Recurrent Pneumothorax Research Articles

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.

Risk factors for the recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery in patients younger than 40 years.

Video-assisted thoracoscopic surgery (VATS) is a standard primary spontaneous pneumothorax (PSP) procedure. However, its high recurrence rate compared to open thoracotomy is a problem. Therefore, various methods to prevent recurrence have been developed. The present study investigated the risk factors for postoperative recurrence of PSP after VATS. From January 2008 to November 2022, 207 patients younger than 40 years of age without underlying pulmonary disease underwent thoracoscopic bullectomy for PSP. Among them, 96 underwent staple line reinforcement with a polyglycolic acid (PGA) sheet and autologous blood spraying. Patient characteristics and surgical outcomes were analyzed to determine the prognostic factors for postoperative recurrence. Twenty-seven patients (13.0%) experienced recurrences. A multivariate analysis using Cox regression analysis revealed that age younger than 20 years [P=0.039; hazard ratio (HR) =2.337; 95% confidence interval (CI): 3.283-17.287], history of contralateral pneumothorax (P<0.001; HR =7.533; 95% CI, 1.486-12.336), and no staple line reinforcement (P=0.007; HR =4.282; 95% CI, 1.043-5.236) were risk factors for recurrence after pneumothorax surgery. Age younger than 20 years and history of contralateral pneumothorax were risk factors for postoperative recurrence of pneumothorax. Staple line reinforcement with a PGA sheet and spraying of autologous blood reduced the postoperative recurrence rate of PSP.

The determination of pleurodesis using sonography after surgical pleurectomy for pneumothorax: a pilot study.

The aim of this study is to evaluate feasibility of monitoring the process of pleurodesis after surgical pleurectomy with thoracic ultrasound. Repetitive measurements with thoracic ultrasound after surgical pleurectomy could provide information on the extent and development speed of pleurodesis. We conducted a prospective single-center cohort study. Adult patients who required surgical pleurectomy after pneumothorax were eligible. Participants had daily thoracic ultrasound examination until discharge to determine lung sliding [present (0 point), questionable (1 point), or absent (2 points)], and pleural thickening [normal (0 point), questionable (1 point), or present (2 points)]. Thoracic ultrasound was performed in six regions, the sum of all scores was divided by the number of regions. Fourteen patients were enrolled. Thoracic ultrasound on day 1-4 was 0.25±0.26, 0.39±0.48, 0.84±0.49, 1.12±0.56 for mean lung sliding, and 1.0±0.56, 1.17±0.48, 1.44±0.44, 1.54±0.34 for mean pleural thickening. Lung sliding and pleural thickening increased significantly between day 1 and day 4 (P=0.002 and P=0.023, respectively). One (7%) and 3 (21%) patients reached the maximum achievable grade for lung sliding and pleural thickening, respectively. Thoracic ultrasound grades tended to be lower in three patients with recurrent pneumothorax, although this was not statistically significant. This study shows a significant increase in thoracic ultrasound grading for pleurodesis lung sliding and pleural thickening during the first postoperative days after surgical pleurectomy, probably attributable to progressing pleurodesis. Only a minority of patients reached complete pleurodesis before discharge despite complete surgical pleurodesis (SP). The results of this study may guide future research regarding optimal timing of chest tube removal.

P08-010-23 Hydrocarbon Poisoning Presenting With Recurrent Pneumothorax in a Child With Severe Acute Malnutrition

P08-010-23 Hydrocarbon Poisoning Presenting With Recurrent Pneumothorax in a Child With Severe Acute Malnutrition

Catamenial Pneumothorax: An Unusual Cause of Abdominal Pain.

A catamenial pneumothorax is a very rare condition resulting in spontaneous and recurrent pneumothoraces that occur in relationship with menses (T. Marjański et al., 2016). Although rare, emergency providers should consider this condition when female patients present to the emergency department with chest discomfort and dyspnea during menstruation. This case describes a patient who presented to the emergency department with abdominal pain who was incidentally found to have a catamenial pneumothorax on diagnostic imaging for her complaint of acute abdominal pain.

How Real is the Diagnosis of Copd in a Young Patient?

Abstract We present the case of a young patient, known to have COPD and DZ, who presented to the emergency room for dyspnea and sudden onset right laterobasal pain. From the patient's recent history we note episode of right total pneumothorax five days prior to presentation to our unit, for which pleural drainage was fitted. Clinical examination and standard chest X-ray performed in the emergency department established the diagnosis of recurrent total pneumothorax. Given the medical history and recent history of pneumothorax in a young heavy smoker patient with two episodes of right pneumothorax, one of which was recent, known with diabetes mellitus and COPD, with imaging changes such as "reticulo-nodular lesions with cystic appearance and interstitial fibrosis on the left lung area", the diagnosis of COPD was questioned and the suspicion of pulmonary histiocytosis X was raised, which is why, together with the radiologist and thoracic surgeon, the decision was made to perform a surgical treatment and a lung biopsy to establish a definite diagnosis. The result of the lung biopsy confirmed the suspicion of pulmonary histiocytosis X. Since in histiocytosis X the damage is multi-organ, one month postoperatively the patient underwent a complex biological, functional and imaging evaluation to identify or exclude other affected organs. Imaging and functional investigations performed, collaborated with the patient's history, age and medical history refuted the diagnosis of COPD. Therapeutically for pulmonary histiocytosis X it was recommended to stop smoking urgently and monitor respiratory function at 6 months in the first year after diagnosis.

Recurrent Pneumothorax Caused by an Unexpected Lymphangioleiomyomatosis: A Case Report

Lymphangioleiomyomatosis is a rare disease characterized by the proliferation of atypical smooth muscle cells. Recurrent pneumothorax is a frequent complication of lymphangioleiomyomatosis. We present the case of a 41-year-old woman who presented with recurrent pneumothorax. Video-assisted thoracic surgery was performed. We did not suspect the possibility of lymphangioleiomyomatosis because of the presence of very few cysts on chest computed tomography.

Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis.

In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay. We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI). The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance. The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

Treatment Outcome with Talc or Povidone Iodine in Recurrent Pneumothorax or Recurrent Pleural Effusion

Abstract Background: The present study assessed the treatment outcome of pleurodesis with talc or povidone iodine in recurrent pneumothorax or recurrent pleural effusion and the efficacy and safety of talc or povidone iodine in the same. Materials and Methods: A total of 23 patients with recurrent pneumothorax (15) and recurrent pleural effusion (8) were enrolled. Pleurodesis with either talc or povidone iodine was performed via intercostal drainage tube. Treatment outcome along with complications was studied by routine follow up of patients for 6 months. Results: A total of 23 patients (19 males and 4 females) were included in the study. 16 patients were subjected to povidone iodine pleurodesis while 7 patients underwent talc pleurodesis. Mean age of patients was 38.68+19.6 for the povidone iodine group and 43.85+16.32 for the talc group. Eight (34.78%) patients had recurrent pleural effusion whereas 15 (65.21%) patients had recurrent pneumothorax. Post procedure pain was experienced by 5 (31.25%) patients in the povidone iodine group and 4 (57.14%) patients in the talc group. Two (12.5%) and one (14.28%) patient had fever following povidone iodine and talc pleurodesis respectively. Pleurodesis was successful in 13 (81.25%) patients in the povidone iodine group and 7 (100%) patients in the talc group, during the follow up period of 6 months. Conclusion: Both talc and povidone iodine are effective pleurodesis agents and povidone iodine can be considered a good alternative to talc as a pleurodesis agent in recurrent cases of pneumothorax or pleural effusion, irrespective of the underlying cause, as it is safe, easily available and cost effective. Keywords: Recurrent pneumothorax, Recurrent pleural effusion, Pleurodesis, Talc, Povidone Iodine

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.

The Descriptive Features of Primary Spontaneous Pneumothorax Patients in King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background Primary spontaneous pneumothorax (PSP) is a fairly prevalent disorder in emergency medicine. PSP most frequently affects tall, thin male smokers and is most prevalent during adolescence. Published literature contains a wide range of Primary Spontaneous Pneumothorax (PSP) recurrence rates, but there is limited information on the variables affecting recurrence. Objective To identify the descriptive features of PSP in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods This retrospective cross-sectional study was conducted in Surgery King Abdulaziz Medical City, Riyadh, Saudi Arabia. Including all PSP patients from 2016-2021, excluding pediatric and geriatric patients. Participants were selected using a simple random sampling technique, and data were collected from hospital records. Data analysis was conducted by using SPSS. Results In this study, we included a total of 131 participants. Most were males (93.1%), and most were aged between 21-30 years. Our findings showed that most PSP events occurred in winter (28.6%). Followed by fall (25.7%), summer (25.0%), and spring (20.7%). Concerning the smoking status of our respondents, our results revealed that most of them were active smokers (72.5%). Left-PSP was the most commonly reported type of PSP (43.5 %), followed by right-PSP (38.9%), non-simultaneous bilateral PSP (14.5%), and bilateral simultaneous PSP (3.1%). Moreover, we found that the recurrence rate of PSP was 42%. Regarding the management of PSP, almost half of the respondents were managed initially by Chest tube. The most frequently used surgical option was VATS- Bullectomy with Abrasion Pleurodesis. Finally, the recurrence rate of PSP was 42% among the patients. The percentage of patients with one recurrence only was 65.5% among the patients with recurrent PSP, second recurrence at 29.1%. Third, Fourth, and Fifth had the same recurrence percentage of 1.8%, and these percentages came to be statistically significant. (P value < 0.001) Conclusion Our study concluded that PSP was more prevalent in tall, thin, young male smokers. Almost half of the respondents suffered from at least one recurrence attack of PSP. The majority of the patients with recurrences experienced one recurrence only, and the second recurrence was estimated to be almost one-third. There is no significant association between the occurrence and seasons of the attack at a time. Most of the participants were managed initially by a chest tube. The most frequently used surgical option was Video Assisted Thoracoscopic Surgery (VATS) with abrasion pleurodesis.

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.

Pneumothorax and pneumomediastinum among COVID-19 patients with mechanical ventilation: a case series

The incidence of pneumothorax is 10% of all COVID-19 patients and increases in patients who develop acute respiratory distress syndrome (ARDS) with mechanical ventilation, responsible for 24% of the population. As many as 60.7% of patients who have complications of pneumothorax or pneumomediastinum lead to mortality. This study was established to determine the potential of early tracheostomy in preventing the occurrence of pneumothorax and pneumomediastinum in COVID-19 and reducing mortality. This research was conducted as a descriptive study by case series of three COVID-19 patients in Jakarta, Indonesia in the span of 2021-2022. Tracheostomy performed within 10 days, did not develop a pneumothorax. Although, the patient did not have any comorbidities, age below 70 years, and coagulopathy problem, there was still a risk of recurrent pneumothorax post COVID-19 after tracheostomy. However, a tracheostomy is a procedure that poses an aerosol risk, so there is concern about the transmission of COVID-19 to medical personnel who perform it. Early tracheostomy has the potential to accelerate the resolution of COVID-19 disease in patients and has a positive impact on lung vitality. It is aimed to prevent hypoxic conditions and optimize the lung recruitment process. In addition, they did not experience complications from COVID-19 in the form of an air leak syndrome such as a pneumothorax or pneumomediastinum.

Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery.

Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

Progression of pulmonary cysts in Birt-Hogg-Dubé syndrome: longitudinal thoracic computed tomography study with quantitative assessment

BackgroundBirt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder characterized by fibrofolliculomas, renal tumors, pulmonary cysts, and recurrent pneumothorax. Pulmonary cysts are the cause of recurrent pneumothorax, which is one of the most important factors influencing patient quality of life. It is unknown whether pulmonary cysts progress with time or influence pulmonary function in patients with BHD syndrome. This study investigated whether pulmonary cysts progress during long-term follow-up (FU) by using thoracic computed tomography (CT) and whether pulmonary function declines during FU. We also evaluated risk factors for pneumothorax in patients with BHD during FU.MethodsOur retrospective cohort included 43 patients with BHD (25 women; mean age, 54.2 ± 11.7 years). We evaluated whether cysts progress by visual assessment and quantitative volume analysis using initial and serial thoracic CT. The visual assessment included the size, location, number, shape, distribution, presence of a visible wall, fissural or subpleural cysts, and air-cuff signs. In CT data obtained from a 1-mm section from 17 patients, the quantitative assessment was performed by measuring the volume of the low attenuation area using in-house software. We evaluated whether the pulmonary function declined with time on serial pulmonary function tests (PFT). Risk factors for pneumothorax were analyzed using multiple regression analysis.ResultsOn visual assessment, the largest cyst in the right lung showed a significant interval increase in size (1.0 mm/year, p = 0.0015; 95% confidence interval [CI], 0.42–1.64) between the initial and final CT, and the largest cyst in the left lung also showed significant interval increase in size (0.8 mm/year, p < 0.001, 95% CI; -0.49–1.09). On quantitative assessment, cysts had a tendency to gradually increase in size. In 33 patients with available PFT data, FEV1pred%, FEV1/FVC, and VCpred% showed a statistically significant decrease with time (p < 0.0001 for each). A family history of pneumothorax was a risk factor for the development of pneumothorax.ConclusionsThe size of pulmonary cysts progressed over time in longitudinal follow-up thoracic CT in patients with BHD, and pulmonary function had slightly deteriorated by longitudinal follow-up PFT.

Pneumorrhachis and pneumocephalus resulting from pneumothorax: illustrative case.

Pneumorrhachis and pneumocephalus are rare conditions in which air is found within the spinal canal and brain, respectively. It is mostly asymptomatic and can be located in the intradural or extradural space. Intradural pneumorrhachis should prompt clinicians to search and treat any underlying injury of the skull, chest, or spinal column. A 68-year-old man presented with a history of cardiopulmonary arrest together with pneumorrhachis and pneumocephalus following a recurrent pneumothorax. The patient reported acute headaches with no other neurological symptoms. He was managed conservatively with bed rest for 48 hours following thoracoscopic talcage of his pneumothorax. Follow-up imaging showed regression of the pneumorrhachis, and the patient reported no other neurological symptoms. Pneumorrhachis is an incidental radiological finding that self-resolves with conservative management. However, it can be a complication resulting from a serious injury. Therefore, close monitoring of neurological symptoms and complete investigations should be performed in patients with pneumorrhachis.

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.

Chemical Pleurodesis Using Tetracycline for the Management of Postoperative Pneumothorax Recurrence.

Although there is no obvious recommendation for the management of pneumothorax recurrence after surgery, chemical pleurodesis with tetracycline has been applied as a significant treatment approach. The objective of this study was to evaluate the effectiveness of chemical pleurodesis with tetracycline for the management of postoperative recurrence of primary spontaneous pneumothorax (PSP). We retrospectively analyzed patients who underwent video-assisted thoracic surgery (VATS) as therapy for PSP at Hallym University Sacred Heart Hospital from January 2010 to December 2016. Patients who had ipsilateral recurrence after surgery were included in this study. Patients who underwent pleural drainage with chemical pleurodesis were compared with patients who only underwent pleural drainage. In total, 932 patients who underwent VATS for PSP were analyzed, and ipsilateral recurrence after surgery occurred in 67 patients (7.1%). The treatment modalities for recurrence after surgery were observation (n=12), pleural drainage alone (n=16), pleural drainage with chemical pleurodesis (n=34), and repeated VATS (n=5). Eight of the 16 patients (50 %) treated with pleural drainage alone had recurrence again, while 15 of the 34 patients (44.1%) treated with pleural drainage and chemical pleurodesis experienced further recurrence. Chemical pleurodesis with tetracycline did not show a meaningful difference in the re-recurrence rate in comparison with pleural drainage alone (p=0.332). Chemical pleurodesis with tetracycline for the management of postoperative recurrence of PSP was not effective. Further research is required to identify alternative drugs that can significantly decrease the re-recurrence rate.

Atypical presentation of tuberculosis: a case report highlighting the challenges of diagnosis and management

Tuberculosis (TB) remains a significant public health issue worldwide and can present with atypical symptoms, making it difficult to diagnose. Atypical TB symptoms include non-specific symptoms and extrapulmonary TB, and patients with comorbidities may present with atypical TB due to impaired immune function. TB treatment includes antibiotics, which can cause hepatotoxicity, and require close monitoring for signs of liver injury. A 32-year-old female with intellectual developmental disorders was admitted to the hospital with suspected pneumonia and acute respiratory viral infection. Despite initial treatment with antibiotics, her oxygen saturation decreased, and she developed recurrent pneumothorax on the right side and neutrophilic pleuritis. Computed tomography (CT) scans showed increasing infiltrative changes, and bronchoalveolar lavage eventually revealed Mycobacterium tuberculosis DNA, leading to the diagnosis of tuberculosis pneumonia with pleurisy. This case report highlights the challenges of diagnosing TB and the importance of maintaining a high index of suspicion for TB in patients who do not fit the typical profile of the disease. The case also emphasizes the potential for drug-induced liver damage with TB treatment and the need for close monitoring. Early diagnosis and appropriate management are crucial to prevent further complications and improve outcomes in patients with TB.