Spontaneous Pneumothorax In Patients Research Articles

The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan

IntroductionSecondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. MethodsIn this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. ResultsWe enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. ConclusionOur study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.

Secondary Spontaneous Pneumothorax in Patients with Silicosis.

Background and aims: Patients with silicosis are at increased risk of pneumothorax. However, the true incidence of pneumothorax in these patients is yet unknown. Our objective was to study the proportion of secondary spontaneous pneumothorax (SSP) in patients with silicosis who present with acute respiratory deterioration. We also analyzed the risk factors, clinical course, actual management, and treatment outcomes of pneumothorax in patients with silicosis. Materials and methods: It was a hospital-based descriptive cross-sectional study. A total of hundred silicosis patients presenting with any acute worsening respiratory symptoms (dyspnea, cough, and chest pain) warranting admission were enrolled. A detailed history, clinical examination, and radiological investigations were done in all cases. Results: A total of 100 patients were included in this study. The mean age of subjects was 51.6 years. Breathlessness was the most common presenting symptom followed by chest pain. A total of 43 (43%) patients had pneumothorax at presentation. Right-sided pneumothorax was seen in 26 (26%) cases, left-sided in 11 (11%) cases, and six patients (6%) had bilateral pneumothorax. No significant correlation of smoking with pneumothorax was observed in the present study. Around 42% of patients had pulmonary tuberculosis which was microbiologically confirmed. Conclusion: The present study emphasizes that all patients of silicosis who present with acute worsening shortness of breath and or chest pain need to be evaluated for pneumothorax. How to cite this article: Bairwa M, Sharma A, Luniwal M. Secondary Spontaneous Pneumothorax in Patients with Silicosis. J Assoc Physicians India 2023;71(10):64-66.

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum.

Patients with primary spontaneous pneumothorax (PSP) tend to be young, tall, and thin, as do those with pectus excavatum (PE). Notably, the Haller index, which measures the severity of PE, tends also to be higher in patients with PSP, further suggesting a potential predisposing factor for the development of PSP in individuals with PE. This study aimed to share clinical experiences with case series of concomitant PSP and PE and to emphasize the importance of evaluating these two conditions together. In this single-center study, we conducted a retrospective records review to identify patients who were diagnosed and treated (including surgical or conservative treatment and follow-up observation) for the diagnosis of PE between July 2011 and February 2023. From these, we selected patients who were diagnosed with both PE and PSP and analyzed their clinical presentations. Among a total of 139 patients with PE, there were 8 (5.76%) who had concurrent diagnoses of PE and PSP and who underwent surgery for PSP, PE, or both. The average age of these 8 patients (male:female = 7:1) was 19.38 years. The 8 patients were grouped into four categories based on their clinical scenarios. Group A had 1 patient with PE diagnosed first, followed by the discovery of PSP during evaluation; Group B included 2 patients initially presenting with PSP and subsequently diagnosed with PE during evaluation; Group C consisted of 1 patient who had PSP before undergoing surgical PE correction; and Group D comprised 4 patients who developed PSP after PE correction. The incidence of PSP in patients with PE was 5.76% (8 out of 139 patients), indicating the importance of vigilant monitoring for PSP prior to PE surgery, and vice versa. Furthermore, the authors recommend close observation for PSP independent of PE surgery, even in the absence of postoperative complications.

A Case of Secondary Spontaneous Pneumothorax in a Patient with Interstitial Lung Disease

Secondary Spontaneous Pneumothorax occurs in people with wide variety of parenchymal lung disease. These individuals have underlying pulmonary pathology that alters normal lung structure. Patients presenting with acute respiratory distress with underlying lung pathology should always be evaluated radiologically for any complications such as secondary spontaneous pneumothorax and managed accordingly. My case report of secondary spontaneous pneumothorax in a female patient with interstitial lung disease illustrates the importance of computed tomography (CT scan of Chest), insertion of intercostal drain tube and course of antibiotics for infection control and prevention. Keywords: Secondary spontaneous pneumothorax, Interstitial lung disease, Intercostal drainage tube

An air-locking port and high-flow nasal cannula in non-intubated uniportal video-assisted thoracic surgery for pneumothorax with pulmonary dysfunction: a case report

BackgroundNon-intubated video-assisted thoracic surgery is a therapeutic option for intractable secondary spontaneous pneumothorax in patients who are poor candidates for surgery with endotracheal intubation under general anesthesia. However, intraoperative respiratory management in this surgery is often challenging because of hypoxia caused by surgical pneumothorax.Case presentationA 75-year-old man with idiopathic pulmonary fibrosis who had been on home oxygen therapy underwent non-intubated uniportal video-assisted thoracic surgery for intractable spontaneous pneumothorax. During the operation, oxygen was administered using a high-flow nasal cannula at a high flow rate. An air-locking port for single-incision surgery was used to minimize the inflow of air into the pleural cavity. The intrapleural air was continuously suctioned through the chest tube. The air-leak point was easily identified and closed using ligation. Oxygenation was satisfactory throughout the operation.ConclusionsNon-intubated uniportal video-assisted thoracic surgery for secondary spontaneous pneumothorax with an air-locking port, continuous pleural suction, and high-flow nasal cannula may achieve satisfactory intraoperative oxygenation in patients with respiratory dysfunction. The intrapleural space can be feasible for surgical manipulation without surgical pneumothorax in non-intubated video-assisted thoracic surgery even when supplied with oxygen at a high flow rate using a high-flow nasal cannula.

Management of spontaneous pneumothorax in patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups. The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.

Finding the bubble: atypical and unusual extrapulmonary air in the chest

ObjectiveTo describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. ConclusionIn this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

Buscando la burbuja: aire torácico extrapulmonar atípico e inusual

ObjectiveTo describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. ConclusionIn this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

A Case of Bilateral Spontaneous Pneumothorax in a Patient with COVID-19 Pneumonia

One of the rare complications of coronavirus disease-2019 (COVID-19), which can present with different clinical pictures, is pneumothorax. In our case, a patient who did not have predisposing risk factors for pneumothorax such as a history of trauma, smoking, past intubations, asthma, chronic obstructive pulmonary disease, and who developed bilateral spontaneous pneumothorax while under treatment with the diagnosis of COVID-19 is presented. Acute worsening in COVID-19 patients may be due to primary disease or pulmonary embolism. With this case, we emphasize the importance of considering spontaneous pneumothorax in patients with acute clinical deterioration.

Acute respiratory distress syndrome and pneumothorax in COVID-19 patients

Background: Spontaneous pneumothorax is known as a fatal complication in patients with COVID-19. However, the exact pathogenesis of the spontaneous pneumothorax occurrence and its cause remains unknown. Accordingly, the present study examined 30 patients with acute COVID-19-induced respiratory failure who were under biphasic positive airway pressure (BIPAP) and medical ventilator machines. Methods: This study is a retrospective study and was performed on patients with COVID-19-induced acute respiratory failure who were admitted to the intensive care unit. The study population included 30 patients (10 patients with pneumothorax complication and 20 other patients without this complication). All study patient demographic data and device parameters (physiological parameters observed by the device) were collected and compared with each other. Results: Overall, 30 patients with COVID-19 and acute respiratory distress syndrome (ARDS) were selected during the 3 months from April to July 2020, with complications of spontaneous pneumothorax and emphysema detected in the collected chest X-ray images of 10 patients. In general, the results showed that p-plateau and p-peak parameters in the group with pneumothorax were significantly higher than the other group. Alternately, it was observed that static compliance for the group with pneumothorax was significantly lower than the uncomplicated group. Further, the mortality rates obtained were equal to 80% for the group with pneumothorax complication and 55% for the other group. Conclusion: Spontaneous pneumothorax in patients with ARDS and COVID-19 is a rare complication with a high mortality rate that occurs even in patients without intubation and patients undergoing BIPAP. Hence, if low static compliance and high pulmonary pressures are observed for patients, physicians should seek the complication diagnosis and treatment following changes in patients' symptoms.

Silicosis With Secondary Spontaneous Pneumothorax in the Western Rajasthan.

ObjectiveSilicosis is one of the common occupational lung diseases caused by crystalline silica respiration. Pneumothorax is one of the most common and morbid complications of silicosis involving lung pleura. It is commonly seen unilaterally in chronic silicosis and can often be lethal. The purpose of this study is to report secondary spontaneous pneumothorax (SSP) in critically ill patients with silicosis.MethodsA cross-sectional study was done between January 2019 and June 2019 at Sawai Man Singh (SMS) Medical College in Jaipur, India. A cohort of 50 patients with dyspnea and a history of silicosis were studied. A chest X-ray and sputum for acid fast bacilli were checked on all suspected cases.ResultsThe present study showed that the mean age of patients was 38.7 years, all silicosis patients had dyspnea, and 96% of patients had severe chest pain. The results of chest X-rays concluded the evidence of silicosis. Bilateral pneumothorax was seen in three cases, right-sided pneumothorax in eight cases, and left-sided pneumothorax in 11 cases. The rate of pneumothorax incidence in silicosis patients was about 44%, which is higher than the current evidence. Six patients were managed conservatively with oxygen and bronchodilators, and 16 patients underwent through tube thoracostomy.ConclusionThis study highlights the importance of considering spontaneous pneumothorax in patients who are presenting with shortness of breath and/or chest pain especially with a known history of silicosis, as the timely diagnosis can alter the management of this morbid condition which carries a high mortality rate if left untreated, compromising the lung expansion, venous return, cardiac output, oxygenation and eventually leading to death.

Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study

BackgroundRecent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.Research QuestionDo the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?Study Design and MethodsThis case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.ResultsWe identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.InterpretationSP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.

Frequency, Risk Factors, Clinical Characteristics and Outcomes of Spontaneous Pneumothorax in Patients with COVID-19 Results of the UMC-19-S7

Objective: We investigated the incidence, risk factors, clinical characteristics and outcome of spontaneous pneumothorax (SP) in COVID-19 patients attended in emergency departments (ED) before hospitalization. Methods: We retrospectively reviewed all COVID patients diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs), during the first two months of the COVID outbreak and compared them with two control groups: COVID patients without SP (control group A) and non-COVID patients with SP (control group B). Relative frequencies of SP were estimated in cases and control group B. Unadjusted comparisons between cases and controls included 52 clinical, analytical and radiological characteristics and 4 outcomes. Results: We identified 40 SP in 71,904 patients with COVID-19 attending EDs (0.56‰, 95%CI=0.40-0.76‰). This incidence was higher than that observed in non-COVID patients (387/1,358,134, 0.28‰, 95%CI=0.26-0.32; OR=1.93, 95%CI=1.41-2.71). In COVID patients the characteristics associated with a higher risk of SP were: male sex, shorter symptom length, less fever, greater dyspnea, tachycardia, tachypnea and hypoxia, higher hemoglobin, leukocyte count, D-dimer and LDH, and lower lymphocyte count. Compared to control group B, case group patients were older, more frequently had obesity, asthma, dyspnea, tachycardia, tachypnea, hypoxia and analytical disturbances, and less frequently diabetes mellitus, hypertension, smoker habit, and chest pain. All the outcomes measured, including in-hospital death, were worse in cases than in control groups A and B. Conclusions: SP as a form of COVID presentation is unusual (<1‰ cases) but is associated with worse outcomes than SP developed in non-COVID patients and in COVID patients without SP. Funding Statement: The present work was performed without any direct or indirect financial support. Declaration of Interests: No author reports any conflict of interest directly or indirectly connected with this manuscript. Ethics Approval Statement: The UMC-19 project was approved by the Ethics Committee of the Hospital Clinic of Barcelona (Spain), with the reference number HCB/2020/0534, and acted as the central ethical committee. Under the exceptional circumstances generated by the COVID-19 pandemic, the urgent need to obtain feasible data related to this new disease, and the non-interventional and retrospective nature of the project, the requirement of obtaining written patient consent to be included in the study was waived.

Катамениальный пневмоторакс как особая форма спонтанного пневмоторакса (обзор литературы)

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

Conservative treatment for recurrent secondary spontaneous pneumothorax in patients with a long recurrence-free interval.

BackgroundAlthough recurrence is included in surgical indications, there is no definitive guideline for managing recurrent spontaneous pneumothorax (SP) according to characteristics of recurrence, such as the type [primary SP (PSP) or secondary SP (SSP)] and recurrence-free interval (RFI). Actually, some patients with early cessation of air leak after closed thoracostomy tubes, a long RFI, or medical comorbidities are often managed conservatively without surgery. However, the validity of this management is unclear. The aims of the present study are to analyze treatment outcomes for recurrent SP according to the type of SP and RFI, and to check the validity of conservative treatment for patients according to type of SP and RFI.MethodsWe included 1,250 consecutive cases (624 right sided and 626 left side cases for the first episode) who were hospitalized and treated from January 2012 to June 2018. To investigate recurrence according to treatment modality (surgical or conservative treatment), we estimated RFI in each group during the observation period. RFI was measured from the completion of treatment to recurrence or last follow-up. We divided patients into two groups [the early (EG) and the late (LG) recurrence group] according to 1-year. Recurrence was defined as a subsequent episode of an ipsilateral SP, while a contralateral SP was regarded as an independent case in the present study. RFI between subgroups was compared using the Kaplan-Meier method with the log-rank test. A P value less than 0.05 (two-sided) was regarded as statistically significant.ResultsRecurrence occurred in 47 cases after surgical intervention for the first episode (585 cases). Recurrence occurred in 265 cases after conservative treatment for the first episode of SP (665 cases). For the first episode, the surgical group (SG) had a significantly longer RFI than the conservative group (CG), regardless of the type (both, P<0.001). Conservative treatment and surgical intervention for the second episode after conservative treatment for the first episode were performed in 98 and 167 cases, respectively. For the second episode after conservative treatment for the first episode, SG also had a significantly longer RFI than CG, regardless of the types (PSP P<0.001, SSP P=0.031). To check the validity of conservative treatment for patients with a long RFI, we analyzed recurrence by dividing patients into two groups according to one-year RFI. For PSP, the early recurrence group (EG, RFI ≤1 year) had 99 cases and the late recurrent group (LG, RFI >1 year) had 67 cases. SG had a significantly longer RFI than CG in both EG and LG (EG, P<0.001 and LG, P=0.001). In addition, for SSP, there were 67 cases of EG and 32 cases of LG, SG had significantly longer RFIs than CG in EG (P=0.007). However, there was no significant difference in RFI between SG and CG in LG (P=0.748).ConclusionsThe present study revealed diversity of management outcomes according to characteristics of recurrence and provides some evidences of the validity of conservative treatment in recurrent SSP with a long RFI. Further large-scale prospective randomized trials are required to validate these findings.

Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients.

There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien-Dindo classification) were analysed for efficacy and safety assessment, respectively. Median postoperative air leaks continued for 0 days (range 0-25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00-1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38-27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

Secondary spontaneous pneumothorax in patients with sarcoma treated with Pazopanib, a case control study

BackgroundThe tyrosine kinase inhibitor pazopanib is used for treatment of sarcoma. Recent studies have suggested that the use of pazopanib may lead to the development of pneumothorax, an unexpected adverse effect in patients with sarcoma metastatic to the chest.MethodsWe conducted a retrospective case control study of patients with sarcoma with metastases to the chest with pneumothorax (cases) and without pneumothorax (controls). The control population was selected from tumor registry in a 1:4 (cases to controls) ratio. The primary outcome of interest was the association between pazopanib and pneumothorax risk in patients with sarcoma metastatic to the chest. Secondary objective was to evaluate risk factors for pneumothorax.ResultsWe identified 41 cases and 164 controls. Using purposeful selection method the odds of developing pneumothorax while being on pazopanib was not significant in univariate (p = .06) and multivariable analysis (p = .342). On univariate analysis risk factors of pneumothorax in patients with sarcoma were age, male sex, African American race, the presence of cavitary lung nodules/masses, and the presence of pleural-based nodules/masses. On multivariate analysis, only the presence of cavitary lung nodules/masses (P < .001) and the presence of pleural-based nodules/masses (P < .001) remained as risk factors for developing pneumothorax.ConclusionPazopanib does not increase the risk of pneumothorax in patients with sarcoma and evidence of metastatic disease to the chest. Presence of cavitary lung nodules/masses and the presence of pleural-based nodules/masses were found to be risk factors for pneumothorax.

Pneumothorax in the cases of silicosis in southern part of Rajasthan

Background: Silicosis is an occupational lung disease caused by inhalation of dust containing crystalline silica particles of size 0.5-5 microns in diameter. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work and ceramics. Pneumothorax is one of the complications of silicosis. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The incidence of secondary spontaneous pneumothorax (SSP) in silicosis as such is not known. This study aims to report the cases of secondary spontaneous pneumothorax in patients of silicosis in Southern part of Rajasthan.Methods: 50 patients of silicosis established by historical, clinical evaluation and radiological evidence with increased dyspnoea were included in the study. In all patients Chest X ray was done immediately.Results: Among 50 patients of silicosis with increased dyspnoea, Chest X ray showed pneumothorax in 20 patients of which 4 had bilateral pneumothorax, 7 had right pneumothorax and 9 had left pneumothorax. The mean duration of exposure to silica particles was 10 years (5 to 15 years). All the patients had various degrees of dyspnoea and chest pain. Tube thoracostomy was performed in 15 patients while 5 patients were managed conservatively with oxygen and bronchodilators.Conclusions: Our study showed an increased incidence of secondary pneumothorax in silicosis patients. The occurrence of pneumothorax, though rare in silicosis is a potentially life-threatening complication and may cause serious morbidity and mortality. The patients of silicosis who develop sudden onset of dyspnoea should be promptly investigated for this complication.

Chronic myeloid leukemia following repeated diagnostic X-ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review.

Previous studies have indicated that X-ray irradiation may increase the risk of chronic myeloid leukemia (CML), and the incidence of spontaneous pneumothorax in patients with ankylosing spondylitis (AS) is higher than in the general population. Patients with AS usually develop spontaneous pneumothorax several years after the diagnosis of AS. The present study reports the unusual case and complicated clinical history of a 29-year-old man with recurrent pneumothorax and AS, who developed CML following repeated exposure to low doses of radiation via diagnostic X-rays and chest computed tomography imaging. Pneumothorax was diagnosed prior to AS in this patient; the present case report highlights the importance of recognizing AS as a possible underlying cause of recurrent spontaneous pneumothorax. Patients with AS may be more sensitive to injury via X-ray-derived radiation, and even small diagnostic doses may be associated with CML. Diagnostic X-ray exposure should therefore be limited to reduce the risk of radiation-associated malignancies, including CML, particularly in patients with AS.

Bilateral Pneumothoraces After BAL in a Thin Female With Nontuberculous Mycobacterium

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Pneumothorax after bronchoalveolar lavage (BAL) is rare, but there is association with spontaneous pneumothorax in nontuberculous Mycobacterial (NTM) and low BMI.1,2 We describe a case of bilateral pneumothoraces after diagnostic bronchoscopy with BAL. CASE PRESENTATION: A 79 year old female with bronchiectasis presented for evaluation of malaise with diagnostic flexible bronchoscopy. Friable mucosa and thick white secretions were noted and BAL was performed in lingula and RML with 120 ml of normal saline in each lobe. Post-procedure she developed chest pain and dyspnea. Chest x-ray (CXR) showed bilateral pneumothoraces, left more than right. A left-sided 14 Fr chest tube was placed with noted air leak. A repeat CXR showed resolving left pneumothorax but enlargement of right pneumothorax, and a right side 14Fr chest tube was placed. Repeat CXR showed resolution of pneumothoraces. BAL grew mycobacterium avium complex and she was started on antibiotics. DISCUSSION: Pneumothorax post flexible bronchoscopy without transbronchial biopsy occurs rarely, typically in elderly patients with underlying pulmonary disease.1There is association of spontaneous pneumothorax in patients with NTM and low BMI. Research on spontaneous pneumothorax in rats has shown that a malnourished state may weaken the structure of the alveoli or cause structural changes predisposing to rupture at a time of increased intra-thoracic pressure such during cough.2 During BAL there may be increased intra-alveolar pressure from fluid being aspirated, creating local gas trapping, and increase transpulmonary pressures due to cough, especially with wedged bronchoscope.3 CONCLUSIONS: Our patient developed bilateral pneumothoraces after BAL likely due to a combination of factors including underlying NTM disease, weakened alveoli from a malnourished state, and transient increases in intra-alveolar pressures.1-3 Therefore while pneumothorax is considered a rare complication post bronchoscopy with BAL certain populations may be at an increased risk.3 Reference #1: Nicholson, TT et al. Pneumothrorax following brochoalveolar lavage for the diagnosis of non-tuberculous Mycobacterial infection- An “atypical” complication of bronchoscopy?Arch Bronch.2016;52:278-9. Reference #2: Corless JA et al. Simultaneous bilateral spontaneous pneumothoraces in a young woman with anorexia nervosa.Int J Eat Dis.2001;30:110-112. Reference #3: Setu, P et al. Bilateral pneumothorax after bronchoscopy without biopsy. A rare complication: Case presentation and literature review.J of Bron & Int Pul.2012;19(1):57-60. DISCLOSURE: The following authors have nothing to disclose: Nadia Pletukhina, Vivian Keenan, Naveen Tyagi, Shilpa DeSouza, Sepideh Sedgh No Product/Research Disclosure Information