 who had episodes. This suggests that familial spontaneous pneumothorax might have hereditary factors.

Adolescent↗
PubMed2002

Pneumothorax manifesting primary lung cancer.

Pneumothorax is a rare lung cancer manifestation. We report 2 patients in which pneumothorax occurred as a first manifestation of lung cancer. Postoperative lung tissue examination after pneumothorax showed lung cancer by chance. One patient had dissemination suspected due to ruptured bulla with adenocarcinoma. Both immediately underwent additional lobectomy with mediastinal lymphadenectomy after lung cancer was diagnosed, but we detected lung cancer recurrence in the bottom of the pleural cavity on the same side some 11 months after radical surgery in the patient suspected of dissemination. We could resect it completely, followed by adjuvant radiotherapy. The possibility of lung cancer should thus be considered in pneumothorax patients, even if middle-aged.

Adenocarcinoma↗
PubMed2001

Life-threatening pneumothorax of the ventilated lung during thoracoscopic pleurectomy.

PURPOSE: To report the case of a patient who underwent right thoracoscopic pleurectomy with lung exclusion and developed contralateral (left) pneumothorax with resulting life-threatening alteration of the respiratory and cardiovascular functions. CLINICAL FEATURES: A 28-yr-old male was admitted to the intensive care unit for a well tolerated, second episode of spontaneous right pneumothorax and scheduled for right thoracoscopic pleurectomy. Anesthesia was induced and maintained with sufentanil and propofol. A double lumen endotracheal tube (ETT) was inserted, its correct positioning checked clinically and by fiberoptic bronchoscopy and the patient was placed in the left decubitus position. Approximately one hour into the procedure, during the second period of right pulmonary exclusion, SpO2 values decreased within two minutes to 78%. End tidal capnography (EtCO2) values decreased to 6-8 mmHg within seconds and peak airway pressure increased to values between 50 and 60 cm H2O. Severe cyanosis, sinus bradycardia and arterial hypotension developed. The surgical procedure was stopped, propofol administration discontinued, bipulmonary ventilation reinstituted and the patient placed in the supine position which restored hemodynamic and respiratory function. Inspection and auscultation were consistent with tension left pneumothorax which was evacuated. CONCLUSION: Pneumothorax of the ventilated lung during one lung ventilation for thoracoscopic procedures must be diagnosed quickly. Reinstitution of bipulmonary ventilation should probably be the first therapeutic attitude.

Adult↗