Bilateral Tension Pneumothorax Research Articles

Bilateral Tension Pneumothorax and Bronchospasm in the Patients with Recent History of Croup - A case report -

Tension pneumothorax is a rare but critical complication of mechanical ventilation. Many researchers regard elevated peak inspiratory pressure as a major etiology for pneumothorax during ventilatory care. Bronchospasm is another adverse events under general anesthesia and it has been reported that the risk of bronchospasm is increased in the children with recent upper respiratory infection. We have experienced a case of recurrent bronchospasm which finally ends up with bilateral tension pneumothorax and debilitating consequences. A 2 year-old boy with a history of croup one week before neuroblastoma excision operation developed several times of bronchospasm attacks during the operation. Episodes of bronchospasm continued in the ICU and complicated with sudden postoperative bilateral tension pneumothorax. Pneumothorax possibly associated with bronchospasm was rarely reported until now. Therefore, we present this case with the literature review. (Korean J Anesthesiol 2007; 52: 724～7)

A Case of Tracheostomy Induced Bilateral Tension Pneumothorax

□ 이달의 X선 □Tracheostomy is one of the oldest surgical procedures in medica l history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and trac heal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct inju ry to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon c ase of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature. (Tuberc Respir Dis 2007; 62: 437-440)Key word: Tracheostomy, Tension pneumothorax.Address for Correspondence: Sang Myeon Park, M.DDivision of Pulmonology Kangnam Sacred Heart Hospital, Hallym University 948-1, Daelim-1 dong, Youngdungpo-gu, Seoul, 150-950, KoreaPhone: 82-2-829-5118, Fax: 82-2-846-4669E-mail: thoraxmd@hallym.or.krReceived: Mar. 26. 2007Accepted: May. 4. 2007

Tension Pneumothorax Secondary to Colonic Perforation During Diagnostic Colonoscopy: Report of a Case

We report a case of tension pneumothorax, which occurred secondary to colonic perforation during a colonoscopy. The patient was a 77-year-old woman in whom acute respiratory decompensation developed suddenly during a diagnostic colonoscopy for iron deficiency anemia. We diagnosed bilateral pneumothoraces, tension pneumothorax, pneumomediastinum, pneumoperitoneum, and emphysema of the face, neck, and chest. At laparotomy, a posterior colonic perforation was identified at the site of an ileocolic anastomosis performed 3 years earlier. We performed a primary repair and the patient was discharged from hospital 12 days later. Although diagnostic colonoscopy-induced intestinal perforation is rare, it is the most common and serious complication associated with this procedure. Occasionally, air spreads from the retroperitoneum into continuous tissue planes and decompresses into the adjacent structures. To our knowledge, this is the first report of two unique manifestations of diagnostic colonoscopy-induced intestinal perforation: tension pneumothorax and perforation at the site of a previous anastomosis. Both of these conditions should be considered in the event of acute respiratory failure in the endoscopy suite.

Computed tomography whole body imaging in multi-trauma: 7 years experience

To assess the impact of the introduction of a computed tomography (CT) imaging protocol for multi-trauma patients on the workload, overall diagnostic yield, and effect on detection of cervical spine injury and pneumothorax. Between February 1997 and April 2004, all patients presenting acutely to the Emergency Department (ED) with haemodynamically stable trauma (Abbreviated Injury Scale 3 or more) involving more than two body systems were imaged with a comprehensive pre-set helical CT protocol (including non-contrast head, cervical spine: cranio-cervical and cervico-thoracic junctions; and oral and intravenous contrast-enhanced thoracic, abdomen and pelvis) after initial triage and a standard trauma series of radiographs (chest, lateral C-spine and pelvis). Diagnosis of cervical spine fracture and pneumothorax was noted before and after the CT protocol was carried out and findings from all studies were recorded prospectively. Over the 7-year period 296 multi-trauma CT studies were completed of which 41 (13.8%) were negative. Of the positive cases there were 127 (43%) head injuries; 25 cervical spine fractures (8%); 66 pelvic fractures (22%);48 thoracic or lumbar spine fractures (16%); 97 pneumothoraces (33%); 22 mediastinal injuries (7%) and 49 intra-abdominal injuries (17%) with 19 (6%) splenic tears/ruptures. Positive findings included many unsuspected injuries, including 19 cervical spine fractures which were not demonstrated on the standard lateral radiograph from the resuscitation room. Of the 97 CT detected pneumothoraces, 12 were bilateral, 52 already had a chest drain in situ and 36 were not detected on initial supine chest radiography in the resuscitation room. One undetected case had bilateral tension pneumothoraces that were promptly drained on the CT table. Only three patients did not complete their multi-trauma examination because of deterioration in clinical condition and these were all immediately returned to the resuscitation room. Over the 7-year period in a large acute National Health Service (NHS) hospital trust currently averaging 85,000 ED attendances per year only 296 patients fulfilled the stated criteria for an immediate multi-trauma CT study. Although disruptive in the short-term, the overall impact on workload was small. A wide range of significant injuries were demonstrated rapidly, accurately and safely, including 19 cervical spine fractures and 26 pneumothoraces not detected on plain radiographs.

Pneumothorax bilatéral au retrait du cathéter de jet ventilation à haute fréquence

We report a bilateral tension pneumothorax which occurred in a 36-year-old man after high-frequency jet ventilation (HFJV) for panendoscopy. The patient had been treated with radiotherapy and chimiotherapy two years ago for an oropharyngeal adenocarcinoma, and by surgery for a recurrence. The incident occurred after a cough episode triggered by the withdrawal of the Ravussin transtracheal catheter. We are discussing the risk factors and the mechanisms of pneumothorax during HFJV with special emphasize on trapping and lung fibrosis.

A Case of Simultaneous Bilateral Spontaneous Pneumothorax Developed into Tension Pneumothorax

Spontaneous pneumothorax is a relatively common disease in the clinical practice setting and is generally recognized to occurs most often in slender young men. However, spontaneous pneumothorax that occurs bilaterally and simultaneously and progresses to tension pneumothorax has rarely been documented. Although spontaneous pneumothorax can be diagnosed based on the patient's medical history or information from ambulance personnel, it should be remembered that there are some rare cases of bilateral tension pneumothorax. Prompt and appropriate diagnosis and treatment are necessary for patients with such conditions, which may can be life-threatening.

Bilateral tension pneumothorax following rigid bronchoscopy: A report of an epignathus in a newborn delivered by the EXIT procedure with a fatal outcome

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minutes later. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.

Bilateral tension pneumothorax

The report discusses three patients who presented with pulseless electrical activity (PEA), caused by chronic respiratory disease, with bilateral tension pneumothorax. In each case needle decompression failed to relieve the tension and cardiac output was restored only after the insertion of a chest tube.

Research Reviews: Reports of Adverse Events& Related Papers: Bilateral Tension Pneumothorax after Acupuncture

Research Reviews: Reports of Adverse Events& Related Papers: Bilateral Tension Pneumothorax after Acupuncture

An autopsy case of bilateral tension pneumothorax after acupuncture

Acupuncture is one of the most popular complementary therapies in the world. Pneumothorax due to perforation of the lungs by needle insertion is one of the most common and serious complications of acupuncture treatment. Although there have been several case studies of pneumothorax induced by acupuncture, as far as we know there have been no reports on the pathological findings of autopsy cases. In this report, we describe the pathological findings of an autopsy case of bilateral tension pneumothorax after acupuncture. The patient suffered dyspnea and chest pain soon the completion of an acupuncture treatment, and died 90 min later. Several ecchymoses were macroscopically observed on the parietal pleura in the left and right thoracic cavity, suggesting that needles were inserted into the thoracic cavity and that the lungs were perforated. The many black spots we observed on the parietal pleura along the vertebral column microscopically consisted of a number of dust-like black pigments and macrophages containing these pigments. These spots seemed to have appeared because of the previous insertion of needles.

Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results

Background The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax. Methods From July 1991 to December 1997, 182 patients with primary spontaneous pneumothorax were treated by a single technique at our institution. Seven patients had single-stage bilateral procedures and 11 other patients had staged bilateral procedures. Indications for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral recurrence (n = 25), synchronous bilateral pneumothorax (n = 3), hemopneumothorax (n = 3), and tension pneumothorax (n = 1). All patient data were reviewed retrospectively, and 167 patients were available for late follow-up (92%). Results Mean operative time was 57 ± 19 minutes Conversion to thoracotomy was required in 1 patient (0.6%). Mean duration of pleural drainage was 5.8 ± 1.2 days (range, 4 to 26 days), and mean postoperative stay was 7.7 ± 1.6 days (range, 6 to 31 days). Postoperative complications occurred in 50 patients (27.4%), the most frequent being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a mean follow-up of 93 ± 22 months (range, 57 to 134 months; median, 84 months), five ipsilateral recurrences were noted (3%). Three recurrences occurred within 12 months of videothoracoscopy and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and were treated conservatively with chest tube insertion and tale slurry. After 1 year, 10.7% of patients complained of chronic chest pain or discomfort, although none was taking pain medication after 3 months. Most patients (89.8%) were satisfied or very satisfied of their operation. All patients had returned to sport activities within 2 years. Conclusions Videothoracoscopic bullectomy and pleural abrasion is a reliable and safe method to treat primary spontaneous pneumothorax. Long-term recurrences occur with an acceptable rate that compares with results after limited thoracotomy. Chronic chest pain or discomfort is unpredictable and may represent a problem in a few patients.

Tracheobronchial injuries

A 27-year-old man, formerly in good health, arrived at the local trauma center after a high-speed rollover motor vehicle crash. He was in frank shock, with bilateral tension pneumothoraces. The team intubated him immediately and placed bilateral chest tubes. A computed tomography scan of the head showed severe traumatic brain injury with diffuse axonal injury and intraventricular bleeding. Additional injuries included bilateral full-thickness burns to his lower extremities, multiple facial fractures, multiple rib fractures, and pulmonary contusion.

Elevación del ST y neumotórax a tensión

We present a case of a sixty-nine-year-old male admitted to the hospital because of an acute respiratory failure that needed intubation and mechanical ventilation. Shortly after several attempts of right and left (the last one successful) subclavian vein cannulation (the last one successful) he developed a bilateral tension pneumothorax with important hemodynamic repercussion, a critical hypoxia and an ST elevation in inferior leads. Other more typical electrocardiographic changes could be observed: decrease in QRS amplitude and diminishing of precordial R voltage. After removing the air of the right pleural space, all the electrocardiographic signs disappeared returning to normal without electric or enzymatic assay of myocardial necrosis.

Case report: Bilateral recurrent tension pneumothorax complicating combination chemotherapy for soft tissue sarcoma

Case report: Bilateral recurrent tension pneumothorax complicating combination chemotherapy for soft tissue sarcoma

Replacement of the Descending Thoracic Aorta for Massive Aneurysm in Neonatal Marfan Syndrome

We describe a patient with neonatal Marfan syndrome presenting with massive ascending and descending thoracic aortic aneurysm. Because of rapidly progressive respiratory distress due to tracheobronchial compression, emergency replacement of the descending thoracic aorta with a 12-mm PTFE vascular prosthesis was undertaken at 1 month of age. The postoperative course was complicated by bilateral tension pneumothorax contributing to irreversible respiratory failure. The unique clinico-pathological features and the relevant surgical implications of the case are discussed.

Pneumatoceles and pneumothoraces complicating staphylococcal pneumonia: treatment by synchronous independent lung ventilation.

A 54 year old man with a staphylococcal sepsis developed staphylococcal pneumonia complicated by multiple pneumatoceles and bilateral tension pneumothoraces caused by bronchopleural fistulae. Excessive enlargement of the right sided pneumatoceles and a tension pneumothorax not improved by drainage led to mediastinal shift and compression of the right lung. Reversal of the mediastinal shift and closure of the bronchopleural fistulae was achieved by assisted independent lung ventilation.

Subcutaneous Emphysema, Pneumomediastinum, and Potentially Life-Threatening Tension Pneumothorax: Pulmonary Complications from Arthroscopic Shoulder Decompression

Subcutaneous emphysema, pneumomediastinum, and tension pneumothorax are previously unreported complications of shoulder arthroscopy with subacromial decompression. Three patients developed extensive subcutaneous emphysema, pneumomediastinum, and bilateral tension pneumothorax during or immediately after shoulder arthroscopy with subacromial decompression. The procedure was terminated and appropriate treatment was given. All three patients recovered completely with no residual damage. The complications are thought to be associated with the extravasation of air that may be drawn in from the lateral portal when the arthroscopic infusion pump and power shaver with suction are turned on. Early diagnosis, followed by immediate termination of the infusion pump and suction shaver along with appropriate treatment can be life-saving.

Bilateral tension pneumothorax due to a defective anesthesia breathing circuit filter

A 25-year-old healthy patient developed bilateral tension pneumothorax during general endotracheal anesthesia due to a defective anesthesia breathing circuit filter. Prompt diagnosis and treatment of the pneumothorax was facilitated by the use of capnography and pulse oximetry. The manufacturing process of the breathing circuit and filter that made this accident possible has since been corrected by the manufacturer. Anesthesiologists must be alert to the possibility of such accidents with any breathing system using bacterial filters.

Multiple pneumatocoeles and bilateral tension pneumothoraces complicating Pneumocystis pneumonia in AIDS

Pneumatocoele and pneumothorax are uncommon complications of Pneumocystis carinii pneumonia. We report a patient with the Acquired Immune Deficiency Syndrome who developed multiple bilateral pneumatocoeles which we demonstrate to have ruptured leading to the subsequent bilateral tension pneumothoraces and to death. The computerised tomographic appearances, and histopathology of these unusual complications are presented. The literature on these manifestations is reviewed and management discussed.

Cricothyroid membrane puncture

A method for pediatric airway support was evaluated for the situation when mask ventilation or intubation is impossible. Mongrel dogs were sedated, intubated, and allowed to breathe room air for 30 min. Baseline variables were recorded, and the airway obstructed. After 2 to 3 min of hypoxia, arterial blood gas and hemodynamic data were again recorded. A percutaneous cricothyroid membrane puncture (PCMP) was then performed with a 12-ga iv catheter. Studies were carried out both in the presence and absence of spontaneous ventilatory efforts. With spontaneous ventilation, continuous low flow (1.0 L/min) oxygen insufflation provided oxygenation for 30 min and reversed increases in mean arterial pressure, pulmonary artery pressure (PAP), and systemic and pulmonary vascular resistance that had been produced by the obstruction. Respiratory acidosis occurred but was well tolerated. With paralyzed animals, whose ventilation was supported by a self-inflating bag with 10.0 L/min of oxygen, all hemodynamic variables except PAP returned to normal, oxygenation was excellent, and PaCO2 values were maintained at steady, but elevated levels. Complications included bilateral tension pneumothorax in one animal. This experimental study supports anecdotal experiences where PCMP has been used and has proven lifesaving when standard resuscitative measures to establish a clear airway have failed.