Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PNEUMOTHORAX”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2006

Congenital bronchial atresia associated with spontaneous pneumothorax.

A 36-year-old woman presented with left chest pain and frequent symptoms of upper respiratory infection. Chest roentgenograms revealed a left pneumothorax and apical bulla, and hyperlucency in the left pulmonary field. She was diagnosed with congenital bronchial atresia associated with a left spontaneous pneumothorax. A thoracoscopy-assisted left superior segmentectomy was performed. There was no recurrence of the pneumothorax or symptoms of recurrent upper respiratory infection at the 1-year follow-up examination. Bulla formation was believed to have resulted from emphysematous changes in the peripheral lung due to congenital bronchial atresia. The pneumothorax may have occurred due to rupture of the bulla.

Adult↗
PubMed2006

Management of spontaneous pneumothorax.

Management of patients with a spontaneous pneumothorax continues to challenge clinicians. Recent guidelines help provide care pathways for these patients and highlight the many areas in need of additional study. Management options for spontaneous pneumothoraces should be selected based primarily upon a patient's clinical status. Observation or pleural air drainage, in selected patients, plays a significant role in patients with primary spontaneous pneumothorax. By contrast, pleural air drainage plays the central role in patients with a secondary spontaneous pneumothorax. Surgically directed recurrence prevention and air leak management are preferred for both primary and secondary spontaneous pneumothorax patients.

Drainage↗
PubMed2005

Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia.

OBJECTIVE: VATS using the conventional three ports is currently the technique of choice for blebectomy/bullectomy for spontaneous pneumothorax. However, the procedure has recently been shown to have neurological complications related to the port sites. Uniportal VATS has recently been proposed as an alternative to conventional three-port VATS. It is anticipated that the single incision will predispose to a lower incidence of neurological complications. METHODS: We report our initial single surgeon experience of uniportal VATS (n = 16) and provide a comparison of post-operative pain and residual paraesthesia to conventional three-port procedures (n = 19) for the same pathology. RESULTS: In both groups, the pneumothorax pathology was principally primary. There was no difference between the groups in terms of age, spirometry, tissue resected, drainage time and inpatient stay. A difference was, however, noted in inpatient pain scores. The uniportal group had a lower median score of 0.4 (visual analogue range 0-4) while the three-port technique reported 0.8 (P = 0.06, Mann-Whitney test). The maximum score trend was similar (1.4 vs. 2.6, respectively, P < 0.001, Mann-Whitney test). Follow-up for uniportal and three-port VATS averaged 9.4+/-6.6 and 32.1+/-9.9 months, respectively. One patient in the three-port group had a pneumothorax recurrence. Three-port VATS also had a higher residual pain score (0.5) compared to uniportal VATS (0.3). Of clinical significance was the incidence of neurological complications. Eighty-six percent of uniportal patients reported no symptoms. The remaining experienced only mild 'numbness' or 'swelling'. However, in the three-port group, only 42% reported no symptoms. A similar number experienced 'numbness'. Two females described sexual dysfunction due to altered breast sensitivity. Seventeen percent (2/12) reported 'pins and needles'. CONCLUSIONS: Uniportal VATS appears to be tolerable, safe and efficient in treating spontaneous pneumothorax in our series. Moreover, post-operative pain and paraesthesia incidence was lower than three-port VATS. Prospective randomised trials are important to evaluate this technique.

Adolescent↗
PubMed2006

Preliminary report of a prospective, randomized trial of underwater seal for spontaneous and iatrogenic pneumothorax.

BACKGROUND: Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. STUDY DESIGN: From April 2001 through October 2003 patients with iatrogenic or spontaneous pneumothorax were enrolled in this prospective, randomized trial. Small-bore catheters were inserted. Initial management was 1 hour -20 cm H2O suction, chest radiography, and randomization into -20 cm H2O suction, -10 cm H2O suction, or underwater seal. Tubes were discontinued at 48 hours if there were no pneumothoraces and no air leaks. Those with air leaks and recurrent pneumothoraces persisting 5 days underwent pleurodesis. The primary end point was successful chest tube removal at 48 hours. The secondary end point was need for pleurodesis. RESULTS: Twenty-nine patients were analyzed. Seven were randomized to -20 cm H2O suction, 11 to -10 cm H2O suction, and 11 to underwater seal. Most (59%, 17 of 29) chest tubes were successfully removed 48 hours after placement: 57% (4 of 7) after -20 cm H2O suction, 73% (8 of 11) after -10 cm H2O suction, and 45% (5 of 11) after underwater seal (p = 0.48). Seven (24%) required pleurodesis: 29% (2 of 7) after -20 cm H2O suction, 27% (3 of 11) after -10 cm H2O suction, and 18% (2 of 11) after underwater seal (p = 0.70). CONCLUSIONS: Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.

Adolescent↗
PubMed2006

Comparison between two methods for estimating pneumothorax size from chest X-rays.

AIM: To compare the estimated size of spontaneous pneumothoraces using the established Rhea inter-pleural distances method with the CT-derived Collins method. METHOD: Adult patients with spontaneous pneumothorax treated conservatively were identified from the ED databases. X-rays were reviewed independently by two researchers and measured according to the methods described by Rhea and Collins. Estimates of size derived by the two methods were compared using bias plot analysis techniques. RESULTS: A total of 156 X-rays in 57 patients were identified. A total of 82% were male with a median age of 22 years. Pneumothoraces varied in size from 4% to 88%. The average difference between methods was 4% (Collins method estimating larger size) with 95% limits of agreement -3.8% to 11.7%. Agreement was very close for small pneumothoraces but deteriorated with increasing pneumothorax size (Collins methods estimated larger pneumothorax size). CONCLUSION: The Rhea method for estimating pneumothorax size is acceptably accurate for smaller pneumothoraces but may significantly under-estimate the size of larger pneumothoraces.

Adult↗
PubMed2002

Prevention of postoperative pneumothorax in patients undergoing cardiac surgery.

BACKGROUND: Postoperative pneumothorax is a potentially fatal complication occurring in approximately 1.4% of patients after cardiac surgical procedures. Prevention of this complication could save lives, morbidity, and money in this large patient population. This study was undertaken to evaluate the effectiveness of a very simple technique to prevent this complication. METHODS: One thousand three hundred and ninety-seven consecutive adult patients undergoing cardiac surgical procedures performed by the author were evaluated. In each patient a 3-cm opening in the mediastinal pleura of any unopened hemithorax was performed to allow communication of the pleural space with the mediastinum. When a hemithorax had been opened for internal mammary harvesting, the usual pleural drain was inserted. A standard, straight mediastinal tube was then placed in routine fashion without any additional tube placement or unusual positioning. The essence of the approach was the establishment of communication of both pleural spaces with the mediastinum in such a way that any air exiting the lung would be able to evacuate through the mediastinal tube. RESULTS: One patient with obstructive lung disease developed a loculated basilar pneumothorax that was treated with chest tube placement. Two patients required maintenance of mediastinal tube drainage for persistent air leak for 7 and 9 days, respectively. No other patients required chest tube placement for pneumothorax. No patient experienced any complication that could be attributed to the small opening in the pleural space. CONCLUSIONS: The technique herein described is a safe and effective method for prevention of postoperative pneumothorax. It adds nothing to the cost of the surgical procedure. The author would recommend that this technique be adopted as a surgical routine.

Adult↗
PubMed2000

Primary spontaneous pneumothorax: one-stage treatment by bilateral videothoracoscopy.

BACKGROUND: The goal of the study was to report our 7-year experience with single-stage bilateral videothoracoscopy for bleb excision and pleural abrasion in patients suffering primary spontaneous pneumothorax. METHODS: From November 1992 through June 1999, 12 men were operated on in our department. Preoperative chest computed tomographic scans were obtained for all patients. Operative indications included simultaneous bilateral pneumothorax (n = 2), contralateral recurrence (n = 1), ipsilateral recurrence with contralateral blebs or bullae, and job restrictions (n = 9). RESULTS: Mean age at operation was 26+/-6 years. All patients had multiple blebs or bullae located in upper lobes, and 4 patients (33%) had pleural adhesions. All blebs or bullae were resected at operation. The mean number of staple cartridges was 5 per patient (range, 3 to 8). All patients had bilateral pleurabrasion. There were no perioperative complications and no conversion to thoracotomy. The mean operative time was 168+/-17 minutes (range, 140 to 190 minutes). The mean drainage time was 5 days (range, 4 to 26 days) and the mean hospital stay was 7.7+/-1.4 days for 11 of 12 patients. Postoperative complications included prolonged air leak (16.5%), incomplete lung reexpansion (25%), and pleural effusion (8.5%). One patient required reoperation on the right side through transaxillary thoracotomy within 1 month of videothoracoscopy for pleurodesis failure. Follow-up was 100% complete. Mean follow-up is 50+/-34 months (range, 9 to 88 months) and no patient has had recurrence of pneumothorax. All patients except one returned to full occupational activity within 5 weeks of surgery. CONCLUSIONS: Single-stage bilateral videothoracoscopy for bilateral bleb excision and pleurabrasion is a safe procedure that does not result in major complications and provides excellent long-term results. This approach could be considered in young patients with bilateral primary spontaneous pneumothorax, or in those requiring radical therapy for the prevention of ipsilateral and contralateral recurrences.

Adolescent↗
PubMed2002

Catamenial pneumothorax: chest X-ray sign and thoracoscopic treatment.

We report the case of a 25-year-old woman with recurrent right-sided catamenial pneumothorax. At thoracoscopy, the diaphragm presented several violet implants with holes. The presence of diaphragmatic endometrial implants was confirmed at pathologic examination. Re-review of the preoperative chest x-ray film showed 8 x 5 and 1 x 1 mm bubbles at the level of the right diaphragm associated with the homolateral pneumothorax, thus suggesting that passage of air from the genital tract through the diaphragm was responsible for the pneumothorax. This may further clarify the pathogenesis of catamenial pneumothorax which remains controversial in the literature.

Adult↗
PubMed2003

Catamenial pneumothorax: retrospective study of surgical treatment.

BACKGROUND: Catamenial pneumothorax is a rare entity characterized by recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is also associated with a high rate of postoperative recurrence. The aim of this study was to discuss the etiology and to determine the optimal surgical treatment of this entity. METHODS: From December 1991 to September 2000, 10 patients with catamenial pneumothorax were treated at our institution. Median age at time of operation was 37 years (range, 21 to 44 years). We retrospectively evaluated the pathologic findings, the operation performed, and the results in all patients. The mean follow-up was 55.7 months. RESULTS: Pleurodesis alone was performed in 5 patients and an associated diaphragmatic procedure was performed in 5 patients. In 5 patients, no diaphragmatic anomaly was discovered: 3 experienced one or more recurrences and all still suffer from chronic catamenial chest pain. Hormonal therapy temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5 patients surgical pleurodesis was associated with the repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence (n = 0/5, p = 0.0016) and no subsequent catamenial chest pain. CONCLUSIONS: The postoperative outcome is influenced by the diagnosis of diaphragmatic defects with or without endometriosis. Surgical treatment should be accomplished during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. Because diaphragmatic lesion is frequent and may be occult, we propose the systematic coverage of the diaphragmatic surface by a polyglactin mesh to prevent catamenial pneumothorax recurrence even when the diaphragm appears normal.

Adult↗
PubMed2003

Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study.

BACKGROUND: The objectives of the study were to review our experience of video-assisted thoracoscopic apical pleurectomy and to evaluate whether suction or water seal is superior in the postoperative treatment of primary spontaneous pneumothorax. METHODS: One hundred consecutive patients undergoing thoracoscopy for primary spontaneous pneumothorax from January 1995 to December 1999 were prospectively randomly assigned after surgery to receive suction or water seal to their chest tubes after a brief period of suction. RESULTS: There were 50 patients in each group. The two groups were evenly matched for age and operation performed. The method of management was stapling of an identified bleb or apex of the upper lobe and apical pleurectomy. Postoperative prolonged air leak longer than 5 days occurred in 8 patients (8%), 7 in the suction group and 1 in the water seal group (p = 0.03). The mean duration of chest tube days was lower in the water seal group (2.7 days) than in the suction group (3.8 days; p = 0.004). The mean hospital stay in the water seal group was 3.7 days and in the suction group it was 4.8 days (p = 0.004). Mean follow-up was 48 months (range, 30 to 60) for all patients. Pneumothorax recurred in 2 patients (2%). The recurrences occurred in the first year. CONCLUSIONS: Video-assisted thoracoscopic apical pleurectomy is effective and safe for treating primary spontaneous pneumothorax. Placing chest tubes on water seal after a brief period of suction shortens the duration of chest tube placement and hence the hospital stay.

Adolescent↗
PubMed2003

Thoracoscopic ipsilateral approach to contralateral bullous lesion in patients with bilateral spontaneous pneumothorax.

BACKGROUND: Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgical practice. This study describes a novel ipsilateral approach to a contralateral bullous lesion using VATS to achieve simultaneous bilateral bleb excision and pleurodesis. METHODS: From 2001 to 2003, 6 patients underwent our ipsilateral approach with VATS for bilateral pneumothorax. The clinical features, surgical indications, and patient outcomes were reviewed. RESULTS: All the patients were men between 18 and 35 years old (mean age, 25.8 years). The ipsilateral-approach VATS procedure for bilateral pneumothorax was performed successfully in 4 patients. Two patients were switched to a one-stage sequential bilateral VATS procedure. The bullous lesions were at the apex or confined to the upper lobe in 5 patients; multiple lobes were involved in 1 patient. The bullae were resected with an Endo-GIA stapler or ligated with a homemade endoloop. The mean duration of operation was 54.8 minutes. The mean time of chest tube removal was 4.7 days after insertion, and the mean postoperative stay was 5.7 days. There was no recurrence of pneumothorax during the follow-up period. CONCLUSIONS: The thoracoscopic ipsilateral approach is technically feasible for treating patients with bilateral pneumothorax.

Female↗
PubMed1983

Iatrogenic pneumothorax and mortality in congenital diaphragmatic hernia.

In a review of 22 infants who underwent surgical repair of congenital diaphragmatic hernias, it was noted that one of the most common factors correlating with death was perioperative tension pneumothorax. Each of the seven infants who died developed an iatrogenic pneumothorax with air leak due to face-mask or endotracheal ventilation with pressures in excess of 34 cm H2O, or to thoracentesis. Only two infants with tension pneumothorax survived. Infants who developed tension pneumothorax experienced severe respiratory distress at an earlier age and required more vigorous resuscitative measures than those infants without an air leak.

Female↗
PubMed1982

Pneumothorax in cystic fibrosis: management and outcome.

We reviewed our experience over the past 12 years to determine the best method of management, to determine the morbidity and the physiologic outcome of medical vs surgical treatment of pneumothorax complicating CF, and to assess the influence of age, sex, and Shwachman scores on survival. Sixty-five patients, ages ranging from 5 to 32 years (mean 18 years). Shwachman scores ranging from 25 to 87 (mean 57), and a male-female ratio of 1:1, experienced 170 pneumothoraces, 93 first episodes, and 77 recurrences, requiring 211 trials of management. All methods of management except needle aspiration resulted in a fair rate of resolution (70 to 100%), but recurrence rates were high for observation (60%), needle aspiration (79%), trocar thoracotomy (63%), tetracycline sclerosis (86%), and silver nitrate sclerosis (43%). The recurrence rates were 12.5% for quinacrine sclerosis and 0% for parietal pleurectomy. Quinacrine sclerosis and parietal pleurectomy were the most effective methods of management. There was no significant difference in pulmonary function before pneumothorax and after pleural sclerosis or parietal pleurectomy. Age, sex, and severity of pulmonary disease were all independent variables influencing prognosis. Severity of disease, rather than the occurrence of a pneumothorax, appears to be the major cause of death. We recommend that quinacrine sclerosis should be considered for management of the first pneumothorax, and parietal pleurectomy if it fails.

Adolescent↗
PubMed2000

Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy.

OBJECTIVE: To determine independent predictors for the development of hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. METHODS: We reviewed 968 laparoscopic cases between January 1, 1997, and December 31, 1998. Patients who had hypercarbia (end-tidal carbon dioxide of 50 mmHg or greater), pneumothorax/pneumomediastinum, and subcutaneous emphysema were compared with controls according to age, operative time, type of surgery, extraperitoneal or intraperitoneal approach, preexisting medical conditions, body mass index, sex, use of Hasson technique, and number of surgical ports. Maximum positive end-tidal CO(2) (PETCO(2)) was added as an independent variable for subcutaneous emphysema, pneumothorax, and pneumomediastinum. Data were analyzed using univariate analysis and then subjected to multivariate analysis using multiple logistic regression analysis. RESULTS: Incidence rates were 5.5% for hypercarbia, 2.3% for subcutaneous emphysema, and 1.9% for pneumothorax/ pneumomediastinum. Independent risk factors for development of hypercarbia were operative time greater than 200 minutes (odds ratio [OR] 2.02), patient age greater than 65 years (OR 2.19), and Nissen fundoplication surgery (OR 3.18). Predictors of the development of subcutaneous emphysema were PETCO(2) greater than 50 mmHg (OR 3.49), operative time greater than 200 minutes (OR 5.27), and the use of six or more surgical ports (OR 3.06). Variables that predicted the development of pneumothorax and/or pneumomediastinum were PETCO(2) greater than 50 mmHg (OR 4. 15) and operative time greater than 200 minutes (OR 20.49). CONCLUSION: Longer operative times, higher maximum measured end-tidal CO(2), greater number of surgical ports, older patient age, and Nissen fundoplication surgery predispose patients to hypercarbia-related complications during laparoscopy.

Adult↗
PubMed1998

Pleurotomy, pneumothorax, and surveillance during living donor nephroureterectomy.

OBJECTIVES: To determine the incidence of and risk factors associated with pneumothorax after donor nephroureterectomy and to determine the utility of postoperative chest roentgenography. METHODS: A retrospective review was made of 130 living donor nephroureterectomies performed at one institution (Yale-New Haven Hospital) using an extraperitoneal flank incision. RESULTS: Incidental pleurotomy occurred in 11 cases (8.5%). Rib resection was associated with pleurotomy. Patient age, sex, and side of operation were not associated with pleurotomy. Ten (91 %) of the 11 cases were identified intraoperatively. One unrecognized pneumothorax was identified postoperatively with chest roentgenography; no specific intervention was necessary. CONCLUSIONS: The extraperitoneal flank incision poses a significant risk for pneumothorax. Most pneumothoraces will be recognized intraoperatively. No adverse effects were noted secondary to pneumothorax.

Adolescent↗
PubMed1993

Needle thoracostomy fails to detect a fatal tension pneumothorax.

Needle thoracostomy is an emergency procedure used to both diagnose and initially treat a tension pneumothorax. We report a case of fatal tension pneumothorax in an intubated patient with chronic obstructive pulmonary disease that was missed by this technique. A tension pneumothorax involving only the right middle and lower lobes was found at autopsy. The autopsy also suggested that needle thoracostomy was misleading because it sampled air from a noncommunicating bulla in the right upper lobe rather than from the pleural space. Tension physiology can exist with only localized collapse of a lung, and diagnostic needle thoracostomy can be falsely negative. When tension pneumothorax is strongly suspected, if empiric thoracentesis does not vent air under pressure, subsequent tube thoracostomy is indicated.

Acute Disease↗
PubMed1985

Left tension pneumothorax masquerading as anterior myocardial infarction.

Spontaneous pneumothorax is an emergency that can present with variable signs and symptoms. Diagnosis of pneumothorax can be difficult, particularly in patients who present with unusual clinical findings. The electrocardiographic changes that develop with left pneumothorax are not widely known and can mimic acute myocardial ischemia. Our patient was admitted to the Cardiovascular Intensive Care Unit because of characteristic changes on the electrocardiogram. An admission chest film revealed left tension pneumothorax.

Diagnosis, Differential↗
PubMed1997

Sports-related pneumothorax.

Pneumothorax and pneumomediastinum are rare complications of athletic activity. Spontaneous pneumothorax has been reported in association with several sports, but reports of pneumothorax associated with blunt trauma sustained during sporting activity are rare. We present a case series of patients in whom pneumothorax or pneumomediastinum developed as a result of blunt trauma sustained during participation in a contact sport.

Adult↗