Simultaneous Bilateral Spontaneous Pneumothorax Research Articles

Simultaneous Bilateral Primary Spontaneous Pneumothorax (SBPSP) in a young male athlete: A rare presentation

Simultaneous Bilateral Primary Spontaneous Pneumothorax (SBPSP) in a young male athlete: A rare presentation

RARE CASE OF PAZOPANIB-ASSOCIATED BILATERAL PNEUMOTHORACES IN A PATIENT WITH METASTATIC SYNOVIAL SARCOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bilateral pneumothoraces are a rare occurrence, comprising 1.4% to 7.6% of cases [1]. Secondary causes of pneumothorax include bullous emphysema, cystic parenchymal lung disease and tuberculous lung disease [2]. Malignancy is a rare cause of pneumothorax, yet sarcomas have been associated with pneumothorax in 2% of patients [3]. Pazopanib, a tyrosine kinase inhibitor used in the treatment of metastasized sarcoma, has been shown to have a 3.3% risk of developing pneumothorax [4]. CASE PRESENTATION: A 24-year-old previously healthy Yemeni female initially presented with left-sided groin pain and swelling. Computed tomography of the pelvis showed a large heterogeneous mass in the proximal left thigh. Biopsy was consistent with synovial sarcoma. Staging via chest computed tomography showed multiple pulmonary nodules concerning for metastasis. Over the course of two years, she failed multiple lines of chemotherapy and had progression of disease with new and enlarging bilateral pulmonary nodules. She was started on fourth-line chemotherapy with pazopanib (Votrient) 400 mg daily. Two months later, she presented with shortness of breath, found to be tachypneic, tachycardic and hypoxemic. Chest x-ray revealed bilateral pneumothoraces with left mediastinal shift concerning for tension pneumothorax. Two tube thoracostomies were placed; however, course was complicated by persistent air leak bilaterally, requiring video-assisted thoracoscopic surgery with bullectomy and surgical talc pleurodesis. Patient had a slow resolution of pneumothorax and subsequently discharged home without recurrence. DISCUSSION: Bilateral pneumothoraces can be life-threatening and are associated with poor long term prognosis, especially in patients with poor underlying lung function [5]. Pneumothorax is seen in approximately 2% of sarcoma patients with pulmonary metastases. In patients with sarcoma and pulmonary metastases, 41.6% of pneumothoraces were bilateral, and typically associated with multiple lung nodules, cystic or cavitary lesions, or presence of pleural nodules or thickening [3]. Additionally, cytotoxic agents have been shown to induce cavitation in pulmonary lesions and increase the risk of pneumothorax development [6]. Per the PALETTE trial which led to the approval of pazopanib for use in sarcoma, there was a 3.3% risk for pneumothorax development [4], comparable to the baseline rate of pneumothorax development in patients with sarcoma. Nevertheless, bilateral pneumothoraces carry potentially fatal consequences. CONCLUSIONS: In patients with sarcoma undergoing treatment with pazopanib, a bilateral pneumothorax, though rare, may be life threatening and should be acutely suspected. REFERENCE #1: TG Rim, JS Bae, YS Yuk. Life-Threatening Simulatenous Bilateral Spontaneous Tension Pneumothorax - A case report. Korean J Thorac Cardiovasc Surg. 2011 Jun; 44(3): 253-256.2. Mason RJ, Braoddus VC, Murray JF, Nadel JA. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Elsevier Saunders (2005); Vol 2, Chapter 81. Philadelphia, PA. REFERENCE #2: Hoag JB, Sherman M, Fasihuddin Q, Lund ME. A comprehensive review of spontaneous pneumothorax complicating sarcoma. CHEST. 2010 Sep; 138(3);510-8.4. Van der Graaf WT, Blay JY, Chawla SP, Kim DW, et al. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012 May 19; 379(9829):1879-86. REFERENCE #3: Graf-Deuel E, Knoblauch, A. Simultaneous bilateral spontaneous pneumothorax. CHEST. 1994 Apr; 105(4):1142-6.6. Interiano RB, McCarville MB, Wu J, Davidoff AM, Sandoval J, Navid F. Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors. J Pediatr Surg. 2015 Sep; 50(9):1484-9. DISCLOSURES: No relevant relationships by Sally Askar, source=Web Response No relevant relationships by Owais Nadeem, source=Web Response

BILATERAL SPONTANEOUS PNEUMOTHORAXES ASSOCIATED WITH VAPING

TOPIC: Tobacco Cessation and Prevention TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette or vaping product use associated lung injury (EVALI) has received increasing attention by the Centers for Disease Control and Prevention (CDC) within the last year due to a recent increase of cases of acute lung injury associated with vaping. The CDC has established criteria for EVALI: 1) the patient must have vaped within 90 days prior to symptom onset;2) there is evidence of pulmonary infiltrate on chest radiographs or chest CT;3) absence of pulmonary infection on initial work-up;4) no evidence alternative diagnoses.Spontaneous pneumothoraces (SPs) are often idiopathic in nature, classically in tall, thin males between the ages of 15-34 years old, as well as underlying lung or connective tissue diseases. There are few reported cases of SPs in association with vaping or e-cigarette use, with bilateral pneumothoraces being nearly unseen. CASE PRESENTATION: A 26-year-old Caucasian male with past medical history of polysubstance abuse presented to the emergency department with a one-day history of shortness of breath and chest pain. He was an active daily vaper. On arrival, he endorsed dyspnea, hemoptysis, presyncope, and pleuritic pain. Vitals showed hypotension, tachycardia, and tachypnea. Physical exam shows no trauma or tracheal deviation. Lung sounds were decreased at both apices. Chest X-ray showed bilateral apical pneumothoraces. Workup for respiratory virus panel and COVID were negative. CBC and CMP lab values were largely unremarkable, only with lactic acidosis to 4.4 mmol/L. Toxicology was positive for cocaine, THC, and opiates. A left sided thoracostomy was performed, resulting in resolution of the left sided pneumothorax. Shortly after placement, the patient traumatically removed his thoracostomy tube. 100% oxygen resulted in resolution of the right sided pneumothorax. The patient was downgraded from the ICU and discharged on hospital day three with resolution of symptoms. DISCUSSION: Spontaneous pneumothorax is a potentially life-threatening emergency condition. This patient's concerning presentation with spontaneous bilateral secondary pneumothoraces (SBSP) and multifocal opacities on the chest x-ray in the setting of vape use, without a prior or family history of lung disease, created a concerning clinical picture. EVALI is already a concerning condition. Per the CDC as of January 14, 2020, there were 2,668 cases of EVALI requiring hospitalization, with 68 cases resulting in mortality CONCLUSIONS: This case is highlighted in order to add to increasing evidence of the dangerous effects of vaping. Patients should be counseled on the wide variety of risks of vaping. Furthermore, cases of SBSP are quite rare, and this patient's history makes vaping and marijuana use the most likely contributing factors to his presentation. Patients with a history of spontaneous pneumothorax should be monitored over time for recurrences and counseled on vaping cessation. REFERENCE #1: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html REFERENCE #2: Graf-Deuel E, Knoblauch A: Simultaneous bilateral spontaneous pneumothorax. Chest. 1994, 105:1142-1146. 10.1378/chest.105.4.1142 DISCLOSURES: No relevant relationships by Riley Ewen, source=Web Response No relevant relationships by Gilad Guez, source=Web Response no disclosure on file for Brijesh Patel;no disclosure on file for Farhan Shah;

SPILLED MILK: BUFFALO CHEST WITH BILATERAL CHYLOTHORAX

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The term "buffalo chest" is used to define a single pleural space with no anatomic separation of the two hemithoraces, seen in an American buffalo or bison. There have been less than ten cases reported where spontaneous bilateral pneumothorax was suspected due to interpleural communication. The interpleural connection reported have been associated with major invasive thoracic procedures such as esophagectomy, cardiothoracic surgery, pacemaker and central venous catheter placements. We present a rare case of simultaneous bilateral chylothorax fashioned by such an interpleural communication. CASE PRESENTATION: A 45-year-old male chronic smoker with past medical history of esophagitis presented with one week of cough and reflux. He otherwise denied fevers, odynophagia, chest pain, weight loss or early satiety. He was hypoxic on admission requiring 2 L oxygen supplementation. Physical exam revealed decreased breath sounds in the left lower lung base. Chest radiograph showed minimal atelectasis at the left lung base. CT Chest showed a large sliding hiatal hernia with distention of esophagus and centrilobular nodules in the right middle lobe and bilateral lower lobes. The presumptive diagnosis was aspiration pneumonia likely secondary to hiatal hernia. Thus, he underwent laparoscopic para-esophageal hernia repair with EGD. Two days later, he developed acute hypoxic respiratory failure and was intubated. Chest radiograph was concerning for new large bilateral pleural effusions. Within hours, he underwent an ultrasound guided right thoracentesis draining four liters of opaque, pink, non-purulent fluid (figure 1). Left thoracentesis drained only five mL. Pleural fluid revealed pH 7.48, elevated triglycerides (600 mg/dL) and low cholesterol (50 mg/dL) indicating chylothorax. He had bilateral chest tubes placed and was on placed on bowel rest. Decision was made to evaluate for thoracic duct injury in the setting of recent hiatal hernia repair and he was taken for right video-assisted thoracoscopic surgery with thoracic duct ligation and talc pleurodesis. It was seen that there was a communication from the pleural cavity into the mediastinal area from the hiatal hernia dissection. This interpleural communication explained the resolution of the bilateral chylothorax with a single right-sided thoracentesis. Patient was extubated thereafter and was discharged. DISCUSSION: This report documents a rare case of bilateral chylothorax completely resolved with a single sided thoracentesis. The phenomenon was explained by the interpleural connection formed during hiatal hernia repair suggesting buffalo chest. CONCLUSIONS: Recognition of buffalo chest syndrome as a life-threatening complication is important in the setting of iatrogenic injuries during mediastinal surgeries. Prompt resolution can be achieved with a single sided thoracentesis. REFERENCE #1: Eguchi T, Hamanaka K, Kobayashi N, et al. Occurrence of a simultaneous bilateral spontaneous pneumothorax due to a pleuro-pleural communication. Ann Thorac Surg 2011;92:1124-6 Hartin DJ, Kendall R, Boyle AA, et al. Case of the month: Buffalo chest: a case of bilateral pneumothoraces due to pleuropleural communication. Emerg Med J 2006;23:483-6 REFERENCE #2: Männer J, Jakob C, Steding G, et al. Horseshoe lung: report on a new variant—"inverted" horseshoe lung--with embryological reflections on the formal pathogenesis of horseshoe lungs. Ann Anat 2001;183:261-5 REFERENCE #3: Rali AS, Manyam H. Bilateral Pneumothoraces Following BiV ICD Placement: A Case of Buffalo Chest Syndrome. Am J Case Rep. 2015;16:703–6. DISCLOSURES: No relevant relationships by Jaclyn Boozalis, source=Web Response No relevant relationships by Kevin Ferriter, source=Web Response No relevant relationships by Paul Harford, source=Web Response No relevant relationships by Kanza Muzaffar, source=Web Response No relevant relationships by Nisha Soneji, source=Admin input

Simultaneous Bilateral Spontaneous Pneumothorax with COVID-19 Pneumonia

The declared COVID-19 pandemic has come to affect the entire world. Ever since the first cases were detected, pneumothorax has been considered a rare but possible complication, and may develop in patients under mechanical ventilation due to high pressure. We present here a case of simultaneous bilateral spontaneous pneumothorax with COVID-19 pneumonia with no history of chronic lung disease and no mechanical ventilation.

Non-smokıng patient with pulmonary langerhans cell histiocytosis x diagnosed with the help of simultaneous bilateral spontaneous pneumothorax

Introduction: Pulmonary Langerhans cell histiocytosis X (PLCHx) is a rare interstitial lung disease of unknown aetiology and occurs mostly in young smokers. Lung involvement alone accounts for >85% of the cases; other organs may be involved too (5%–15%).
 Case Report: A 19-year-old boy was presented to the emergency service with sudden-onset, sharp, stabbing chest pain and dyspnoea. The patient had no history of smoking. His medical and family histories were negative for any disease. Thoracic radiography showed increased reticulonodular density with a near-total bilateral pneumothorax at the left and partially at the right. Hence, bilateral tube thoracostomy was performed. High-resolution computed tomography (HRCT) showed pronounced thin-walled cystic structures smaller than 10 mm and small millimetre-sized nodules in the upper and middle zones. Extrapulmonary Langerhans cell histiocytosis was excluded based on the radiological and laboratory findings. Based on the clinical and tomography findings, diagnosis of PLCHx was made.
 Conclusion: Our case highlights that PLCHx should be suspected in non-smokers. Further studies elucidating the aetiology of PLCHx are needed.

NECROTIZING MRSA PNEUMONIA CAUSING SIMULTANEOUS BILATERAL SPONTANEOUS PNEUMOTHORAX: A RARE AND LIFE-THREATENING CLINICAL CONDITION

SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumothorax (PTX) is the presence of air in the pleural space causing compression of the lungs, leading to subsequent respiratory distress. Spontaneous PTX develops in the absence of trauma and is classified as primary or secondary if underlying lung disease is noted. Rarely, a patient can develop simultaneous bilateral spontaneous pneumothoraces, which can result in a life-threatening state requiring intubation or resuscitation. Some sources list this occurrence to be about 1-1.9% of spontaneous pneumothorax-related cases. CASE PRESENTATION: A 38-year-old female with a history of Type 1 DM and ESRD on peritoneal dialysis, presented with a cough, fever, and significant dyspnea. CXR showed bilateral lung consolidation consistent with pneumonia. She was admitted to the ICU for acute hypoxia. Broad spectrum antibiotics were started. Blood and sputum cultures grew methicillin resistant streptococcus aureus (MRSA). Her blood cultures also grew VRE and the antibiotics were changed appropriately and PD catheter was removed. Despite overall clinical improvement, her respiratory status declined due to worsening hypoxia which was attributed to mucus plugging due to her inability to initiate a good cough reflex. Aggressive pulmonary toileting resulted in no improvement. A repeat CXR was done and showed bilateral pneumothoraces significantly worse on the left side, without evidence of tracheal shift. Urgently, a chest tube was inserted on the left side and placed to suction, with follow up imaging showing improvement of the left PTX, but significant worsening of the right PTX. This prompted another chest tube placement on the right side. Repeat CXR showed improvement in both pneumothoraces. Despite this, she failed multiple attempts at discontinuing her chest tubes due to reaccumulating air. Invasive procedures were avoided due to her persistent pneumonia and critically ill condition. The patient and family decided to pursue comfort care measures. DISCUSSION: In a Taiwan study of Spontaneous Secondary Pneumothoraces, a bacterial etiology was identified in about 11% of patients. The pathogenesis was postulated to be to be associated with migration of the bacteria into the pleural space, leading to empyema. It is hypothesized the patients developed the pneumothoraces secondary to bilateral necrotizing bacterial pneumonia. The causative bacterial agents were Staphylococcus, Klebsiella, Pseudomonas, Streptococcus Pneumoniae, and Anaerobic organisms. CONCLUSIONS: Since our patient had MRSA pneumonia, it can be inferred that this was the culprit of her pneumothoraces as there was no other cause. Akcam et al reported a mortality rate of 54% in patients with SBSP within the first 6 months of follow-up. Hence, it is important to have a high suspicion for SBSP in patients who have respiratory decline after initial improvement. Reference #1: Akcam, Tevfik Ilker, et al. “Analysis of the Patients with Simultaneous Bilateral Spontaneous Pneumothorax.” The Clinical Respiratory Journal, U.S. National Library of Medicine, Mar. 2018, www.ncbi.nlm.nih.gov/pubmed/28544468. Reference #2: Athanassiadi K, Kalavrouziotis G, Loutsidis A, et al. Treatment of spontaneous pneumothorax: ten-year experience. World J Surg 1998;2013:803–6 [PubMed] Reference #3: Aydin, Y., Turkyilmaz, A., Intepe, Y. S., & Eroglu, A. (2010). Simultaneous bilateral spontaneous pneumothorax: a rare emergency clinical condition. The Eurasian Journal of Medicine, 42(1), 5–8. https://doi.org/10.5152/eajm.2010.02 DISCLOSURES: No relevant relationships by Lilibeth Jauregui, source=Web Response No relevant relationships by Navneet Kaur, source=Web Response No relevant relationships by Enoemem Okpokpo, source=Web Response

心肺停止で搬送された両側緊張性気胸の14歳男児の1例(A case of 14–year–old boy with cardiopulmonary arrest caused by simultaneous bilateral primary spontaneous pneumothorax)

要旨 自然気胸の多くは片側であり重症例は少ない。しかし緊張性気胸および両側気胸は診断および介入が遅れると致死的となりうる。我々は，発症から1時間も経たないうちに心肺停止となり救急搬送された両側緊張性気胸の14歳男児の症例を経験した。本例では心肺蘇生により自己心拍は再開したが，頻脈・低血圧が遷延し，胸部X線写真で両側緊張性気胸と診断し胸腔ドレナージを行った。しかし，直後に撮影した頭部CTで低酸素脳症を呈し，その後意識障害が遷延し自発呼吸はなく，第12病日に平坦脳波を確認し，最終的にPCPC（pediatric cerebral performance category）6となった。両側気胸は気管支喘息発作と混同されやすく，アナフィラキシーも合わせて鑑別する必要がある。緊張性気胸には片側だけでなく，稀に両側があり，その診断は身体所見のみでは困難なため，近年有用性が報告されている超音波検査を併用し，可及的速やかに胸部X線写真を撮るべきである。

SIMULTANEOUS BILATERAL SPONTANEOUS PNEUMOTHORAX (SBSP) AS THE FIRST PRESENTATION OF COPD

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: A secondary spontaneous pneumothorax is defined as pneumothorax secondary to underlying lung disease that occurs without a trauma or iatrogenic cause [1,2]. Simultaneous bilateral spontaneous pneumothorax (SBSP) forms a total of 1.3% of all spontaneous pneumothorax cases [3]. CASE PRESENTATION: A 66-year-old male with significant smoking history who presented to the Emergency Department (ED) for exertional shortness of breath of 3 weeks duration associated with mild chest pain and persistent dry cough. The patient initially went to a secondary hospital where he was diagnosed with bilateral pneumothoraces and was treated with bilateral pigtail chest tubes and oxygen therapy. However, he was in moderate respiratory distress; hence he was referred to a tertiary hospital. In ED, his vital signs were normal except for low oxygen saturation. Physical examination was remarkable for moderate distress, decreased breath sounds bilaterally and bilateral pigtail chest tubes attached. Laboratory studies including metabolic panel and complete blood counts were normal except for leukocytosis of 19.7 K/CMM. Computed tomography scan showed 60-70% bilateral pneumothoraxes, 2 chest tubes, and bilateral patchy consolidation (Figure 1). Patient was followed by repeated physical examinations and CXRs. His right pneumothorax improved and the chest tube was removed. However, the left chest tube showed persistent air leak necessitating pleurodesis with Doxycycline initially and Talc later as the patient wanted to be treated conservatively. Later, he became hemodynamically unstable, CXR showed right tension pneumothorax and an urgent right chest tube was inserted which normalized his vital signs. However, shortly after, he became unstable again, repeated CXR showed recurrent right tension pneumothorax, another chest tube was inserted complicated by right hemothorax; hence he was taken emergently for Video-Assisted Thoracoscopic Surgery (VATS) for hemothorax evacuation. Biopsy from VATS showed dense fibrosis and honeycombing emphysematous changes. Right-sided talc pleurodesis was done, and both chest tubes were removed. Repeated CXR demonstrated small left pneumothorax. Patient was discharged home, pulmonary rehabilitation and smoking cessation were strongly recommended. DISCUSSION: SBSP is a rare life-threatening emergency that requires immediate recognition and treatment. The presentation may vary from mild respiratory distress to cardiopulmonary failure. Diagnosis is confirmed on radiological findings and bilateral chest tubes are the initial appropriate treatment which in 82% of cases can stop air leak in 48 hours. However, the persistent air leak is an indication for surgery with VATS being most common. CONCLUSIONS: Presentation of SBSP can vary from mild respiratory symptoms to respiratory failure, diagnosis can be confirmed on chest radiography and the treatment is emergent chest tube placement. Reference #1: [1]Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000 Mar 23;342(12):868-74. Review. PubMed PMID: 10727592. [2] Noppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121-7. https://doi.org/10.1159/000135932. Epub 2008 Jun 26. Review. PubMed PMID: 18708734 [3] Esther Graf-Deuel, Andreas Knoblauch: Simultaneous bilateral spontaneous pneumothorax. Chest. 1994;105:1142–6. DISCLOSURES: No relevant relationships by Noor Hajjaj, source=Web Response no disclosure on file for Chandler Patton; no disclosure on file for Julio Pernia; No relevant relationships by Ahmad Sharayah, source=Web Response

Surgery for simultaneous bilateral primary spontaneous pneumothorax: when and how?

Although primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is an unusual and potentially life-threatening condition with limited data on its incidence in the literature. There are evidence-based guidelines for the management of PSP, whereas the specific treatment strategy is not clearly defined in SBPSP despite clinical practice recommendations that surgery should be offered at the first episode. Currently, for most thoracic surgeons worldwide, video-assisted thoracic surgery (VATS) has taken a leading role in the treatment of PSP, due to its well-known advantages including less pain, better cosmetics, and faster recovery. In this article, we aim to explore the aspects of epidemiology, pathophysiology, diagnosis, management, and evolution of surgical approaches related to SBPSP.

Simultaneous bilateral spontaneous pneumomediastinum and pneumothorax in a cannabis user

Cannabis – the most commonly used illegal drug – also has some medical applications. Cannabis is being legalised more and more in the Western world, however it is not a safe substance as many people think. It can cause detrimental acute and chronic lung injuries such as bullous lung disease, chronic bronchitis, chronic obstructive pulmonary disease, pneumothorax, pneumomediastinum, pulmonary emphysema. A clear mechanism for acute pulmonary pathologies has not been established, but pneumothorax and/or pneumomediastinum can be considered as a typical presentation in cannabis users. We present a cannabis user case with simultaneous pneumomediastinum and bilateral spontaneous pneumothorax.

Unilateral single-port thoracoscopic surgery for bilateral pneumothorax\xa0or\xa0pulmonary bullae

BackgroundRapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP.MethodsFrom November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae.ResultsFifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively.ConclusionsTubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.

Simultaneous bilateral spontaneous pneumothorax

Introduction. Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlights the potential difficulties in diagnosis and management of patients with SBSP. Case outline. A 23-year-old female was urgently assessed because of a progressive dyspnoea of 2-day's duration with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During initial examination, there was the evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea and agitation. She was found to have type II respiratory failure with the following biochemical parameters: pH=7.34, PaCO2=6.3 kPa and PaO2=7.9 kPa. The chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, she subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies and pleural abrasion. Her chest drains were removed 3 days after surgery and a chest radiograph post-treatment demonstrated resolution of the pneumothoraces. She was discharged home without complications. Conclusion. Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.

Simultaneous bilateral spontaneous pneumothorax and radiation pneumonitis following thoracic radiotherapy for the treatment of high grade follicular lymphoma

Simultaneous bilateral spontaneous pneumothorax and radiation pneumonitis following thoracic radiotherapy for the treatment of high grade follicular lymphoma

Analysis of the patients with simultaneous bilateral spontaneous pneumothorax.

Simultaneous bilateral spontaneous pneumothorax (SBSP) is an uncommon condition with limited data on its incidence in the literature. In this study, we aimed to describe the bilaterality in both primary and secondary spontaneous pneumothorax cases, and the clinical approach in simultaneous disease and prognosis of these patients. A total of 16 patients who were followed with the diagnosis of bilateral spontaneous pneumothorax between January 2005 and January 2017 were retrospectively analyzed. The patients were divided into two groups: secondary spontaneous pneumothorax (SSP; Group 1, n = 11) and primary spontaneous pneumothorax (PSP; Group 2, n = 5). Demographic data, underlying lung pathologies, treatments applied, clinical findings and survival data were recorded. Of the patients in Group 1, four (36.3%) had chronic obstructive pulmonary disease (COPD), three (27.3%) had granulomatous lung disease, two (18.2%) had idiopathic pulmonary fibrosis, one (9.1%) had bronchiectasis and one (9.1%) had hypersensitivity reaction. Of these patients, four had bilateral tube thoracostomy, four had unilateral tube thoracostomy and the remaining three received medical treatment under follow-up. Of the Group 1 patients, six (54.6%) died during the 72-month follow-up period, while only one of these patients had COPD. All patients in Group 2 were treated using bilateral video-assisted thoracoscopic surgery either in the first or the second episode. These results suggest that simultaneous and bilateral occurrence of SPP is an indicator of an advanced lung pathology with a poor prognosis.

Single-staged uniportal VATS in the supine position for simultaneous bilateral primary spontaneous pneumothorax

BackgroundSimultaneous bilateral primary spontaneous pneumothorax (SBPSP) is rare, but requires surgery on both sides, in patients with definite bilateral bullae to prevent life-threatening conditions. Recently, uniportal video-assisted thoracoscopic surgery (VATS) has been widely accepted as a less invasive technique for the treatment of pneumothorax. Thus, we introduced single-staged uniportal VATS technique in the supine position, for the management of two cases of SBPSP.Case presentationA 17-year-old boy presented with bilateral spontaneous pneumothorax and he underwent single-staged uniportal VATS in the supine position. Single wide draping in consecutive bilateral approaches removes the needs of changing patients’ position. Whole thoracoscopic procedure for wedge resection of bullae lesions was conducted without difficulty. The total operation time took 65 min and the patient discharged 3 days after the operation. The patient was followed for 24 months without recurrence of both sides. Another 18-year-old boy was admitted with bilateral spontaneous pneumothorax and single-staged uniportal VATS was also performed in the supine position. The total operation time took 79 min and the patient discharged on postoperative day 4. He was followed for 19 months without recurrence of both sides.ConclusionsSingle-staged uniportal VATS approach yielded satisfactory results from simplicity that not requires position change compared to conventional multi-ports VATS in the lateral position, and with better cosmetics. This technique is thought to be a feasible procedure in selective patients with SBPSP or with contralateral bullae for preventive role.

Traitement d’un pneumothorax spontané bilatéral au cours d’un traitement par pazopanib pour la prise en charge de métastases pulmonaires d’un sarcome. Quelle conduite à tenir ?

Soft tissue sarcomas are rare malignant tumors with a great variety of histological types and different response to multimodality treatment. Pazopanib has been recently introduced for the treatment of non-adipocytic metastatic soft tissue sarcomas which are resistant to conventional chemotherapy. Spontaneous pneumothorax is a rare but well recognized complication of this molecule and its treatment is quite challenging. The case reported herein describes the surgical management of a simultaneous bilateral spontaneous pneumothorax in a patient with pulmonary metastases treated with pazopanib. It underlines the fact that the main objective should be the maintenance of the treatment in patients who benefit from it. Close oncologic and surgical collaboration is crucial in order to deal with adverse effects due to the anti-angiogenic action of pazopanib.

Life-threatening primary simultaneous bilateral spontaneous tension pneumothorax, successfully managed with single-stage bilateral video-assisted thoracoscopic surgery

Life-threatening primary simultaneous bilateral spontaneous tension pneumothorax, successfully managed with single-stage bilateral video-assisted thoracoscopic surgery

Root Cause of Analysis of Peculiar Response of Pneumothorax to Chest Tube Drainage

Chest tube drainage is a simple system to manage pneumothorax. It is inserted at the safety triangle after local anesthesia. Due to the positive intrapulmonary pressure and the negative intrapleural pressure during inspiration, air in the pleural space will be forced out into the chest drain bottle with underwater seal. The resorption of pneumothorax is further enhanced by oxygen therapy, which displaces the nitrogen inside the pneumothorax. Out of our expectation, there are cases with peculiar response to chest tube drainage. We should consider the following in the root cause analysis. 1. Chest drain system integrity: The chest drain should be placed in the pleural cavity, rather than sub-cutaneous or intra-abdominal cavity. The tubing should not be kinked or disconnected and the connection site should not be masked by dressing. 2. Anatomy of the pneumothorax: The anatomy of the pneumothorax should be on CXR or preferably contrast CT thorax. Any loculation, endobronchial obstruction, trapped lung due to old inflammatory process, lung entrapment due to persistent active inflammatory process should be noted. 3. Clinical assessment: It includes pleural fluid analysis, if present, and pleural manometry with air aspiration. In case of persistent air-leak seen in the chest drain bottle, suspect alveolopleural or bronchopleural fistula especially when patient is on positive pressure ventilation. Alternating or persistent bilateral pneumothorax without air-leak suggests interpleural communication (Simultaneous Bilateral Spontaneous Pneumothorax). The observed phenomena can be explained by considering the pressure change between various intra-thoracic compartments accounts for the observed phenomena, although confirmation of the communication during thoracoscopy is preferred.

Beware of Simultaneous Bilateral Spontaneous Pneumothorax: Case Reports and Literature Review

Beware of Simultaneous Bilateral Spontaneous Pneumothorax: Case Reports and Literature Review