Bilateral Pneumothorax Research Articles

Characteristics and outcome of pneumothorax, pneumomediastinum, and subcutaneous emphysema in COVID-19 patients

Background: Pneumothorax, pneumomediastinum, and subcutaneous emphysema are few of fatal complications noted in patients with COVID-19 pneumonia. Various studies have shown prevalence of pneumothorax ranging between 1% and 2% in COVID-19 pneumonia. Materials and methods: A total of 10 inpatients admitted with COVID-19 disease confirmed by RT-PCR test who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema during hospital stay by sequential sampling method were included in the study. Demographic data, duration of hospital stay, underlying comorbidities, predisposing factors, radiographic characteristics, and mode of oxygen delivery were collected and analyzed. Results: In our study, mean age group of patient who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema was 39.8 years. Male to female ratio was 9:1. Mean time duration of onset of pneumothorax, pneumomediastinum, and subcutaneous emphysema from the day of hospitalization was 17.3 (8–30) days. Nine patients were on NIV (non-invasive ventilation) while one patient was on NRBM. Right sided involvement was noted in five patients, three had left sided involvement, and two patients had bilateral pneumothorax. Five patients had pneumomediastinum and subcutaneous emphysema along with pneumothorax. All patients received antivirals (Inj. Remdesivir), systemic steroids along with other supportive treatment. Except for one patient, all patients who developed pneumothorax, pneumomediastinum, and subcutaneous emphysema succumbed. All patients’ chest radiograph was consistent with COVID-19 pneumonia. One patient had pulmonary cyst on Computerized Tomography (CT) thorax which was done post intercostal drainage of pneumothorax. Mean time of death after development of pneumothorax, pneumomediastinum, subcutaneous emphysema was 4.3 days. Comorbidities observed were bronchial asthma, obesity, and status post Caesarian section. Conclusion: Development of pulmonary barotrauma in COVID-19 patients is associated with high mortality. Presence of pulmonary cyst, prexisting bronchial asthma, obesity, systemic steroids are possible poor determinants.

Insidious, deadly, common - polytrauma with pelvic fracture

Polytrauma patients with pelvic injuries have a high mortality rate, particularly in those who are haemodynamically unstable, reaching up to 42%. This case study involves a 66-year-old cyclist struck by a tram in Gdańsk, Poland in October 2022. Upon arrival at the Emergency Department of the Medical University of Gdańsk, the patient exhibited stability but later entered the initial shock phase. Comprehensive imaging unveiled flail chest, bilateral pneumothorax, spinal fractures, and an unstable pelvis. Despite a negative point-of-care ultrasound, the planned orthopaedic pelvic stabilization surgery transitioned to endovascular intervention due to deteriorating shock and suspected retroperitoneal bleeding. Despite a successful procedure, the patient succumbed to irreversible shock and multiple organ failure the next day in the intensive care unit. The significance of rapid identification of internal bleeding followed by timely endovascular intervention and retroperitoneal pelvic packing is underscored, as it has demonstrated decreased mortality in similar cases.

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

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

Emergency repair of traumatic avulsion of the right main stem bronchus using biliary stent in a 6-year-Old girl: A case report

Pediatric thoracic trauma is a rare condition, but results in high levels of morbidity and mortality. These injuries are often more devastating in the pediatric population due to differences in children's anatomy and physiology relative to adult patients. Tracheobronchial injuries secondary to blunt trauma are difficult to diagnose compared to penetrating trauma. So, a high index of suspicion is of utmost importance. We report a case of a 6-year-old girl who experienced complete avulsion of the right main bronchus. The patient presented with extensive emphysema and severe respiratory distress with bilateral tension pneumothorax. Endotracheal intubation and two thoracostomy tubes were applied. Pneumothorax and a massive air leak persisted on the right side. After thoracotomy, right main bronchus avulsion was present and then repaired by end-to-end anastomosis and muscle flap. minimal air leaks from right chest tubes and partially expanding right lung on chest X-ray are seen after that. So, reinforcement by biliary (instead of bronchial) stent was performed because unavailability of bronchial stent with the desired size at that time. Traumatic tracheobronchial damage occurs in just 0.05-3% of all pediatric thoracic traumas. It's fatal condition especially in first hour. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Biliary stent placement could be a reasonable treatment option for tracheobronchial damage.

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

Spontaneous pneumothorax in metastatic osteosarcoma: a case series

BackgroundMalignancy-associated secondary spontaneous pneumothorax (MSSP) has an incidence of 1% with a risk for recurrence of 9.4% reported in association with sarcomas, histiocytoma, malignant thymoma, and cancers of the breast and thyroid.Case presentationWe report a series of four patients who presented to us with MSSP associated with pulmonary metastasis of osteosarcoma, all four being young males with metastasis to the lungs. All four patients were non-smokers and had no family history of malignancy. Less than 2% of all spontaneous pneumothoraxes present with bilateral pneumothorax, and our series reports the same in three patients. The occurrence of pneumothorax in two of the patients was in the week following chemotherapy. As there was evidence of pulmonary metastasis in these patients along with the clinical presentation of pneumothorax following chemotherapy, tumor necrosis was considered the likely etiology of spontaneous pneumothorax in these patients. All four patients required intercostal chest drain insertion, and the ICD tubes had to be retained for a prolonged duration due to either persistent air leak or secondary infection. ICD tube insertion further compromised the poor mobility of patients with lower limb lesions due to increased pain and was detrimental to the emotional morale of the patient and caregivers. The 2-year survival in such patients with pneumothorax is less than 10%.ConclusionsOur series highlights the need for respiratory evaluation and follow-up both clinically and radiologically in cases of osteosarcoma, especially in the immediate post-chemotherapy period.

Bilateral Pneumothoraces During Tracheostomy in a Case of Neck Injury: A Rare Case

Bilateral Pneumothoraces During Tracheostomy in a Case of Neck Injury: A Rare Case

Bilateral pneumothoraces with apical consolidations.

Bilateral pneumothoraces are extremely rare. Patients with pleuroparenchymal fibroelastosis are frequently complicated by pneumothorax, which is sometimes bilateral. Pleuroparenchymal fibroelastosis should be considered a cause of bilateral pneumothoraces with apical fibrosis.

Anesthetic management of total thyroidectomy and tracheostomy in a patient with Graves’ disease and bilateral pneumothorax : a case report

気胸患者の全身麻酔は術前に胸腔ドレーンを留置することが望ましい．本症例は人工呼吸器管理中の57歳の男性で，甲状腺全摘出術と気管切開術が予定された．両側気胸があったが，左胸腔ドレーンのみで自発呼吸で管理されていた．全身麻酔の強制換気に伴い右胸腔ドレーンの留置が検討されたが，甲状腺機能亢進症状から術前に侵襲を加えることを控えたため，右肺への圧を最小限に抑える必要が生じた．甲状腺全摘出術中はダブルルーメンチューブを用いて，左片肺換気と右肺CPAPで対応した．気管切開術では気管切開チューブの入れ替え後の両肺換気のため，レミマゾラムを拮抗し自発呼吸をすみやかに確立した．良好に管理できた本症例を報告する．

Perioperative ventilator-induced lung injury- An unexpected complication of post COVID-19 sequelae

In today’s era of the COVID-19 pandemic, post-covid lung sequelae increases the incidence of ventilator-induced lung injury in patients undergoing cancer surgeries. A 68 years old female patient underwent surgery for squamous cell carcinoma lower lip under general anesthesia. 10 minutes after reversal and adequate respiratory efforts, sudden desaturation with high peak airway pressures of 35-40 cmH2O was noticed. Bilateral air entry was markedly reduced with crepitus all over the chest and abdomen with stable hemodynamics. Chest X-ray revealed a bilateral deep sulcus sign suggesting bilateral pneumothorax and subcutaneous emphysema. Bilateral thoracostomy tubes were inserted immediately. The saturation and airway pressure improved, and she was extubated the next day. Retrospectively, a possible history of previous undiagnosed COVID-19 infection was sought and this emphasizes the importance of this history, in the ongoing pandemic. Previous history of COVID-19 predisposes patients to a high risk of ventilator-induced lung injury perioperatively.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved significantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusions: Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.

Manejo quirúrgico del neumotórax espontáneo primario. Encuesta nacional del Grupo Emergente de Cirugía Torácica de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR)

IntroductionIn February 2022, the Emerging Thoracic Surgery Group of the Spanish Society of Pneumology and Thoracic Surgery initiated a multicenter study on the surgical management of primary spontaneous pneumothorax (PSP). As a preliminary step, this survey was developed with the aim of finding out the current situation in our country to specify and direct this project. MethodA descriptive study was carried out based on the results of this survey launched through the Google Docs® platform. The survey was sent to all active national thoracic surgeons, a total of 319. It consisted of 20 questions including demographic, surgical and follow-up data. ResultsWe obtained 124 responses (39% of all specialists and doctors in training in the national territory). The most consistent indications were: homolateral recurrence for 124 (100%), lack of resolution of the episode for 120 (96.7%), risk professions for 104 (84%) and bilateral pneumothorax for 93 (75%). The approach of choice for 100% of respondents was videothoracoscopy. Of these, 96 contemplated pulmonary resection of obvious lesions (77%). Regarding the pleurodesis technique, pleural abrasion was the technique most used by 70 respondents (56.7%) while 49 (40%) performed chemical pleurodesis with talc either alone or in combination with mechanical pleurodesis. ConclusionsWhile there is some consistency in some aspects of surgical management of PSP, this survey makes evident the variability in pleurodesis techniques applied among surgeons in our country.

ALL OVER THE PLACE: A CASE OF MULTIVALVULAR INFECTIVE ENDOCARDITIS

ALL OVER THE PLACE: A CASE OF MULTIVALVULAR INFECTIVE ENDOCARDITIS

LARGE BILATERAL PNEUMATOCELES COMPLICATING COVID-19 RECOVERY

LARGE BILATERAL PNEUMATOCELES COMPLICATING COVID-19 RECOVERY

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

BILATERAL PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA: A CASE OF A RARE SYNCHRONOUS TRIAD IN ASTHMA EXACERBATION

BILATERAL PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA: A CASE OF A RARE SYNCHRONOUS TRIAD IN ASTHMA EXACERBATION

Bilateral pneumothorax in a parturient undergoing cesarean section under general anesthesia

Pneumothorax is quite unusual to occur during or following cesarean section, as only six cases have been reported so far, and only one of them was bilateral. Here, we report a 19-year-old, previously healthy, non-smoking primigravida who underwent a cesarean section under general anesthesia, and whose oxygen saturation level quickly dropped to 81% following endotracheal intubation. Although an initial chest radiograph did not demonstrate pneumothorax, a CT scan performed on the following day showed the patient had developed bilateral pneumothorax. Chest tubes were inserted on both sides, and the patient was discharged on the sixth postoperative day in stable condition. This case underlines the need to include pneumothorax in the differential diagnosis when managing a patient with acute respiratory distress during cesarean section or in the immediate post-operative period.

Delayed subcutaneous emphysema, mediastinal emphysema and pneumothorax after tracheal intubation in a child: a case report

Subcutaneous emphysema and mediastinal emphysema and/or pneumothorax after mechanical ventilation through endotracheal intubation is not uncommon. However, cases of delayed mediastinal emphysema and subcutaneous emphysema after extubation and their further development into pneumothorax have rarely been reported, especially in children. Given this, we provide such a case for the reference of clinicians. We report a case of a 2-year-old girl with no abnormalities at the preoperative examination, who developed subcutaneous emphysema and mediastinal emphysema 4 hours after recovery from general anesthesia due to ophthalmic arterial infusion chemotherapy for retinoblastoma, and bilateral pneumothorax 12 hours later. The patient recovered and was discharged following aggressive treatment of subcutaneous exhaust and thoracic closed drainage. Due to fiberoptic bronchoscopy was refused by the guardian to determine the cause, we hypothesized tracheal intubation injury occurs, air enter the trachea or bronchial mucosa, extend up to the neck, head and face along the blood vessels, larynx and deep cervical fascia spaces, causing subcutaneous emphysema, and then gradually spread to the mediastinum, resulting in mediastinal emphysema and pneumothorax. However, the etiology and preventive measures warrant further study. Strengthen the etiological study of subcutaneous and/or mediastinal emphysema and pneumothorax due to endotracheal intubation, perioperative observation and postoperative follow-up are important measures for the effective prevention, early diagnosis, and timely treatment of subcutaneous and/or mediastinal emphysema and pneumothorax, and are also conducive to ensuring the safety of patients.

Bilateral Pneumothorax in a case of severe COVID-19 Pneumonia with Pregnancy

A 19-year old patient with 8th-month pregnancy was admitted in our hospital with severe COVID infection. She was put on oxygen support and managed as per COVID protocol. She had spontaneous vaginal delivery and the baby was found to be COVID-negative. She developed initially left and later right-sided Pneumothorax. She had prolonged hospitalization and was managed with intercostal drains, NIV, Remdesivir and chest physiotherapy. The pneumothoraxes resolved and she made a satisfactory recovery and could be discharged on room air.

Spontaneous bilateral pneumothorax and pneumomediastinum independent of mechanical ventilation as complications of COVID-19 pneumonia: A case report.

Since the beginning of the COVID-19 pandemic, several infected patients have suffered from unusual and severe complications. Among these rare complications, pneumothorax and pneumomediastinum have attracted clinical attention. Such complications might be challenging to diagnose immediately because of the atypical presentation in some cases. Accurate diagnosis is essential to ensure effective treatment. Here, we present the case of a 62-year-old male who presented with symptoms of COVID-19 acute respiratory distress. There was diffuse subcutaneous emphysema in the face, neck, shoulder, and chest wall on clinical examination. The patient was started on oxygenation via a non-rebreather mask. On further evaluation, his chest X-ray revealed bilateral peripheral opacities in the lung fields, bilateral pneumothorax, and subcutaneous emphysema, after which intercostal drainage tubes were inserted. The patient's oxygen saturation was not satisfactory, and he was switched to a high-flow nasal cannula. However, his condition deteriorated, and he was put on mechanical ventilation and inotropic support. Despite our best efforts, the patient succumbed to the disease. We want to emphasize the importance of this adverse event despite his nonsmoking history and the exclusion of positive pressure ventilation. Although benign, early diagnosis of this condition is vital, as the condition could lead to worse morbidity if left unrecognized.