Closed thoracic drainage in elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax:A retrospective study

BACKGROUND Chronic obstructive pulmonary disease(COPD)combined with spontaneous pneumothorax,is characterized by significant decline in lung function,and even cause cardiopulmonary failure and hypoxia.AIM To evaluate the clinical effectiveness of central venous catheters and indwelling pleural catheters(IPC)in managing closed thoracic drainage in patients diagnosed with COPD with concomitant by spontaneous pneumothorax.METHODS Retrospective analysis was conducted on the clinical information of 60 elderly patients with COPD complicated by spontaneous pneumothorax admitted to the Shexian Branch of the second affiliated hospital of Zhejiang university school of medicine between March 2020 and March 2023.The clinical efficacy,complications,hospitalization duration,and costs were compared between patients with an indwelling thoracic catheter and those with a central venous catheter.Univariate logistic regression was used to analyze the causes of catheter displacement.RESULTS According to our findings,there were significant differences in the IPC group’s clinical efficacy,catheter operation time,and lung recruitment time(P<0.05).Comparing the complications after catheter treatment between the two groups revealed statistically significant variations in the incidence of postoperative analgesics,catheter abscission,catheter blockage,and subcutaneous emphysema in the IPC group(P<0.05).Univariate analysis demonstrated significant differences between patients with and without catheter dislodgement regarding duty nurse’s working years(less than three),Acute Physiology and Chronic Health Evaluation II(APACHE II)scores(less than 15),lack of catheter suture fixation,and the proportion of catheters not fixed twice(P<0.05).CONCLUSION Our results demonstrated that when treating elderly COPD patients with spontaneous pneumothorax,indwelling thoracic catheters are more effective than the central venous catheter group.Patients’catheter shedding is influenced by the primary nurse’s working years,APACHE II scores,and catheter fixation technique.

Chest Radiographs Based Pneumothorax Detection Using Federated Learning

Pneumothorax is a thoracic condition that occurs when a person’s lungs collapse,causing air to enter the pleural cavity,the area close to the lungs and chest wall.The most persistent disease,as well as one that necessitates particular patient care and the privacy of their health records.The radiologists find it challenging to diagnose pneumothorax due to the variations in images.Deep learning-based techniques are commonly employed to solve image categorization and segmentation problems.However,it is challenging to employ it in the medical field due to privacy issues and a lack of data.To address this issue,a federated learning framework based on an Xception neural network model is proposed in this research.The pneumothorax medical image dataset is obtained from the Kaggle repository.Data preprocessing is performed on the used dataset to convert unstructured data into structured information to improve the model’s performance.Min-max normalization technique is used to normalize the data,and the features are extracted from chest Xray images.Then dataset converts into two windows to make two clients for local model training.Xception neural network model is trained on the dataset individually and aggregates model updates from two clients on the server side.To decrease the over-fitting effect,every client analyses the results three times.Client 1 performed better in round 2 with a 79.0%accuracy,and client 2 performed better in round 2 with a 77.0%accuracy.The experimental result shows the effectiveness of the federated learning-based technique on a deep neural network,reaching a 79.28%accuracy while also providing privacy to the patient’s data.

Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

Risk factors for development of pneumothorax in patients with COVID-19 at a government health facility in North India:An exploratory case-control study

Objective:To explore risk factors for the development of pneumothorax in patients with COVID-19 during the second COVID-19 wave at a northern Indian level 2 health facility.Methods:Patients suffering from SARS-CoV-2 infection during the second wave of the COVID-19 pandemic in India(January-June 2021)at a tertiary care teaching hospital and level 2 COVID care facility were included.Cases who suffered from SARS-CoV-2 infection but did not develop pneumothorax were selected as matched controls.All details regarding demographics,clinical presentation,treatment,and outcome were recorded in a semi-structured proforma.Results:Eleven patients with COVID-19 developed pneumothorax during the study period and 40 controls were included in the study.Five cases were smokers in comparison to only two in the control group.Type 2 diabetes mellitus was the most common comorbidity among both groups.Median change in C-reactive protein overall for cases and controls were around+14.0 and-41.9 and was statistically significant.Conclusions:Inflammatory markers like C-reactive protein have significant correlations with the development of pneumothorax in COVID-19-infected patients.There is no sex predisposition to develop pneumothorax among patients with COVID-19.

Pneumothorax in Children: Epidemiological Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar

Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often associated with a favoring factor. When it is large, it can affect the life expectancy. The objective of our study was to determine the epidemiological, diagnostic and evolutionary aspects of pneumothorax in children aged 0 to 15 years, hospitalized at the Albert Royer National Children’s Hospital in Dakar. This is a retrospective descriptive study of patient records followed at the Albert Royer National Children’s Hospital (CHNEAR) for the management of a pneumothorax during the period from 2020 to 2022. During our study, 15 patients were hospitalized for pneumothorax, with an average annual incidence of 7.5 cases per year. The sex ratio (H/F) was 2.03. The average age was 3.7 years. Chest pain was present in 27% of patients, dyspnea was found in 93%, and cough in 87% of patients. All patients underwent chest radiography and the location of the pneumothorax was predominant on the right in 60% of cases. Thoracic drainage was performed in 93.3% of patients associated with etiological treatment. The average length of hospitalization was 27.8 days with a cure rate of 86.7% and a recurrence rate of 13.3%.

Spontaneous Bilateral Pneumothorax in a Healthy Young Adult: A Comprehensive Case Report

Background: Spontaneous bilateral pneumothorax in healthy young adults is a rare and challenging condition that defies conventional diagnostic and etiological paradigms. This case report explores the presentation, diagnostic evaluation, management, and potential contributing factors in a 29-year-old male with no prior medical history who experienced bilateral spontaneous pneumothoraces. Aim: This case report aims to shed light on the complexities of managing spontaneous bilateral pneumothorax, particularly in the absence of common risk factors. It underscores the need for a thorough assessment and ongoing research to unravel the enigma surrounding this condition. Case Presentation: A healthy 29-year-old male presented with acute chest pain and shortness of breath, ultimately diagnosed with bilateral spontaneous pneumothoraces. Despite the absence of typical risk factors, advanced imaging techniques revealed valuable insights into the diagnosis and management of this unique presentation. Conclusion: Spontaneous bilateral pneumothorax in healthy individuals presents diagnostic challenges and raises questions about potential genetic predisposition, connective tissue disorders, and lifestyle-related triggers. While the acute phase was effectively managed, this case underscores the importance of interdisciplinary collaboration and ongoing research to comprehensively understand this condition.

SARS-CoV-2 with concurrent coccidioidomycosis complicated by refractory pneumothorax in a Hispanic male: A case report and literature review

BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could be encountered in such conditions.CASE SUMMARY A 50-year-old Hispanic male who was a prior smoker presented with shortness of breath.He was diagnosed with SARS-CoV-2.He improved and was discharged with home oxygen.A month later,he presented with sudden onset cough and shortness of breath.Chest X-ray showed development of right-sided tension pneumothorax,right pleural effusion and an air-filled cystic structure.Computed tomography thorax showed findings suggestive of pulmonary coccidioidomycosis.Coccidioides antigen was positive,and fluconazole was initiated.For pneumothorax,a pigtail catheter was placed.The pigtail chest tube was later switched to water seal,unfortunately,the pneumothorax re-expanded.Another attempt to transition chest tube to water seal was unsuccessful.Pigtail chest tube was then swapped to 32-Fr chest tube and chemical pleurodesis was performed.This was later transitioned successfully to water seal and finally removed.He was discharged on a four-week oral course of fluconazole 400 mg and was to follow up closely as an outpatient for continued monitoring.CONCLUSION Pneumothorax is associated with a worse prognosis,especially with comorbidities such as diabetes,immunosuppression and malignancy.Suspicion for concomitant fungal infection in such patients should be high and would necessitate further investigation.

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.

Iatrogenic pneumothorax related to mechanical ventilation

Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients' history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or Pa O2/Fi O2 < 200 mm Hg were found to have higher mortality.

Coexistence of pneumothorax and chilaiditi sign:A case report

We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm;however,the term"Chilaiditi syndrome"is used for symptomatic hepatodiaphragmatic interposition.The patient had no symptoms of abdominal pain,constipation,diarrhea,or emesis.Incidentally,Chilaiditi sign was diagnosed on chest radiography.Pneumothorax is defined as air in the pleural space.Pneumothoraces are classified as spontaneous or traumatic.Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present,or secondary,when it is associated with pre-existing lung disease.Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.

Mechanisms and anatomical risk factors of pneumothorax after Bevacizumab use:A case report

BACKGROUND Bevacizumab is an antiangiogenic agent,and that synergizes with chemotherapeutic drugs.When used in combination therapies,Bevacizumab is associated with adverse events such as hemorrhage,gastrointestinal perforation,delayed wound healing,and pneumothorax.However,the molecular mechanisms underlying these adverse events are not fully understood.CASE SUMMARY A 45-year-old female with multiple lung metastases that were derived from primary breast cancer,was placed on Bevacizumab+paclitaxel therapy,since this combination has a potent antitumor effect.She reported dyspnea before cycle 3,day 1 and we therefore ran a chest X-ray,which detected a right pneumothorax.The coronal plane computed tomography revealed that one solid mass rapidly necrosed and was replaced by a cavity that passed through the bronchus in the right lower lobe.The cavity eventually ruptured the pleura and made the bronchopleural fistula that led to this pneumothorax.Thoracic cavity drainage using an intercostal catheter was performed.On the 7th day of drainage,the patient was discharged from our hospital on recovery.Recurrence of pneumothorax was not reported,and continuation of chemotherapy was made possible by changing the regimen.CONCLUSION Patients with lung metastases surrounding the bronchi and on the pleura should be monitored for pneumothorax by Bevacizumab-containing chemotherapies.

Pacemaker lead induced cardiac perforation presenting with pneumothorax

An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocardiogram (Figure 1). Transthoracic echocardiography showed reduced left ventricular function (LVEF = 47%) with regional wall motion abnormality of right coronary artery (RCA) and left circumflex coronary artery (LCx) artery. Coronary angiography showed patent previous proximal RCA and distal LCx stents. Temporary pacemaker was inserted initially and the patient was planned for permanent pacemaker insertion after the surgery.

Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience

Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.

Role of Thoracic Sonographic Scan in Diagnosis of Pneumothorax

Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax;this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.

Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax:A case report

BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.

Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients

Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.

Operative Benefits of Artificial Pneumothorax in Thoracoscopic Esophagectomy in the Left Lateral Decubitus Position for Esophageal Cancer

Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical outcomes including learning curve of 60 consecutive patients who underwent thoracoscopic esophagectomy with artificial pnuemothorax in the left lateral decubitus position between April 2010 and November 2012 in our department. Results: The median operation time and intraoperative blood loss were 443 min and 220 ml, respectively, and these values were 174 min and 95 ml, respectively, in the thoracic phase of surgery. The median number of harvested lymph node was 37. Only 1 patient required conversion to open esophagectomy. The postoperative 30-day mortality rate was 1.7%. The thoracic operation time significantly decreased after an experience of 10 cases and intraoperative blood loss during thoracic phasesignificantly decreased after an experience of 20 cases (p < 0.05), and operation time remained constant for the following cases. The number of harvested lymph nodes did not exhibit significant changes with an increase in the number of case experienced. Conclusions: Artificial pneumothorax provided the shorting of learning curve at the thoracoscopic esophagectomy in the left lateral decubitus position.

An unusual cause of simultaneous bilateral spontaneous pneumothorax

INTRODUCTION Scrub typhus,a tropical febrile vector borne disease also known as"Tsutsugamushi disease",is caused by Orientia tsutsugamushi,a gram negative obligate intracellular slow growing bacteria.The infection is transmitted by the bite of larval stage(chiggers)mites belonging to the family Trombiculidae.The disease

A Chickenpox Pneumothorax: A Case Report of Pneumothorax Secondary to VZV Infection

Varicella (chickenpox) is a generalized, self-limiting viral infection that is caused by varicella zoster virus (VZV). Chickenpox commonly infects children from 2 - 8 years without severe outcomes, but is particularly severe when affecting adults.