Forms Of Spontaneous Pneumothorax Research Articles

Катамениальный пневмоторакс как особая форма спонтанного пневмоторакса (обзор литературы)

Spontaneous pneumothorax is a common (more than 12.5% of all urgent conditions in thoracic surgery) life-threatening condition, statistically more commonly found in men with pulmonary emphysema. However, a rare and difficult diagnostic form of spontaneous pneumothorax that develops in more than 73% of women of reproductive age with thoracic endometriosis is spontaneous catamenial pneumothorax. In the prevailing majority of patients, this pneumothorax turns out to be right-sided and recurrent in more than 70% of cases. The “gold standard” for verification of thoracic endometriosis is the visual inspection of the chest organs and biopsy using video-assisted mini-thoracotomy (VATS). The signs of thoracic endometriosis detected intraoperatively include the identification of fenestrations of the diaphragm, endometriosis of the visceral pleura, bullae of various calibers, cicatricial changes in lung parenchyma, etc. There is no consensus on the tactics of patients´ management, however, the primary importance in the treatment of thoracic endometriosis and spontaneous catamenial pneumothorax as its main manifestation should be given to surgical interventions: suturing diaphragm defects, typical (anatomical) or atypical resection of the lungs in different volumes, pleurodesis to prevent the recurrence of pneumothorax, etc. The most effective pleurodesis methods are chemical pleurodesis with sterile talc, the use of YAG-ND and CO2 lasers. Apical pleurectomy is actively used; various materials (fibrin gel, polyglycolic acid, etc.) are being studied as suture-line coverage to create aerostasis. Along with surgical methods, the use of COCs, analogues of gonadotropin-releasing hormone, danazole, progestins, and aromatase inhibitors minimizes the recurrence of spontaneous pneumothorax in patients with thoracic endometriosis.

Images in anesthesia: Bilateral pneumothorax following tracheal extubation

gency.1 Iatrogenic pneumothorax is more common than all forms of spontaneous pneumothorax.2 – 5 A 55-yr-old, 101 kg, male underwent cardiac surgery under general anesthesia. Examination of the heart and lungs showed no abnormality and the patient’s past medical history did not indicate any respiratory disease. The preoperative chest radiograph was normal. Arterial blood pressure, heart rate, and arterial oxygen saturation (SpO2) were stable during the operation. Because of hemodynamic instability extubation was possible only six days postoperatively. Soon after extubation, the patient developed cyanosis and SpO2 declined to 90%. Chest radiography revealed bilateral pneumothorax, which was treated successfully by inserting bilateral chest tubes. In the absence of chronic lung disease, especially bronchitis and emphysema, a diagnosis of iatrogenic pneumothorax was made.

Local anesthesia infiltration as a cause of intraoperative tension pneumothorax in a young healthy woman undergoing breast augmentation with general anesthesia

Pneumothorax may be a medical emergency. Iatrogenic pneumothorax is more common than all other forms of spontaneous pneumothorax, and surgical procedures involving the breast are a frequent setting for this. A 32-year-old, 60 kg, woman without any significant medical history underwent a bilateral breast augmentation and rhinoplasty. She underwent a routine general endotracheal anesthetic. Prior to surgical incision, the surgeon infiltrated the breast with lidocaine with epinephrine. Six hours into the surgical procedure, the patient developed hemodynamic compromise and was diagnosed with tension pneumothorax, which was treated emergently with a 14-gauge angiocatheter placed intrapleurally. The patient immediately returned to hemodynamic stability. This case report discusses iatrogenic pneumothoraces as well their most likely causes; which in this specific case was the injection of local anesthetic. Suggestions for prevention and treatment of the unusual complication are discussed.

The surgical treatment of spontaneous pneumothorax by video-thoracoscopy.

Since March 1991, 66 patients with spontaneous pneumothorax were treated thoracoscopically employing the principles of minimally invasive surgery. Of these cases, 14 involved a first occurrence, 18 had a pneumothorax longer than 7 days, and 34 were recurrences; causative lung disease was determined in 25 patients. The blebs and bullae were ligated with chromic catgut Roeder loop or resected with the Endo-GIA stapler. If pathological changes to the lung consistent with Vanderschueren's stage IV were found (n = 36), the treatment was extended to include a parietal pleurectomy. No complications requiring therapy were encountered, the average postoperative hospital stay was 3.2 days. During an average observation period of 10 months (1-27) the recurrence rate was 4.5%. Thoracoscopic therapy proved to be a simple and safe method for all forms of spontaneous pneumothorax.

Simultaneous bilateral spontaneous pneumothorax: Case report

A 22-year-old previously healthy male was admitted to the emergency department for chest pain and dyspnea of 1-day's duration. He had a history of heavy smoking. The patient was cyanotic, agitated, and severely dyspneic. Lung auscultation revealed severe diffuse bronchospasm and equally diminished breath sounds on both sides. Nasotracheal intubation and mechanical ventilation were performed shortly after admission due to acute respiratory failure. Simultaneous bilateral spontaneous pneumothorax was diagnosed from the chest x-ray, and chest tube drainage was immediately performed bilaterally. Computerized tomography of the chest 1 month later showed diffuse emphysematous bullae of the lungs. The case presented here should increase physicians' awareness of this rare form of spontaneous pneumothorax and its diverse manifestations.

Pathogenesis of So-Called Idiopathic Spontaneous Pneumothorax and Related Conditions

There exists two forms of so-called idiopathic spontaneous pneumothorax. One is very benign and due to a sub-pleural bulla which has become permeable. The intrapleural pressure is moderately increased; the volume of air escaping through the bulla is small. Soon an equilibrium is established between the pressure of the bulla and that of the pleural cavity which limits the outgoing air. The part played by the adhesions consists of favoring the genesis and the swelling of the bulla. It is the nature of this benign form that there is never any pleural effusion or hemothorax. Evacuation of air gives real relief and continual drainage is not necessary. In these chronic or recurring cases pleural irritation appears indicated, and in cases of adhesions, their section. The beginning of pneumothorax of this kind does not necessarily depend upon a mechanical factor. The moment when the bulla becomes permeable depends on the degree of attenuation or thinness of the wall. Exceptionally the clinical situation is a dramatic one in case of bilateral pneumothorax, in the presence of serious lesions of the lung, of myocardial disease, or of aged patients. At necropsy, the pathologist endeavors in vain to find a torn bulla as I have witnessed many times. The clinical picture of the second form of spontaneous pneumothorax is due to a ruptured bulla or laceration of pulmonary tissue, which is usually serious. Pressure is considerably increased and the lung greatly collapsed, while the mediastinum is deviated. Aspiration of air has a palliative effect since the volume of air coming from the bronchioles without the intermediary of a tightly stretched bulla is of importance. In order to save the patient's life, one must in some cases establish a continual drainage. The part played by adhesions is important in the pathogenesis of rupture of bullae and other lacerations. The starting of pneumothorax by physical effort or trauma is significant. Hemothorax or pleural effusion can occur because of the lesion of the lung and of the direct communication of the bronchial tree with the pleural cavity.