Refractory pneumothorax treated by parietal pleurolysis.
Pneumothorax, persisting in spite of efficient drainage, may in some cases be caused by discrepancy between lung volume and size of the pleural cavity. The logical treatment is reduction of the pleural cavity simultaneously with a traditional surgical procedure on the pulmonary tissue. An increasing number of refractory pneumothoraces--both spontaneous and istrogenic--is probably due to the fact that more people are living with and suffer the sequelae of pulmonary disease. During a 15-year survey a parietal pleurolysis, tailored to fit the size and shape of the lung, was performed in 10 patients as the main surgical procedure in 100 thoracotomies for 1130 cases of spontaneous and 62 cases of iatrogenic pneumothorax. The results were encouraging. (+info)
Fragile lung in the Marfan syndrome.
Two cases of the Marfan syndrome presented with spontaneous pneumothorax. Both had chest radiographs showing bilateral bullae in the upper lung zones and pulmonary function tests consistent with mild emphysema. There were dereases in forced expiratory flow rates at low lung volumes, carbon monoxide transfer factor, and lung elastic recoil. It is suggested that pneumothorax and bullous emphysema in this syndrome are caused by a weakness in the pulmonary connective tissue framework. (+info)
Bilateral pneumothoraces with multiple bullae in a patient with asymptomatic bronchiolitis obliterans 10 years after bone marrow transplantation.
A 16-year-old boy developed bronchiolitis obliterans (BO) 10 years after BMT for myelodysplastic syndrome. Although the patient complained of almost no dyspnea on exertion, he had mild hypercapnea with a markedly reduced forced expiratory volume of 0.32 l. Chest X-rays showed occasional bilateral minimal pneumothoraces, which is in accordance with the existence of multiple small bullae found on the pleural surface at video-assisted thoracic surgery. Histologic examination of the biopsied lung revealed BO. This case indicates that BO in adolescence following BMT and possible chronic GVHD may be masked because of lung immaturity at BMT, and BO after BMT may be associated with multiple pleural bullae. (+info)
The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy.
BACKGROUND: Tube thoracostomy remains the standard of care for the treatment of pneumothoraces and simple effusions. This report describes a favorable experience with the 8.3 French pigtail catheter as a less invasive alternative to traditional chest tube insertion. METHODS: We retrospectively reviewed 109 consecutive pigtail catheter placements. Catheters were inserted under local anesthesia at the bedside without radiographic guidance. Pre- and post-insertion chest radiographs were reviewed to determine efficacy of drainage. RESULTS: Fifty-one of 109 patients (47%) were mechanically ventilated and 26 patients (24%) had a coagulopathy. There were no complications related to pigtail catheter insertion. Seventy-seven pigtail catheters were placed for pleural effusion and 32 for pneumothorax. Mean effusion volume decreased from 43 to 9 percent, and drainage averaged 2899 ml over 97 hours. Mean pneumothorax size diminished from 38 to 1 percent during an average 71-hour placement. Clinical success rates in the effusion and pneumothorax groups were 86 and 81 percent, respectively. CONCLUSION: The pigtail catheter offers reliable treatment of pneumothoraces and simple effusions and is a safe and less invasive alternative to tube thoracostomy. (+info)
Video-assisted thoracoscopy versus open thoracotomy for spontaneous pneumothorax.
This retrospective study was designed to compare the contribution of the video-assisted thoracoscopic surgery (VATS) and open thoracotomy in the management of spontaneous pneumothorax (SP). The medical records of 100 patients with recurring or persisting (SP) treated were reviewed. The patients were divided into two groups: group I treated by thoracotomy while in group II (VATS) was used. There were 96 men and 6 women aged from 16 to 75 years. Indications for operation and sex distribution were comparable. The mean age for group I was 35 years and for group II was 45 years. Hospital stay was identical in both groups. The amount of narcotic requirements was lesser in group II than in group I as well as the postoperative respiratory dysfunction. There have been no recurrence to date (mean follow-up 6 years for the group I and 3 years for the group II). VATS have been shown to produce results comparable to those obtained following open thoracotomy with reduction of postoperative pain, respiratory dysfunction, catabolic response to trauma and decrease in wound related complications. VATS is a valid alternative to open thoracotomy for primary (SP) but it should be used with caution for the management of secondary pneumothorax. (+info)
Finding-specific display presets for computed radiography soft-copy reading.
Much work has been done to optimize the display of cross-sectional modality imaging examinations for soft-copy reading (i.e., window/level tissue presets, and format presentations such as tile and stack modes, four-on-one, nine-on-one, etc). Less attention has been paid to the display of digital forms of the conventional projection x-ray. The purpose of this study is to assess the utility of providing presets for computed radiography (CR) soft-copy display, based not on the window/level settings, but on processing applied to the image optimized for visualization of specific findings, pathologies, etc (i.e., pneumothorax, tumor, tube location). It is felt that digital display of CR images based on finding-specific processing presets has the potential to: speed reading of digital projection x-ray examinations on soft copy; improve diagnostic efficacy; standardize display across examination type, clinical scenario, important key findings, and significant negatives; facilitate image comparison; and improve confidence in and acceptance of soft-copy reading. Clinical chest images are acquired using an Agfa-Gevaert (Mortsel, Belgium) ADC 70 CR scanner and Fuji (Stamford, CT) 9000 and AC2 CR scanners. Those demonstrating pertinent findings are transferred over the clinical picture archiving and communications system (PACS) network to a research image processing station (Agfa PS5000), where the optimal image-processing settings per finding, pathologic category, etc, are developed in conjunction with a thoracic radiologist, by manipulating the multiscale image contrast amplification (Agfa MUSICA) algorithm parameters. Soft-copy display of images processed with finding-specific settings are compared with the standard default image presentation for 50 cases of each category. Comparison is scored using a 5-point scale with the positive scale denoting the standard presentation is preferred over the finding-specific processing, the negative scale denoting the finding-specific processing is preferred over the standard presentation, and zero denoting no difference. Processing settings have been developed for several findings including pneumothorax and lung nodules, and clinical cases are currently being collected in preparation for formal clinical trials. Preliminary results indicate a preference for the optimized-processing presentation of images over the standard default, particularly by inexperienced radiology residents and referring clinicians. (+info)
Boerhaave's syndrome presenting as tension pneumothorax.
Boerhaave's syndrome can present initially as a case of tension pneumothorax. Mortality rate with delayed treatment is very high, therefore diagnosis should be made rapidly in the emergency department. Multidisciplinary cooperation, immediate radiological confirmation, prompt aggressive resuscitation, and surgical intervention offer the best chance of survival. (+info)
Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon pulmonary disorder, the clinical spectrum of which is variable. We present a fatal case of BOOP, which developed spontaneous pneumothorax, a complication considered rare. Unusual was also the upper lobe distribution of the infiltrates. The histologically diagnosed disease failed to respond to antibiotics and corticosteroids and the 74-year-old patient eventually succumbed with acute respiratory distress syndrome, 50 days after disease onset. Spontaneous pneumothorax should be added to the complications of BOOP, which may adversely affect prognosis. (+info)