Recurrent Spontaneous Pneumothorax Research Articles

Recurrent spontaneous pneumothorax in four surgically treated Japanese Spitz dogs

AbstractFour Japanese Spitz dogs between 5 and 11 months old were presented for acute dyspnoea. Thoracic radiographs and CT identified bilateral pneumothorax and pulmonary cavitary lesions. The median lesion size was 30 mm (range 7‒50 mm). After initial stabilisation, one dog underwent median sternotomy, while three dogs underwent intercostal thoracotomy. Surgical exploration found grossly haemorrhagic pulmonary bullous lesions in all cases. Histopathology revealed blood‐filled cavities with interstitial fibrosis and pneumocyte hyperplasia. Dyspnoea recurred in all dogs postoperatively, with recurrence of lesions confirmed either radiographically or via CT in three of four cases. The median time from surgery to recurrence of pneumothorax was 9 days (range 5‒15 days). The mortality rate was 100%, and the median postoperative survival time was 22 days (range 5‒558 days). This report aims to raise awareness of this group of dogs presenting with spontaneous pneumothorax at a young age and with high recurrence rates despite surgery, contrary to the literature.

A rare diagnosis of Langerhans cell histiocytosis made on thyroid histology with coexisting papillary thyroid cancer and AVP deficiency.

A 48-year-old Asian male, presented to the hospital for an elective total thyroidectomy in the context of 6.3 cm thyroid nodule. The fine needle aspiration cytology of the nodule confirmed papillary thyroid cancer (PTC) with some atypical histiocytes. He has a history of idiopathic arginine vasopressin deficiency (AVP-D) and has been taking oral DDAVP 100 µg daily, self-adjusting the dose based on thirst and polyuria. Additionally, he also has a history of recurrent spontaneous pneumothorax. His total thyroidectomy was aborted due to significant intraoperative bleeding, and his admission was further complicated by post-operative hyponatraemic seizure. Thyroid histology revealed the diagnosis of Langerhans cell histiocytosis (LCH), and further investigation with contrast CT demonstrated multi-organ involvement of the thyroid, lungs, and bones. Langerhans cell histiocytosis (LCH) is a condition that can affect one or more organ systems, including the pituitary, where it can present as AVP deficiency. Strict monitoring of fluid balance, as well as serial monitoring of serum sodium, is essential in all patients with AVP-D in the perioperative setting. Iatrogenic hyponatraemic seizure is an uncommon but serious complication of DDAVP treatment in hospitalised patients with AVP-D. DDAVP dosing must be carefully monitored. LCH with multisystem involvement is an important mimic for metastatic conditions, and histological diagnosis is essential to guide treatment and prognosis. Although LCH without bone marrow involvement is unlikely to increase the risk of bleeding, its effect on tissue integrity may make surgery more challenging. BRAF-V600E mutation is an important driver mutation and a potential therapeutic target in the treatment of LCH.

Recurrent spontaneous pneumothorax in a patient with wilson disease who is on long-term D-penicillamine: Case report

Introduction: Recurrent spontaneous pneumothoraces (PSP) in association with liver disease is well known to occur with alpha 1 antitrypsin deficiency (AATD). Wilson disease (WD) association with recurrent PSP is not a known entity. Case presentation: A 42-year-old nonsmoker man with a history of recurrent PSP was admitted with a large right pneumothorax. Following intercostal chest drain (ICD) patient’s breathing improved and the lung expanded. Despite that, he continued to have a small residual pneumothorax (<2cm). Twelve years ago, he was diagnosed with WD. The patient was on treatment with D-penicillamine. After 3 years of the diagnosis of WD, the patient developed left-sided recurrent PSPs where he ended up with a left-pleurectomy in 2015. For the current event, initially expectant management was done for residual pneumothorax. All the possible causes for PSP were excluded. On follow-up, he continued to be symptomatic. A thoracic surgical referral was arranged for Video-Assisted Thoracoscopic Surgery (VATS) and redo-pleurectomy. The safety of future treatment with D-penicillamine is not concluded as there is no convincing evidence to prove it as a culprit agent for PSPs. Multidisciplinary discussion was arranged and consideration of treatment with alternative copper chelating therapy was emphasized. Conclusion: Though rare, it is important to observe for occurrence of PSP in WD patients. This case report will be eye-opening for the association of lung disease and WD and related treatment.

Improved detection of air-filled lesions using computed tomography in dogs with recurrent spontaneous pneumothorax through reduction of pulmonary atelectasis via positive pressure ventilation.

Spontaneous pneumothorax in dogs is predominantly caused by the rupture of air-filled lesions, such as bullae or blebs. The efficacy of Computed Tomography (CT) in detecting these lesions has been deemed limited due to its reportedly low sensitivity. This retrospective, cross-sectional study investigates the utility of CT in eight dogs diagnosed with recurrent pneumothorax, all of which had surgical confirmation of the cause of the pneumothorax. Thoracic radiographs were obtained before and the day following the CT studies. Initially, a CT study was conducted without positive pressure ventilation (pre-PPV CT). Subsequent CT studies were performed post-evacuation of pneumothorax and with positive pressure ventilation of 15 cmH2O until lung atelectasis was resolved (post-PPV CT). The pre-PPV CT and post-PPV CT images were anonymized and reviewed by two board-certified radiologists. The presence and morphology of air-filled lesions were evaluated on all images. Surgical findings were recorded and compared to the CT findings. Air-filled lesions were detected in 5 out of 8 dogs in the pre-PPV CT studies and in all 8 dogs in the post-PPV CT studies. The CT findings of air-filled lesions were consistent with surgical findings. None of the dogs showed increased severity of pneumothorax in radiographs taken the day following the CT studies. The study concludes that the resolution of lung atelectasis by evacuation of pneumothorax and positive pressure ventilation during CT studies is feasible and enhances the detection of air-filled lesions in dogs with recurrent spontaneous pneumothorax. This could potentially aid in improving surgical planning.

Pleurectomy versus pleural abrasion in patients with spontaneous pneumothorax: a randomized controlled trial

Background A prevalent clinical issue that can affect people of any age is pneumothorax. Depending on the degree of cardiorespiratory impairment, the severity of the symptoms, and the size of the pneumothorax, the course of treatment might range from conservative to surgical. In this study, we examined the risks of pneumothorax recurrence in individuals with spontaneous pneumothorax using the pleural abrasion and pleurectomy procedures. Patients and methods We did a randomized controlled trial involving 80 patients with spontaneous pneumothorax. Patients were randomly allocated to undergo video-assisted thoracoscopic surgery bullectomy with mechanical pleurodesis; pleural abrasion, or pleurectomy. We compared the incidence of recurrence of spontaneous pneumothorax as a primary outcome, postoperative drainage amount, hospital stay, and mortality as our secondary outcome in both groups. This trial is listed on ClinicalTrials.gov as NCT05407974. Results There were two cases of recurrence of pneumothorax in the pleurectomy group and no recurrence in the pleural abrasion group with P value of 0.152. The drainage amount was higher in the pleurectomy group with mean 230.00±75.79 ml than the abrasion group with mean 192.50±65.58 ml (P=0.020). There was no statistically significant difference between the two groups as regards hospital stay (P=0.556), there were no cases with hospital mortality in both groups. Conclusion Mechanical pleurodesis performed with bullectomy as a technique to reduce the recurrence of spontaneous pneumothorax has proven its efficiency in our study. Despite pleurectomy group showed increase in the drainage amount postoperatively compared with pleural abrasion. There was no difference in the recurrence rates, hospital stay, and in hospital mortality in both groups. Our conclusion does support the adoption of mechanical pleurodesis in patients undergoing bullectomy for spontaneous pneumothorax whether by pleurectomy or pleural abrasion.

Prospective Observation Study for Primary Spontaneous Pneumothorax: Incidence of and Risk Factors for Postoperative Neogenesis of Bullae.

Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.

Many years of experience of spontaneous pneumothorax treatment within one medical center

The objective: to analyze results of surgical treatment of the patients with spontaneous pneumothorax.Subjects and Methods. Medical records of patients with spontaneous pneumothorax (SP) who were treated in Surgical Thoracic Department of Ryazan Regional Clinical Hospital from 1998 to 2021 were retrospectively analyzed. The article describes the experience of treatment of 738 cases of spontaneous pneumothorax within one medical center. The evolution of tactics and principles of surgical treatment over a 23-year period is presented. The incidence of spontaneous pneumothorax and efficacy of different surgical options were analyzed. The recurrence of spontaneous pneumothorax was recorded in the following cases: after pleural cavity drainage – in 19.7%, after videothoracoscopic resection of bullous parts of the lung in combination with subtotal parietal pleurectomy – in 2.1%.

Recurrent spontaneous pneumothorax under nintedanib treatment in ınterstitial lung disease associated with systemic sclerosis.

Interstitial lung disease (ILD) is a common complication that can develop during the course of systemic sclerosis (SSc). Nindetanib is an antifibrotic drug approved for the treatment of systemic sclerosis-associated interstitial lung disease. Although there is an insufficient data on the development of pneumothorax, the safety of Nintedanib treatment is also uncertain. We observed recurrent resistant pneumothorax under nintedanib treatment in a patient with systemic sclerosis-associated interstitial lung disease. Nintedanib use may increase the risk of developing refractory pneumothorax. Ssc patients who are started on nintedanib should be followed carefully for pneumothorax.

Adhesion is a risk factor for postoperative recurrence of spontaneous pneumothorax.

Several risk factors for postoperative recurrence of spontaneous pneumothorax have been reported, but the identified risk factors differed among studies. A total of 183 primary spontaneous pneumothorax patients were enrolled in this retrospective study, and the risk factors for postoperative recurrence were evaluated. Among the patients, more than 80% with ipsilateral postoperative recurrence (IPR) relapsed within 3 years and more than 80% with contralateral postoperative recurrence relapsed within 4 years. Compared with patients without IPR, patients with IPR had significantly more cases with history of pneumothorax (P<0.10), more cases without preoperative drainage (P=0.02), more cases with intraoperative adhesion (P<0.01), greater upward lung volume (P=0.04), more numbers of automatic sutures (P=0.04), and more cases with contralateral recurrence (P<0.01). Furthermore, compared with patients without adhesion, patients with adhesion had significantly older age (P<0.01), and more cases with adhesion on CT images (P<0.01). Patients with adhesion also had significantly greater upward lung volume (P<0.01), more cases that received covering with polyglycolic acid (PGA) sheet covering with fibrin glue (P=0.01), and more cases that received re-do surgery (P=0.04). IPR was significantly more common in the adhesion group (P<0.01), while contralateral postoperative recurrence did not differ significantly between the groups with and without adhesion (P=0.06). Univariate analyses showed that body mass index (BMI) <15.6 kg/m2 (P<0.01), history of pneumothorax (P=0.01), intraoperative adhesion (P<0.01), upward lung volume >80% (P=0.02), lateral lung volume >80% (P=0.02), 3 fire or more of automatic sutures (P=0.03), and contralateral recurrence (P=0.01) were significant risk factors for IPR. BMI <15.6 kg/m2 (odds ratio: 20.89; 95% confidence interval: 1.55-280.70; P=0.02) and intraoperative adhesion (odds ratio: 25.58; 95% confidence interval: 1.91-342.39; P=0.01) were identified as risk factors for IPR in a multivariate analysis. The present findings suggest that low BMI and intraoperative adhesion are risk factors for postoperative recurrence of spontaneous pneumothorax. For such patients, additional intraoperative procedures, such as covering with PGA sheet absorbable oxidized cellulose may be required to reduce postoperative recurrence.

Deoxyguanosine kinase deficiency and recurrent spontaneous pneumothorax: a case report

BackgroundDeoxyguanosine kinase deficiency is mainly manifested by hepatic and neurological damage, hence it belongs to the hepatocerebral form of mitochondrial deoxyribonucleic acid depletion syndrome. The association between deoxyguanosine kinase deficiency and recurrent spontaneous pneumothorax has not currently been reported.Case presentationA 12-year-old Russian boy with deoxyguanosine kinase deficiency, a recipient of a liver transplant with amyotrophy secondary to his mitochondriopathy, presented with recurrent spontaneous bilateral pneumothorax refractory to drainage and surgery.ConclusionTo our knowledge, this is the first documented case of deoxyguanosine kinase deficiency associated with recurrent spontaneous pneumothorax, which could be considered a late complication of deoxyguanosine kinase deficiency. At this point, this is only an association and further studies and research need to be performed to help confirm the pathogenesis of this association.

Recurrent Spontaneous Pneumothorax of Unknown Etiology in a Young Patient: Case Report

Introduction: Spontaneous pneumothorax is defined as the abnormal accumulation of air in the pleural space between the lungs and the chest wall, it occurs without an obvious etiology, such as trauma or iatrogenic causes. Primary spontaneous pneumothorax occurs when ther e is no history of underlying lung disease, while secondary spontaneous pneumothorax is associated with a history of underlying lung disease; its diagnosis is based on clinical suspicion and can be confirmed with imaging tests. Case presentation: We prese nt a 17 year old patient who presented spontaneous right pneumothorax, requiring placement of endopleural tube and Heimlich cannula with long stay, discharged for resolution and later relapsing in initial symptomatology one week later, requiring hospital readmission. Conclusion The recidivant spontaneous pneumothorax in the context of a young patient with clinical characteristics like those of our patient: tall stature, pectus excavatum, hyperlaxity of the integuments and aortic-mitral murmur, gives us hig h suspicion of a secondary cause, a good clinical history, with particular focus on the maternalfetal history and a detailed physical examination, are the most useful tools to integrate a diagnosis of connective tissue diseases.

Pigtail catheter versus large bore chest tube for the management of spontaneous pneumothorax in children: A retrospective study.

Introduction Pigtail catheter (PGC) insertion due to spontaneous pneumothorax (SPT) in the pediatric population has increased markedly in the last years. However, only few studies examined its efficacy in terms of length of hospitalization, rate of complications and especially pain management comparing to large bore catheter (LBC) insertion. We sought to compare analgetic drug consumption, efficacy, and complication rate between PGC and LBC in children with SPT. Materials and methods This is a single-center retrospective study of pediatric patients that were admitted to the Schneider Children's Medical Center between 2013 and 2021 with a diagnosis of SPT. The following data was collected: type of drainage (PGC or LBC), duration of drainage, length of hospitalization, no. of X-rays, complication rate, surgery during hospitalization, readmission due to SPT, and pain management. Results 17 PGC and 23 LBC were inserted in our study. No differences were noted in terms of hospitalization length, tube re-position or replacement, and recurrence of SPT between the groups. Patients with PGC underwent less X- rays comparing to the LBC group. (3 x-rays vs 5, median, p < 0.005). Oral analgesic use in terms of length of therapy was significantly lower in the PGC group than in the LBC group (1 day vs 3+ days, median, p < 0.05). There was no major complication in this cohort. Conclusions PGC is an effective, safe, and less painful alternative compared to a LBC for the drainage of SPT in children.

A splicing mutation of the FLCN gene is associated with Birt-Hogg-Dubé syndrome characterized by familial and recurrent spontaneous pneumothorax: A case report.

Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal recessive genetic disorder caused mainly by mutations in the tumor suppressor FLCN gene. Tumors caused by FLCN mutations are frequently benign and develop in skin, lungs, kidney, and other organs, leading to a variety of phenotypes that make early diagnoses of BHD challenging. A 51-year-old female was admitted to Shanghai Seventh People Hospital due to chest congestion and dyspnea that had persisted for 3 years and aggravated for 1 month. She had been diagnosed with pneumothorax prior to this submission, but the etiology was unknown. Chest computed tomography (CT) revealed multiple pulmonary cysts and pneumothorax, and her family members shared similar manifestation. Whole-exome sequencing analysis indicated a heterozygous FLCN splicing mutation (c.1432 + 1G > A; rs755959303), which was a pathogenic variant indicated in ClinVar. Based on FLCN mutation and the family history of pulmonary cysts and pneumothorax, BHD syndrome was finally diagnosed, which had been delayed for 3 years since her first pneumothorax. Pulmonary bullectomy and pleurodesis were finally conducted due to the poor effects of thoracic close drainage. Her pneumothorax was resolved, and no recurrence was found in 2 years. Our study highlights the importance of genetic analysis in diagnosis and clinical management of BHD syndrome.

Probability of sporadic lymphangioleiomyomatosis in women presenting with spontaneous pneumothorax

BackgroundSporadic lymphangioleiomyomatosis (S-LAM) is a rare low-grade neoplasm of young women characterized by multiple pulmonary cysts leading to progressive dyspnea and recurrent spontaneous pneumothorax (SP). The diagnosis of S-LAM may be delayed by several years. To reduce this delay, chest computed tomography (CT) screening has been proposed to uncover cystic lung disease in women presenting with SP. However, the probability to discover S-LAM in this population has not been determined precisely. The aim of this study was to calculate the probability of finding S-LAM in women presenting with (a) SP, and (b) apparent primary SP (PSP) as first manifestation of S-LAM.MethodsCalculations were made by applying the Bayes theorem to published epidemiological data on S-LAM, SP and PSP. Each term of the Bayes equation was determined by meta-analysis, and included: (1) the prevalence of S-LAM in the general female population, (2) the incidence rate of SP and PSP in the general female population, and (3) the incidence rate of SP and apparent PSP in women with S-LAM.ResultsThe prevalence of S-LAM in the general female population was 3.03 per million (95% confidence interval 2.48, 3.62). The incidence rate of SP in the general female population was 9.54 (8.15, 11.17) per 100,000 person-years (p-y). The incidence rate of SP in women with S-LAM was 0.13 (0.08, 0.20). By combining these data in the Bayes theorem, the probability of finding S-LAM in women presenting with SP was 0.0036 (0.0025, 0.0051). For PSP, the incidence rate in the general female population was 2.70 (1.95, 3.74) per 100,000 p-y. The incidence rate of apparent PSP in women with S-LAM was 0.041 (0.030, 0.055). With the Bayes theorem, the probability of finding S-LAM in women presenting with apparent PSP as first disease manifestation was 0.0030 (0.0020, 0.0046). The number of CT scans to perform in women to find one case of S-LAM was 279 for SP and 331 for PSP.ConclusionThe probability of discovering S-LAM at chest CT in women presenting with apparent PSP as first disease manifestation was low (0.3%). Recommending chest CT screening in this population should be reconsidered.

Spontaneous pneumothorax rates following video-assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease.

Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video-assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective. Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months. New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation. Video-assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP.

Spontaneous Pneumothorax Rates Following Video-Assisted Thoracoscopic Talc Pleurodesis With or Without Resection of Macroscopic Bullous Disease

Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video-assisted thoracoscopic (VATS) talc pleurodesis (with or without localised resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective.

Therapeutic pneumoperitoneum in patients with recurrent spontaneous pneumothorax surgical treated

Pneumothorax is defined as the presence of gas in intrapleural space with lung collapse and an altered respiratory dynamic. It can be primary (or spontaneous), more frequently, secondary, and traumatic. Spontaneous pneumothorax is more common in men than in women (roughly three to six times higher). It is not caused by an underlying lung disease, but it is often associated with pleuro-pulmonary abnormalities (mostly subpleural apical blebs) that likely predispose to pneumothorax. We report the case of a 27-year-old man that referred to our Emergency Department with a diagnosis of recurrent spontaneous pneumothorax and indication for surgery. A thoracic drainage has been placed yet and the patient was hemodynamically stable. Despite of surgery, pneumothorax seemed not to solve. In collaboration with general surgeons, it was agreed to cause a controlled pneumoperitoneum to facilitate the pleuro-pulmonary attachment. Our case report aimed to show the effectiveness of a delayed-induced pneumoperitoneum in a single-center experience of spontaneous pneumothorax surgery-resistant.

Variation in perioperative care for recurrent primary spontaneous pneumothorax: a Dutch survey

Quirine C. A. van Steenwijk, Louisa N. Spaans, David J. Heineman, Bas B. Koolen, Frank J. C. van den Broek, Chris Dickhoff

Bronchial tuberculosis with recurrent spontaneous pneumothorax: A case report

BackgroundSpontaneous pneumothorax associated with tuberculosis due to clinical manifestations, imaging findings and negative pleural biopsy is rare. Case reportA 43-year-old young woman went to the hospital several times because of recurrent dyspnea and was diagnosed with a right spontaneous pneumothorax. She underwent multiple closed thoracic drainage procedures, but the pneumothorax was not completely resolved. Pleural biopsy pathology was chronic inflammation; there was no evidence of tuberculosis. A small amount of pneumothorax persisted, intermittent dyspnea became more severe, and pneumothorax increased. Bronchoscopy showed thickening of the left lung lingular segment mucosa, and the bronchial lavage fluid gene X-PERT/rifampicin resistance test was positive. After one month of anti-tuberculosis treatment, the symptoms of short breath were completely relieved, and chest computerized tomography (CT) showed complete resolution of the right pneumothorax.ConclusionsWhen searching for the cause of spontaneous pneumothorax, people should not overlook tuberculosis-related secondary pneumothorax, which should be diagnosed and treated as soon as possible.

Tension and Recurrent Spontaneous Pneumothorax during Pregnancy: A Case Report

Tension and Recurrent Spontaneous Pneumothorax during Pregnancy: A Case Report