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PubMed1982

Determining the size of pneumothorax in the upright patient.

A simple measurement, the average interpleural distance (AID), which is obtained from three linear measurements, closely predicts true pneumothorax size as determined by radiographic thoracic gas volume measurement (mean variation -2.4 +/- 7.23 SD). The distribution of pneumothorax volume between the affected lung and the ipsilateral thoracic cage is variable and unpredictable. It was found that the average volume of pneumothorax that is accommodated by thoracic cage expansion (8%) is much less than previously reported. This appears to be the result of variable degrees of splinting and chest wall pain associated with pneumothorax.

Adolescent↗
PubMed1989

Pneumothorax: appearance on lateral chest radiographs.

The appearance of pneumothorax on lateral radiographs obtained with the patient erect were reviewed in 100 patients (122 total examinations). A pneumothorax could be seen on the lateral projection in 89% of the examinations (109 of 122). The displaced pleural line was most frequently identified anteriorly or posteriorly and was less commonly identified at the lung apex or in a subpulmonic location. In 11 cases, an air-fluid level was the only recognizable finding of a pneumothorax on the lateral projection. Although in 27% of examinations (32 of 122) the pneumothorax was either not seen (11%) (n = 13) or was a subtle finding (16%) (n = 19), in 14% of examinations (17 of 122) the lateral projection provided helpful information to supplement the posteroanterior projection.

Adult↗
PubMed1997

Outpatient treatment of iatrogenic pneumothorax after needle biopsy.

PURPOSE: To evaluate prospectively the feasibility of treating iatrogenic pneumothorax after fine-needle aspiration biopsy (FNAB) of the lung with short-term placement of a small-caliber chest tube and to determine whether a 1-hour clamping trial is adequate to identify patients with persistent air leak. MATERIALS AND METHODS: All patients undergoing FNAB of lung masses over a 28-month period were entered into the study. Patients with symptomatic, enlarging, or greater than 30% pneumothorax were treated with an 8-F chest tube. After 2 hours, the chest tube was clamped, and if the lung remained expanded for an additional hour, the chest tube was removed and the patients were discharged after a brief observation period. Patients were followed up by telephone after 24 hours. RESULTS: Three hundred fifteen patients underwent FNAB of the lung. Sixty-eight patients (22%) developed a pneumothorax. Chest tubes were placed in 14 patients (4%): Six patients (2%) required admission to the hospital (four for air leaks), and the other eight patients were treated successfully as outpatients, with removal of the chest tube before discharge the day of FNAB. CONCLUSION: Patients who develop clinically important pneumothorax after FNAB can be safely treated with short-term, small-caliber chest tubes and require hospital admission only if they demonstrate evidence of continued air leak.

Adolescent↗
PubMedDate not supplied

Chest tube drainage under radiological guidance for pleural effusion and pneumothorax in a tertiary care university teaching hospital: Review of 51 cases.

BACKGROUND: Chest tube drainage under radiological guidance has been used with increasing frequency as a treatment option for pleural effusions and pneumothoraxes. OBJECTIVE: To evaluate the safety and usefulness of pleural drainage under radiological guidance for pleural effusion and pneumothorax in a tertiary care university teaching hospital. METHODS: A retrospective study of cases of chest tube placement under radiological guidance over a 12-month period in a university hospital. RESULTS: Fifty-one percutaneous pigtail catheter drainage cases were reviewed (30 patients). Forty-six (90%) chest tubes were inserted as a first-line treatment. The overall success rate of radiological drainage was 88%. Specific success rates were 92%, 85% and 91% for loculated pleural effusion, pneumothorax and empyema, respectively. The complications were few and minor. CONCLUSIONS: Pigtail catheter insertion under radiological guidance is a useful procedure for the treatment of sterile pleural effusion, empyema and pneumothorax. This technique can be used as a first-line procedure in the majority of cases.

Adult↗
PubMed2002

Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue.

Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease.

Adult↗
PubMedDate not supplied

Wegener's granulomatosis with parotid gland involvement and pneumothorax.

OBJECTIVE: Wegener's granulomatosis is a systemic vasculitis characterized by necrotizing granulomatous lesions mostly involving the upper and lower respiratory tract. The disease rarely causes parotid gland involvement and pneumothorax. We report a case of Wegener's granulomatosis involving parotid gland, and complicated with a pneumothorax. CLINICAL PRESENTATION: A 45-year-old man admitted with a 3-week history of painful left parotid gland enlargement and hemoptysis. On physical examination a painful and hard mass was detected on the left pre-auricular area. Cervical CT revealed a 2 x 1.5 cm hypodense lesion mimicking an abscess on the left parotid gland. Chest radiograph and thorax CT demonstrated nodular and cavitating opacities on the right and left upper zones. There were numerous erythrocytes in urine sediment. The drained pus material from the parotid abscess demonstrated only gram-positive cocci (Staphylococcus aureus). Two weeks treatment with teicoplanin resulted in no improvement. Meanwhile, parotid gland biopsy revealed necrotizing granulomatous inflammation. There was a sixfold increase in serum cANCA levels. With the diagnosis of Wegener's granulomatosis, cyclophosphamide and prednisolone were initiated. However, 1 month later, pneumothorax developed as a complication of rupture of a cavitary lesion. CONCLUSION: Parotid gland swelling may be the initial presenting symptom of Wegener's granulomatosis. It can be confused with infectious or malignant diseases of the gland, and the lung involvement may be complicated with pneumothorax.

Diagnosis, Differential↗
PubMed2006

Diffuse cystic disease of the lung associated with simultaneous bilateral spontaneous pneumothorax: an unknown component of Caroli disease?

Simultaneous bilateral spontaneous pneumothorax is an uncommon and serious medical problem frequently related to an underlying lung disease such as parenchymal lung disease, inflammatory events or neoplasms. Recurrent pneumothorax associated with persistent air leakage may pose a therapeutic dilemma in patients with underlying lung diseases. Caroli disease (CD) is a very rare congenital disorder characterised by intrahepatic biliary cystic dilatations and frequently associated with polycystic kidney and hepatic fibrosis. To date, no relation between CD and the bilateral diffuse cystic structure of pulmonary parenchyma has been described. In this paper we present a patient with the diagnosis of CD in whom simultaneous bilateral spontaneous pneumothorax was the initial finding due to severe underlying pulmonary disease. Our patient's demographic and clinical characteristics, laboratory findings and course made us exclude the other aetiologies leading to such diffuse multi-bullous pulmonary involvement. The coincidence of recurrent pneumothorax and severe pulmonary disease has led to a big therapeutic dilemma. Open or minimally invasive surgery could be morbid or even mortal because of the nature of the parenchyma and the operative risk due to CD. Therefore, we suggest a unique conservative management including tube thoracostomy by locating the correct air spaces with the aid of high-resolution computed tomography followed by talc pleurodesis in patients with severe multi-bullous lung disease associated with potential risks due to co-morbidities.

Adult↗
PubMed1990

The antielastase screen of the lower respiratory tract of alpha 1-proteinase inhibitor-sufficient patients with emphysema or pneumothorax.

The present study was aimed at testing whether alpha 1-proteinase inhibitor-sufficient patients with lung emphysema or idiopathic spontaneous pneumothorax have an impaired antielastase protection at the lung alveolar level. We have collected bronchoalveolar lavage fluids (BALF) from 20 PIMM emphysematous patients (44 +/- 12 yr), 24 patients with pneumothorax but no radiologic evidence of emphysema (30 +/- 11 yr), 32 healthy subjects (27 +/- 6 yr), and 56 patients with sarcoidosis (30 +/- 11 yr). The BALF were assayed for immunoreactive albumin, alpha 1-proteinase inhibitor (alpha 1PI), leukocyte elastase-alpha 1PI complex (LE-alpha 1PI), and mucus proteinase inhibitor (MPI) as well as for porcine pancreatic elastase inhibitory capacity, a measure of active alpha 1PI. The healthy subjects and the patients with emphysema or pneumothorax had comparable levels of total and active alpha 1PI and total MPI. In contrast, the levels of LE-alpha 1PI complex were elevenfold higher in patients with emphysema than in normal subjects (p = 0.021) and tended to increase with the severity of the disease because they were negatively correlated with FEV1/FVC% (r = -0.55; 0.05 less than p less than 0.1). They did not vary with age in a population of patients with sarcoidosis (r = 0.03), suggesting that their eleven-fold increase in emphysematous patients is not related to the age of these subjects. Patients with pneumothorax had levels of LE-alpha 1PI complex that did not significantly differ from those of normal subjects (p = 0.24).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Open thoracotomy for pneumothorax in cystic fibrosis.

The results of open thoractomy and pleurectomy or pleural abrasion for 17 episodes of pneumothorax in patients with cystic fibrosis were compared with the results of observation, closed thoracostomy, and closed thoracostomy with sclerosing agents. Open thoracotomy had the advantage of insuring prompt resolution of the pneumothorax. A small incision minimized postoperative morbidity. The average hospital stay was 15 days after open thoracotomy and 19 days after closed thoracostomy, with or without sclerosing agents. Complications of all treatments were infrequent. A limited symptomatic recurrence was observed in 2 of 17 pneumothoraces successfully treated with open thoracotomy. Recurrence also occurred in 1 of 8 treated with observation, 3 of 9 treated with closed thoracostomy, and 1 of 14 treated with closed thoracostomy and sclerosing agents. A loss of vital capacity was usually noted 4 to 18 months after resolution, regardless of treatment. Forty per cent of patients in both operative and nonoperative groups survived 3 years. In our experience, open thoracotomy can be used safely for treatment of unresolved or recurrent pneumothorax and warrants further evaluation as a primary therapy for pneumothorax in patients with cystic fibrosis.

Cystic Fibrosis↗
PubMed1983

Immediate cardiovascular effects of tension pneumothorax.

We studied the immediate cardiovascular effects of unilateral tension pneumothorax in sheep, a species with an intact mediastinal pleura similar to that in humans. Adult animals were restrained in the prone position and studied in the conscious state to permit spontaneous respiratory adjustments. We measured pressures in the ipsilateral pleural space (Ppli), contralateral pleural space (Pplc), esophagus (Pes), pulmonary artery (Ppa), superior vena cava (Pcv), carotid artery (Ps), as well as thermodilution cardiac output (CO) and heart rate (HR). Acute unilateral pneumothorax of 0, 10, and 20 cmH2O tension produced no significant changes in mean Ps, Pcv, and CO at any level of tension, but it did produce a marked increase in HR at 10 and 20 cmH2O tension (p less than 0.05). Similar observations were made with unilateral pneumothorax of 15 cmH2O for 30 min. These results suggested that tension was transmitted incompletely to the mediastinum and contralateral hemithorax. This was confirmed by an increase from baseline of mean (+/- SE) end-expiratory Pes by 6.6 +/- 4.9 cmH2O and Pplc by 6.7 +/- 6.0 cmH2O, for an increase in Ppli by 20.5 +/- 4.0 cmH2O. The respiratory intrathoracic pressure fluctuations were accentuated with mean increases of 211, 78, and 117% in the ipsilateral pleural space, esophagus, and contralateral pleural space, respectively (p less than 0.05). When the increase in respiratory intrathoracic pressure fluctuations was prevented by artificial hyperventilation, CO decreased. We conclude that unilateral tension pneumothorax does not directly lower CO and Ps because of (1) incomplete transmission of the ipsilateral pleural pressure to the mediastinum and contralateral hemithorax, (2) marked respiratory intrathoracic pressure swings, and (3) compensatory tachycardia.

Animals↗
PubMed2004

Fluorescein-enhanced autofluorescence thoracoscopy in primary spontaneous pneumothorax.

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax, and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.

Administration, Inhalation↗
PubMed2005

Nonsense mutations in folliculin presenting as isolated familial spontaneous pneumothorax in adults.

RATIONALE: Approximately 10% of patients who have a spontaneous pneumothorax have a positive family history. OBJECTIVES: We sought to identify DNA sequence variations that confer susceptibility to pneumothoraces. METHODS: We collected 12 families that had at least 2 first-degree relatives with a spontaneous pneumothorax. All affected family members had no obvious stigmata of known genetic disorders associated with pneumothoraces. We used haplotype analysis, DNA sequencing, and restriction fragment analysis of mutations to evaluate the individuals in these families. MAIN RESULTS: In 2 of the 12 families the disorder cosegregated with markers flanking a candidate locus, FLCN. Sequencing the linked alleles revealed 2 mutations predicted to introduce premature stop codons in 2 of the 12 families. Most mutations in FLCN cause a rare disease, Birt-Hogg-Dubé syndrome, characterized by autosomal dominant inheritance of multiple benign skin lesions, renal tumors, pulmonary blebs, and pneumothoraces. None of the family members with the nonsense mutations had the skin manifestations of Birt-Hogg-Dubé syndrome or renal cancer. Pathologic examination of lung tissue from three affected nonsmokers revealed blebs and underlying emphysema. CONCLUSIONS: Isolated familial spontaneous pneumothorax can be caused by mutations of the FLCN gene. Because development of a pneumothorax and/or pulmonary blebs may be the earliest or the only clinical manifestation of FLCN mutations, pulmonologists should be alert to the contribution of this gene toward this familial form of emphysema.

Adult↗
PubMedDate not supplied

Bilateral pneumothorax resulting from the bronchoscopic removal of a puncture vine fruit.

Because pneumothorax may impair ventilation, it should be included in the differential diagnosis whenever ventilating problems are encountered during intraoperative procedures. Since pneumothorax is not an expected complication following atraumatic removal of tracheobronchial foreign bodies, it may not be considered if ventilation problems arise. When a foreign body has one or more sharp spines, however, consideration should be given to the possibility that the spine may have perforated the airway wall and that a pneumothorax may ensue following removal. Removal of a fruit of a puncture vine (Tribulus terrestris) from the junction of the carina and right main stem bronchus was followed by increased resistance to ventilation due to bilateral pneumothorax. Insertion of chest tubes bilaterally returned respirations to normal. Bronchoscopists should be aware of this possible complication of spine-covered foreign bodies.

Bronchi↗
PubMed2005

A very rare entity: catamenial pneumothorax.

Catamenial pneumothorax, a variant of spontaneous pneumothorax occurs exclusively in women of menstrual age. Catamenial pneumothorax is associated with a high rate of recurrence. The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically. Surgical treatment should be accomplished during menstruation for optimal visualization of pleurodiaphragmatic endometriosis.

Adult↗
PubMed2006

Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax.

The aim of the present study was to evaluate the long-term outcome of patients with primary spontaneous pneumothorax treated with talc pleurodesis. A follow-up study was undertaken in all patients with primary spontaneous pneumothorax who underwent talc pleurodesis for prolonged air leak or recurrence using thoracoscopy. In total, 112 patients underwent pleurodesis and follow-up data was obtained in 63 (56%) patients: 45 patients were available for clinical follow-up, 14 for telephone follow-up and four were dead. The causes of death were unrelated to the pleurodesis. There were no episodes of acute respiratory failure following pleurodesis. A total of 56 (95%) out of the cohort of 59 patients had a successful pleurodesis. Surgical pleurectomy was required in three (5%) patients for persistent air leak. Median duration of follow-up after talc pleurodesis was 118 months. Long-term success was observed in 53 (95%) out of 56 patients. Recurrent pneumothorax was observed in three (5%) out of 56 patients. Patients with successful talc pleurodesis had a median forced vital capacity (FVC) of 102% and median total lung capacity of 99% at follow-up. Comparing smokers and nonsmokers, the forced expiratory volume in one second (FEV(1)) was significantly lower in smokers and there was a tendency for the FEV(1)/FVC ratio to be lower in smokers. Talc pleurodesis in patients with primary spontaneous pneumothorax via thoracoscopy is an effective procedure associated with normal lung function in patients who do not smoke.

Adolescent↗
PubMed1994

Treatment of patients with spontaneous pneumothorax during videothoracoscopy.

Thoracoscopy for spontaneous pneumothorax has been performed over the years by many pulmonologists. The aim of the procedure was merely diagnostic: the detection of blebs and bullae. Therapeutic modalities were restricted to chemical pleurodesis. The development of videothoracoscopy has made more complex interventions, such as bullectomy possible. A protocol for videothoracoscopic treatment of spontaneous pneumothorax, with all treatment modalities in one session, has been developed. All patients with spontaneous pneumothorax underwent videothoracoscopy under general anaesthesia with double lumen tube intubation. If no abnormalities were found on the visceral pleura, talc pleurodesis was performed. Small lesions, blebs or bullae < 2 cm, were coagulated prior to pleurodesis. In case of blebs or bullae > 2 cm, thoracoscopic resection with an EndoGIA stapling device was performed, followed by scarification, i.e. electrocoagulation, of the parietal pleura. In 43 patients, 44 procedures were performed. In 15 cases (34%) no blebs or bullae were found. In 6 cases (14%) only blebs < 2 cm were found. In 23 cases (52%) blebs and bullae > 2 cm were found. In 21 out of 44 cases (48%), talc pleurodesis was performed, and in 23 cases (52%) bullectomy was performed. No major complication occurred. The average hospital stay was 5.7 days after talc pleurodesis and 6.0 days after bullectomy. There were 2 recurrences (5%) after a follow-up of at least 18 months. In conclusion, the use of videothoracoscopy in spontaneous pneumothorax makes it possible to continue a diagnostic procedure as a therapeutic session.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Mechanical and morphometrical changes in progressive bilateral pneumothorax and pleural effusion in normal rats.

Respiratory changes resulting from stepwise intrathoracic injections of 4 ml of either room air or warm (37 degrees C) Haemaccel, simulating pneumothorax and pleural effusion, respectively, were evaluated in anaesthetized, paralysed, and mechanically-ventilated rats. Respiratory system, lung, and chest wall resistances and elastances (static and dynamic) were determined in 14 animals. For this purpose, the end-inflation occlusion during constant inspiratory flow method was used. Chest wall configuration at both functional residual capacity (FRC) and end-inspiration tidal volume (i.e. FRC+(VT)) was also evaluated in: 1) 15 rats by measurements of lateral and anteroposterior diameters, and circumferences at the 3rd intercostal space and xiphoid levels; and 2) in 16 rats by measurements of thoracic cephalocaudal diameter. In addition, changes in functional residual capacity were measured. Both in pneumothorax and pleural effusion, resistances were not altered, but static and dynamic respiratory system and lung elastances increased progressively. Morphometric changes were similar at both functional residual capacity and end-inspiration; however, whereas pleural effusion increased all diameters, pneumothorax did not modify lateral diameter. Functional residual capacity was decreased in both conditions. In conclusion, pneumothorax and pleural effusion induced similar mechanical changes, but thoracic configuration was differently affected, since lateral diameters were increased in pleural effusion only.

Animals↗
PubMed1996

Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax.

The aim of this study was to analyse differences in efficacy and costs in treating first time or recurrent spontaneous pneumothorax by conservative therapy (pleural drainage or observation) and video-assisted thoracoscopic surgery (VATS). Retrospectively, 112 patients treated by conservative therapy during 1985-1989 (Period 1) were compared with 97 patients treated by VATS during 1991-1994 (Period 2). Mean follow-up time in each period was more than 2 yrs. Patients in both periods had comparable clinical characteristics. Irrespective of first time or recurrent spontaneous pneumothorax at presentation, drainage and hospitalization times were longer, and complication and recurrence rates were higher in Period 1. When costs due to the waiting time before VATS were excluded, the total costs in Period 1 were higher than in Period 2. Video-assisted thoracoscopic surgery is more effective in treating patients with first time or recurrent spontaneous pneumothorax, with less morbidity and total costs compared to conservative therapy. In view of cost-effectiveness, we feel that a different management of first time or recurrent spontaneous pneumothorax is not justified.

Adult↗