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PubMed2005

Simultaneous bilateral spontaneous pneumothorax observed during the administration of gefitinib for lung adenocarcinoma with multiple lung metastases.

A 41-year-old man with productive cough was admitted to our hospital. His chest roentgenogram showed multiple small nodules in the bilateral lung fields. The nodules were revealed as intrapulmonary metastases of the adenocarcinoma of the lung. Systemic chemotherapy with paclitaxel and carboplatin was not effective, and continuous oral gefitinib therapy was initiated. Twenty-one days later, spontaneous pneumothorax was found in the left lung, and four days after that, in the right lung as well. The extent of the pneumothorax was slight; therefore, he recovered without drainage within several days. Spontaneous pneumothorax, especially bilateral pneumothorax, is a rare complication of chemotherapy for lung cancer.

Adenocarcinoma↗
PubMed1982

Catamenial pneumothorax: the roles of diaphragmatic defects and endometriosis.

The diagnosis of catamenial pneumothorax should be suspected whenever a women in the third or fourth decade of life has recurrent right-sided chest pain temporally associated with menstruation. This entity was first described in 1958 and since then, 59 cases have been reported in the English literature. There is no universally accepted explanation for the pathogenesis of the pneumothorax. Four additional cases are presented which support the significant role that diaphragmatic defects and endometriosis play in the pathogenesis of catamenial pneumothorax. At thoracotomy, numerous small perforations of the right diaphragm were found in three patients, two of whom had associated endometriosis of that diaphragm. The fourth patient had indirect evidence of diaphragmatic defects proven by a diagnostic pneumoperitoneum. On the basis of the hypothesis of transfallopian passage of air, this patient was treated by tubal ligation only and has not had a recurrence of pneumothorax since. This form of therapy has not been reported previously for this disorder.

Adult↗
PubMed1983

CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma.

Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination or plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows.

Abdominal Injuries↗
PubMed1984

The cross-table lateral view in neonatal pneumothorax.

The cross-table lateral view of the chest can facilitate a more realistic appreciation of a pneumothorax than the supine frontal projection alone or in combination with the vertical-beam lateral view. This view also permits an optimal evaluation of the relative position of the lung, intrapleural air, and the tip of the chest tube in the supine newborn. The presence and size of a pneumothorax can usually be determined by locating the anterior lung edge on the cross-table lateral view. The anteroinferior corner of lung often aids in locating this anterior lung edge. The other structures that simulate the anterior lung edge on the cross-table lateral view include sternal retraction, rib ends, the axillary soft-tissue density, and posterior atelectasis. Because of the cause-effect relation of pneumothorax to intracranial bleeding in the premature infant, more widespread use of this technique to detect pneumothorax is recommended.

Humans↗
PubMed1987

Transthoracic needle aspiration: use of a small chest tube to treat pneumothorax.

The primary complication of transthoracic needle aspiration is pneumothorax. The efficacy and safety of using a small chest tube to treat this complication were examined by reviewing the records of 876 patients who underwent transthoracic needle aspirations between January 1981 and February 1986. Among these patients, 212 (24%) sustained a pneumothorax, and 92 (11%) required placement of a small 9-French chest tube attached to a flutter-type (Heimlich) valve. Duration of chest-tube drainage ranged between 24 hr and 3 weeks (mean, 2.2 days). Complete resolution of the pneumothorax and subsequent removal of the chest tube after 24 hr of drainage occurred in 38 (41%) of the 92 patients. Twenty-nine (32%) required 48 hr of drainage, and nine (10%) required 3 days. The remaining 16 (17%) required longer periods of drainage ranging from 4 days to 3 weeks. The tubes of six of this last group of patients were attached to a suction apparatus, and three of these patients eventually had a 28-French chest tube placed surgically. No significant complications occurred. The use of a small chest tube for treatment of pneumothorax after transthoracic needle aspiration is easy, safe, and efficacious.

Biopsy, Needle↗
PubMed2006

Use of computed tomography for evaluation of lung lesions associated with spontaneous pneumothorax in dogs: 12 cases (1999-2002).

OBJECTIVE: To evaluate use of computed tomography (CT) of the lungs, compared with conventional radiography, for detection of blebs and bullae associated with spontaneous pneumothorax in dogs. DESIGN: Retrospective case series. ANIMALS: 12 dogs with spontaneous pneumothorax. PROCEDURE: Medical records were reviewed, and information was collected that included signalment, body weight, initial owner complaint, laboratory findings, radiographic findings, CT findings, medical and surgical treatment, histologic findings, complications, duration of hospitalization, and final outcome. RESULTS: Radiographs were excellent for identifying pneumothorax (sensitivity, 100%) but poor for identifying the underlying cause (bullae or blebs); these were identified in radiographs of only 2 of 12 dogs. Computed tomography allowed identification of bullae or blebs in 9 of 12 dogs. Ten of the 12 dogs were treated via surgery, and 17 affected lung lobes were identified. Four of the 17 affected lobes were identified via radiography. Thirteen of the 17 affected lobes were identified via CT; however, 1 lobe was incorrectly identified as the right caudal lobe instead of the right cranial lobe. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that CT is better than radiography for identifying the underlying causes of spontaneous pneumothorax.

Animals↗
PubMed1998

Thoracoscopic apical pleurectomy for persisting or recurring pneumothorax.

Regardless of its origin, the treatment of persisting or recurring spontaneous pneumothorax (SP) is classically surgical. To assess the contribution of thoracoscopy in the management of SP 100 consecutive patients with persistent or recurrent pneumothorax were treated at our unit by endoscopic procedure between 1992 and 1997 to obtain permanent pleurodesis and to treat the lung lesion responsible for the leak. There were 90 men and 10 women ranging in age from 16 to 60 years (mean age 28+/-12 years). The technique includes electrocoagulation of pleural blebs and thoracoscopic apical pleurectomy. All patients were subjected to physical examination and plain x-ray at 1 and 3 months and 1 year postoperatively. After completion of the procedure, air leaks disappeared in 90 cases, while 5 cases air leak ceased 5 to 7 days postoperatively. The remaining 5 cases were converted to an open procedure. The mean length of follow-up was 3 years. No patient required transfusion and there were no operative deaths. No recurrence of pneumothorax occurred and no major complications encountered. Video-assisted thoracoscopic pleurectomy for the treatment of pneumothorax is concluded to be that safe and efficacious. It shortens the hospital stay, requires less amount of postoperative narcotic analgesia.

Adolescent↗
PubMed2003

Bilateral spontaneous pneumothorax during cytotoxic chemotherapy for angiosarcoma of the scalp: a case report.

Spontaneous pneumothorax is a rare manifestation of metastatic lung cancers and described in advanced diseases or during cytotoxic chemotherapy which is manifested by sudden onset of dyspnea. The cause or mechanism of spontaneous pneumothorax has been unknown, as well as the association with site of metastases or type of cancers or side effect of chemotherapeutic drugs has been reported rarely. A 68-yr-old man underwent excision of angiosarcoma of the scalp. Chest radiography did not show any evidence of possible metastatic lung lesion at that time. Therefore, systemic doxorubicin and dacarbazine were given. After nineteen days of chemotherapy, he developed a bilateral spontaneous pneumothorax and palpable cervical lymph nodes. Both parietal and visceral pleura were intact and showed no evidence of metastatic and pathologic lesions on thoracoscopic evaluation. The patient managed with bilateral tube thoracostomy and both lungs were expanded. Lymph nodes became unpalpable during three cycles of the paclitaxel and doxorubicin, however, bilateral lung metastases were developed and progressed despite chemotherapy. The patient died due to respiratory failure after five months. This report underlines that spontaneous pneumothorax can occur as the first manifestation of metastatic angiosarcoma even if imaging studies do not show of a metastatic lesion.

Aged↗
PubMed2005

Current management of spontaneous pneumothorax.

Spontaneous pneumothorax is divided into primary, when there is no underlying lung disease, and secondary, mainly caused by chronic obstructive pulmonary disease. A variety of different non-invasive and invasive treatment options exist. Due to the lack of large randomised controlled trials no level A evidence is present. A first episode of a primary spontaneous pneumothorax is treated by observation if it is < 20% or by simple aspiration if it is > 20%, but recurrences are frequent. For recurrent or persisting pneumothorax a more invasive approach is indicated whereby video-assisted thoracic surgery provides a treatment of lung (resection of blebs or bullae) and pleura (pleurectomy or abrasion). In patients with a secondary spontaneous pneumothorax related to chronic obstructive pulmonary disease, there is an associated increased mortality and a more aggressive approach is warranted consisting of initial thoracic drainage followed by recurrence prevention by thoracoscopy or thoracotomy in patients with a low or moderate operative risk. Talc instillation by the thoracic drain is preferred for patients with a high operative risk.

Humans↗
PubMed1999

[Lung cancer detected in a patient under age 40 treated for pneumothorax].

We report a case of lung cancer in a relatively young patient who presented pneumothorax. A 31-year-old man complaining of pressure in his left chest was admitted with left pneumothorax disclosed on X-ray film. Although pleural drainage was performed for a week, the left lung did not expand well, and surgical treatment was required. During surgery, a tumor (1.5 x 1.0 cm in size) was discovered in the upper lobe of the left lung (S3). Histopathological examination revealed that it was a large cell carcinoma. People under the age of 40 account for only a small fraction of the entire lung cancer patient population. Pneumothorax occurs together with lung cancer, especially in people under age 40. We reasoned that lung cancer should be considered a possible complication in patients under 40 who experience recurrent or prolonged bouts of pneumothorax.

Adult↗
PubMed1999

[Regrowth of bullae around the staple-line is one of the causes of postoperative recurrence in thoracoscopic surgery for spontaneous pneumothorax].

Since August 1994, we have performed 65 thoracoscopic surgeries for spontaneous pneumothorax. Our operative method is partial resection of the lung with bullae using endoscopic autosuture. Three patients underwent reoperation because of persistent air leakage in one case and postoperative recurrences in two cases. In addition, we performed a second operation in one case that had undergone thoracoscopic surgery for spontaneous pneumothorax in another hospital. At the second operation, regrowth of bullae was found at the edge of staple-line in three of the 4 cases, and in one of these cases, such regrown bullae seemed to be a cause of recurrence of pneumothorax. The regrowth of the bullae was caused by incomplete resection at the initial surgery in one case. Such incomplete resection and oversight were not noticed in the review of the videotape of the initial surgeries in two cases. Reinforcement of the staple-line is necessary for prevention of recurrence of pneumothorax.

Adolescent↗
PubMed2000

[A case of spontaneous pneumothorax in pregnancy].

Spontaneous pneumothorax rarely happened in woman compared to man generally. Furthermore, it is said that spontaneous pneumothorax in the pregnancy is very rare. We experienced a case of spontaneous pneumothorax in 32 weeks gestation. She complains chest pain and dyspnea in hospital because of medication to urgent premature. Throcar catheter has been placed after delivery. Video assisted thoracoscopic bullectomy was performed on the next day of the delivery and discharged 5 days after operation. Treatment of spontaneous pneumothorax in pregnancy was believed to be difficult, but she delivered safely because of being under the tube drainage. We believed that the tube drainage during pregnancy or the operation were recommended for these cases because of security of mother and embryo.

Adult↗
PubMed2001

[Epidural anesthesia for a patient with catamenial pneumothorax].

Endometriosis extending into the thoracic cage or the lung might induce defect of the tissue and show catamenial symptoms, such as pneumothorax or hemothorax. These events usually occur 48 to 72 hours after menstruation. A 37-year-old woman with ten year history of recurrent catamenial pneumothorax was scheduled for removal of ovarian cyst. Since intermittent positive pressure ventilation or pneumoperitoneum might induce pneumothorax, we selected epidural anesthesia for laparotomy. Epidural cannulations were performed at Th 9/10 and L 4/5 interspaces. After administration of 2% mepivacaine (400 mg) and fentanyl (0.1 mg), the block extended from Th 6 to S 5. The surgery was done without any complication. In this case epidural anesthesia for laparotomy was useful for the patient with catamenial pneumothorax.

Adult↗
PubMed2001

[Tension pneumothorax during removal of a foreign body from the esophagus].

Extracting foreign bodies from the esophagus is a common procedure in emergency rooms. We report the case of an 82-year-old man who came to the emergency room after swallowing a clam shell. After three successive examinations by fiberoptic endoscopy, the last of which was performed with general anesthesia, the patient suffered pneumomediastinum and pneumothorax first on the right side and then, within a few hours, on the left. After extraction of the foreign body, bilateral pleural drainage and emergency repair of esophageal perforation were required. Episodes of pneumothorax have been described after endoscopic procedures on the digestive tract such as esophagoscopy. The cause of esophageal perforation described may be iatrogenic, produced during esophageal manipulations or it may be caused by the foreign body itself, by an awake patient's performance of Valsalva maneuvers during esophagoscopy, or the entrance of air in the pleural cavity through esophageal perforation; any of these would explain the presentation of pneumothorax in this case. In the presence of sudden cardiorespiratory deterioration in a patient undergoing an endoscopic procedure, a diagnosis of tension pneumothorax must be considered.

Aged↗
PubMed2001

Spontaneous pneumothorax: a rare complication of miliary tuberculosis.

Pneumothorax is a rare complication of miliary tuberculosis. In this report, a 25-year old patient developing pneumothorax while on the treatment for miliary tuberculosis treatment is presented and the related literature has been reviewed. Pneumothorax, although rare, should be considered when a patient with miliary tuberculosis develops a sudden, severe pain on either side of the chest with breathlessness. The treatment should be tailored according to the size of pneumothorax either pleural drainage through chest tube or needle aspiration. Meanwhile, antituberculous treatment should be continued without interruption.

Adult↗
PubMed1999

[Effect of pneumothorax on membrane diffusing capacity and pulmonary capillary blood volume].

OBJECTIVE: Investigating the effect of pulmonary membrane diffusing capacity(Dm) and pulmonary capillary blood volume(Vc) on carbon monoxide diffusing capacity (DLCO) in patients with pneumothorax before and after treatment, and clarifying the mechanism of hypoxemia due to pulmonary reexpansion. METHODS: Pulmonary function test, DLCO, Dm, Vc and arterial blood gas analysis were determined in 21 cases of pneumothorax before treatment and one week after pulmonary reexpansion. RESULTS: DLCO, Dm, Vc, partial pressure of arterial oxygen (PaO2), alveolar ventilation volume (VA), percentage of forced expiratory volume in one second to predicted value, and the ratio of dead space ventilation (VD) to tidal volume (VT) [VD/VT] were (64 +/- 4)%, (66 +/- 5)%, (70 +/- 5)%, (83.7 +/- 2.3) mm Hg, (4.4 +/- 0.2) L, (59 +/- 4)%, 0.340 +/- 0.020 respectively before treatment. After pulmonary reexpansion, they respectively were (71 +/- 4)%, (74 +/- 4)%, (80 +/- 6)%, (89.4 +/- 1.5) mm Hg, (5.40 +/- 0.20) L, (79 +/- 4)%, 0.210 +/- 0.010. They were significantly improved after treatment. Except for Dm, they were statistically different. Between Dm, Vc and DLCO, significant positive correlations were found during pneumothorax and one week after pulmonary reexpansion, especially correlation between Dm and DLCO was more apparent. Between Dm and DLCO significant positive correlations (r2 = 0.862, P < 0.0001; r2 = 0.728, P < 0.001) were found in study patients before and after treatment. So were Vc and DLCO (r1 = 0.643, P < 0.01; r2 = 0.52, P < 0.05). The correlation coefficient of Dm was markedly larger than Vc. CONCLUSIONS: The decrease in pulmonary diffusing function is related to Dm and Vc during pneumothorax, while decrease of Dm plays a major role. The hypoxemia is still presented in a period of time after pulmonary reexpansion, which is not related to VA and abnormality of ventilation-perfusion ratio (V/Q). It is chiefly due to unrecovery of Dm.

Adolescent↗
PubMed2002

Treatment of primary spontaneous pneumothorax by simple talcage under medical thoracoscopy.

Medical thoracoscopy under local anesthesia with simple talc poudrage is a safe and cost-effective technique to prevent recurrences in the case of primary spontaneous pneumothorax. Pathogenesis of primary spontaneous pneumothorax, i.e. a pneumothorax occurring without any underlying lung disease, remains unclear; there is no proof that the air leak leading to air escape into the visceral pleura is located in blebs or bullae visualized during the procedure. Therefore we do not have any evidence that blebs or small bullae cauterization or resection adds any further benefit to pleurodesis. Pulmonologists doing thoracoscopic talc pleurodesis should learn to better control pain due to thoracoscopic talcage as it has been shown that thoracoscopic talcage is not more painful than a chest tube drainage in patients providing they receive at least some opioids. There is also a debate on the best surgical approach to treat pneumothorax but minithoracotomy with pleurectomy remains the gold standard although more expensive and associated with some morbidity or mortality.

Humans↗
PubMed2003

[Pneumothorax due to pulmonary metastasis of gingival carcinoma: report of a case].

A 72-year-old woman developed left pneumothorax 14 months after the first operation of a gingival carcinoma. The chest X-ray films and computed tomographic scans on admission revealed left pneumothorax and 2 lesions with a thin-walled cavity in the upper lung field. They seemed to be pulmonary metastasis from a carcinoma of gingiva and one of them ruptured into the pleural cavity. As airleak continued after tube thoracostomy, wedge resections of 2 lesions were performed through thoracotomy. Postoperative histological examination revealed that both of the lesions were moderately differentiated squamous cell carcinoma and they were the same histological findings as the gingival carcinoma excised previously. Pulmonary metastasis from a carcinoma of gingiva is rare, while it may be thought 1% of metastatic lung tumors. And also pulmonary metastasis is unusual cause of pneumothorax, especially without chemotherapy for it. We reported the very rare case of pneumothorax due to pulmonary metastasis from a carcinoma of gingiva.

Aged↗