Risk factors affecting the development of pneumothorax in patients followed up in intensive care with a diagnosis of COVID-19.

BACKGROUND: Pneumothorax is a little known and reported complication of COVID-19. These patients have poorer general outcomes and greater respiratory support requirements, longer hospitalization times, and higher mortality rates. The purpose of this study was to determine which factors predict mortality in patients with tube thoracostomy diagnosed with COVID-19, admitted to the COVID-19 intensive care unit (ICU), and developing pneumothorax. METHODS: This respective, observational study was conducted in all COVID-19 ICUs at the Marmara University Pendik Training and Research Hospital, Türkiye. Patients admitted to the ICU with diagnoses of COVID-19 pneumonia and with chest tubes inserted due to pneumothorax were investigated retrospectively. RESULTS: One hundred patients with tube thoracostomy were included in the study. Their median age was 68 (57-78), and 63% were men. The median follow-up time was 20 [10-29] days, and the median time from initial reverse transcriptase polymerase chain reaction (RT-PCR) results to tube thoracostomy was 17 [9-23] days. Initial RT-PCR results were positive in 90% of the patients, while 8% were negative, and 2% were unknown. Half the patients exhibited pulmonary involvement at thoracic computed tomography (CT) (n = 50), while 22 patients had COVID-19 reporting and data system (CO-RADS) scores of 5 (22%). Sixty-two patients underwent right tube thoracostomy, 24 left side placement, and 14 bilateral placement. The patients' mean positive end expiratory pressure (PEEP) level was 10.31 (4.48) cm H2O, with a mean peak inspiratory pressure (PIP) level of 26.69 (5.95) cm H2O, a mean fraction of inspired oxygen (FiO2) level of 80.06 (21.11) %, a mean respiratory rate of 23.71 (5.62) breaths/min, and a mean high flow nasal cannula (HFNC) flow rate of 70 (8.17) L/min. Eighty-seven patients were intubated (87%), six used non-rebreathable reservoir masks, four HFNC, two non-invasive mechanical ventilation (NIV), and one a simple face mask. Comorbidity was present in 70 patients, 25 had no comorbidity, and the comorbidity status of five was unknown. Comorbidities included hypertension (38%), diabetes mellitus (23%), cardiovascular disease (12%), chronic obstructive pulmonary disease (5%), malignancy (3%), rheumatological diseases (3%), dementia (2%) and other diseases (9%). Twelve of the 100 patients survived. The median survival time was 20 (17.82-22.18) days, and the median 28-day overall survival rate was 29% (20-38%). The multivariate Cox proportional hazards model indicated that age over 68 (HR = 2.23 [95% CI: 1.39-3.56]; p = 0.001), oxygenation status other than by intubation (HR = 2.24 [95% CI: 1.11-4.52]; p = 0.024), and HCO3- below 22 compared with a normal range of 22 to 26 (HR = 1.95 [95% CI: 1.08-3.50]; p = 0.026) were risk factors associated with mortality in patients in the ICU. CONCLUSIONS: Age over 68, receipt of oxygenation other than by intubation, and HCO3- values lower than 22 in patients with COVID-19 pneumonia emerged as prognostic factors associated with mortality in terms of pneumothorax.

Prehospital Trauma Compendium: Traumatic Pneumothorax Care - a position statement and resource document of NAEMSP.

Emergency Medical Services (EMS) clinicians manage patients with traumatic pneumothoraces. These may be simple pneumothoraces that are less clinically impactful, or tension pneumothoraces that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Further, there is also ambiguity regarding EMS management of open pneumothoraces. To provide evidence-based guidance on the management of traumatic pneumothoraces in the EMS setting, NAEMSP performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.NAEMSP recommends:EMS identification of a tension pneumothorax must be guided by a combination of risk factors and physical findings, which may be augmented by diagnostic technologies.EMS clinicians should recognize the differences in the clinical presentation of a tension pneumothorax in spontaneously breathing patients and in patients receiving positive pressure ventilation.EMS clinicians should not perform pleural decompression in patients with simple pneumothoraces but should perform pleural decompression in patients with tension pneumothorax, if within the clinician's scope of practice.When within scope of practice, EMS clinicians should use needle thoracostomy as the primary strategy for pleural decompression of tension pneumothorax in most cases. EMS clinicians should take a patient-individualized approach to performing needle thoracostomy, influenced by factors known to impact chest wall thickness and risk for iatrogenic injury.Simple thoracostomy and tube thoracostomy may be used by highly trained EMS clinicians in select clinical settings with appropriate medical oversight and quality assurance.EMS systems must investigate and adopt strategies to confirm successful pleural decompression at the time thoracostomy is performed.Pleural decompression should be performed for patients with traumatic out-of-hospital circulatory arrest (TOHCA) if there are clinical signs of tension pneumothorax or suspicion thereof due to significant thoraco-abdominal trauma. Empiric bilateral decompression, however, is not routinely indicated in the absence of such findings.EMS clinicians should not routinely perform pleural decompression of suspected or confirmed simple pneumothorax prior to air-medical transport in most situations.EMS clinicians may consider placement of a vented chest seal in spontaneously breathing patients with open pneumothoraces.In patients receiving positive pressure ventilation who have open pneumothoraces, chest seals may be harmful and are not recommended.EMS physicians play an important role in developing curricula and leading quality management programs to both ensure that EMS clinicians are properly trained in the recognition and management of tension pneumothorax and to ensure that interventions for tension pneumothorax are performed appropriately, safely, and effectively.

Comparison of the effect of chest tube diameter on drainage rate and tube performance in patients with pleural effusion. A cross-sectional study.

Introduction: Chest tube insertion is one of the essential procedures that is performed for patients suffering from pneumothorax or pleural effusion. Choosing the best chest tube size, with maximum emptying and minimum discomfort and side effects, is one of the most important factors in patient care, while the best tube size is highly a matter of debate. In this investigation, we aimed to assess the difference between the groups with different chest tube sizes regarding the time needed for drainage, the necessity of additional invasive procedures, or pain severity. Material and methods: In this cross-sectional study, patients with pleural effusion, were entered into the study. patients were randomly divided into two groups based on their chest tube size: size 28 and size 32. Then, the duration of complete effusion emptying and the duration of the chest tube insertion was evaluated. Results: According to this study, 26 (65.0%) participants were male. The duration for complete evacuation of pleural effusion varied from 3 to 10 days. The average duration of chest tube retention in the group of patients with chest tube sized 28 and 32 were 5.82, and 5.91 days, respectively; The average pain intensity in the group of patients with chest tube sized 28 and 32 were 6.71 ±1.02 and 6.48 ±1.21 units, respectively. Conclusions: There was no significant difference in how long the chest tube needed to stay in place to fully drain the pleural effusion. They also didn't differ significantly in the need for additional invasive procedures such as VATS, and secondary chest tube insertion. There was no notable difference for pain severity and the need for painkillers in the two groups of patients.

Percutaneous transthoracic needle biopsy of lung lesions is a safe method associated with a very low risk of pleural recurrence.

AIM: Percutaneous transthoracic needle biopsy (PTNB), an alternative to bronchoscopic confirmation of lung lesions, is today being associated with a risk of pneumothorax and hemorrhage. Further, there are no data on the possible risk of malignant disease spreading to the pleura at the site of the PTNB. Previous studies have dealt with this risk in stage I non-small cell lung cancer only. The aim of this study was thus to assess the risk of pleural recurrence for all types of lung lesions. Secondary objectives included assessment of diagnostic yield and safety with respect to the incidence of pneumothorax and hemorrhage. METHODS: Clinical data of all patients from the University Hospital in Pilsen who had undergone PTNB of lung lesions between 1.1.2018 and 31.12.2022 were included in this retrospective study. RESULTS: Following PTNB, ipsilateral pleural effusion occurred in 4.8% of patients without prior pleural infiltration. The effusion was confirmed as malignant in one patient (0.7%). Diagnostic yield of the method was 86.6%. We recorded pneumothorax or hemorrhage in the lung parenchyma or pleural space requiring medical intervention in 3.4% and 1.1% of patients, respectively. CONCLUSION: In our study, percutaneous transthoracic needle biopsy of lung lesions showed high sensitivity and low degree of acute complications requiring an invasive solution. The risk of pleural recurrence after a biopsy was very low. Consequently, we continue to consider this method to be an alternative to bronchoscopy biopsies.

Peripheral immunological characteristics of spontaneous pneumothorax: a Mendelian randomization study.

Background: Spontaneous pneumothorax (SP) is a common pleural disease in adolescents and adults. However, the role of immunological characteristics in the pathogenesis of SP remains unclear. This study aims to clarify the causal associations between circulating immune cells, lymphocyte subgroups, and SP susceptibility. Methods: Employing Mendelian randomization (MR), the causal association between circulating immune blood cells and lymphocyte subgroups on SP susceptibility have been assessed. Reverse MR analysis was used to further explore the causal relationship. The MR analysis ensured the reliability of the study results through the deletion of confounding single nucleotide polymorphisms (SNPs), heterogeneity testing, sensitivity analysis. Results: Seven immune cells and SP risk under stringent and lenient threshold conditions were identified. Eosinophils absolute count (AC) [odds ratio (OR) =1.0014, 95% confidence interval (CI): 1.0001-1.0014, P=0.02], memory B cell %B cell ratio (OR =1.008, 95% CI: 1.0002-1.0015, P=0.01), CD4+ T cell AC (OR =1.0014, 95% CI: 1.0003-1.0025, P=0.009), effector memory CD4+ T cell %T cell ratio (OR =1.0028, 95% CI: 1.0010-1.0046, P=0.003), and HLA-DR+CD8+ T cell %T cell ratio (OR =1.0019, 95% CI: 1.0004-1.0035, P=0.01) were identified as risk factors for increased susceptibility to SP. Conversely, CD8dim T cell AC (OR =0.9983, 95% CI: 0.9967-0.9999, P=0.03) and CD8dim natural killer T (NKT) %T cell ratio (OR =0.9982, 95% CI: 0.9965-0.9999, P=0.04) exhibited protective effects on SP. In natural killer (NK) cell subgroups and reverse MR analysis, no significance was found. Conclusions: This study establishes a close causal relationship between immune cells and SP through genetic methods, providing a new perspective for understanding the pathophysiological mechanisms of SP.

Evaluation of the nonstapling bullectomy by manual suturing for young men with primary spontaneous pneumothorax.

Background: Currently, surgery for primary spontaneous pneumothorax (PSP) is performed by bullectomy using a stapler with complete video-assisted thoracic surgery (cVATS). However, the postoperative recurrence rate (RR) of PSP is high in young men. The factors of postoperative PSP recurrence are the formation of postoperative bulla neogenesis (POBN) around the staple line, pleural injury caused by forceps for VATS, and bulla overlooked with a thoracoscope. We attempted nonstapling bullectomy with one-port-one-window (1p-1w) by using hybrid VATS (hVATS) to reduce postoperative RR. This study aimed to evaluate nonstapling bullectomy by manual suturing for young male patients with PSP compared with bullectomy by cVATS. Methods: From January 2012 to December 2022, we retrospectively reviewed the medical records of 259 male patients aged ≤25 years who underwent initial surgery for PSP and compared them between two groups, with staple use (S+) or by manual suturing without staple use (S-). RR, operative time, blood loss, and postoperative hospitalization period were examined in both groups. Results: The median operative time was 81 and 63 min in the S- and S+ groups, respectively (P<0.001), with the S- group tending to be statistically significantly longer. The mean intraoperative blood loss was 1.61 and 2.11 mL in the S- and S+ groups, respectively (P=0.003). The median postoperative hospitalization period was 4 days in both groups (P=0.32). Recurrences occurred in 8 (7.1%) and 14 patients (12.2%) in the S- and S+ groups, respectively [odds ratio (OR) =0.55; 95% confidence interval (CI): 0.22-1.37; P=0.19]. In patients aged <20 years, 5 (6.6%) and 10 (14.1%) patients had a recurrence in the S- and S+ groups, respectively (OR =0.42; 95% CI: 0.13-1.32; P=0.13). Conclusions: Compared with stapling bullectomy, nonstapling bullectomy with small thoracotomy for young male patients with PSP had lesser RR. This procedure is beneficial in reducing postoperative recurrence and is one of the surgical choices for young male patients with PSP.

Association of dietary intake with pneumothorax: A Mendelian randomization study.

Background: An association between dietary habits and lung disease has been demonstrated in previous studies. Employing Mendelian randomization, we aimed to explore how different dietary intakes relate to pneumothorax, shedding light on the interplay among gut flora, the lung-gut axis, and pneumothorax. Methods: Employing both two-sample and multi-sample Mendelian randomization (MR) analyses, we investigated 24 dietary intake variables to establish a strong association with pneumothorax. Causal inferences were drawn using the inverse variance weighted (IVW) method. To fortify our findings, we employed a diverse array of methodologies, including Weighted Median Estimator (WME), Weighted Mode, Simple Mode, Mendelian Randomization Pleiotropy Residual Sum and Outlier (MR-PRESSO), MR-Egger regression, and LASSO. Results: Our analysis identified genetic variants reliably predicting dietary intakes, meeting stringent criteria (p < 5 × 10-8) and demonstrating independence (r2 < 0.001). Causal-effect estimates derived from the IVW model unveiled a statistically significant association, indicating a causal correlation between pneumothorax and three dietary intakes. Specifically, heightened consumption of fresh fruit (OR = 0.196, 95%CI: 0.063-0.606, p = 0.004) and dried fruit (OR = 0.323, 95%CI: 0.114-0.911, p = 0.032) correlated with reduced pneumothorax risk, while increased processed meat intake (OR = 2.705, 95%CI: 1.026-7.128, p = 0.044) showed a positive correlation. Conclusion: In summary, our MR analysis yields robust evidence supporting a causal correlation between dietary elements and pneumothorax. This study significantly advances our comprehension of pneumothorax risk factors, protective agents, and the intricate mechanisms of the lung-gut axis.

Utilizing Un-enhanced Chest Computed Tomography Screening for Blunt Trauma Surgery Decisions.

Background Blunt chest trauma is a common and potentially life-threatening condition that requires prompt assessment for potential surgical intervention. Computed tomography (CT) of the chest has emerged as a valuable tool due to its heightened sensitivity and specificity in detecting thoracic injuries compared to conventional chest radiography. Objective This study aims to assess the impact of non-contrast CT chest findings on surgical decision-making and compare these findings with those from chest radiographs. Methods The study was conducted at the Accident and Emergency Department of Medical Teaching Institute, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of all ages and genders who presented with blunt chest trauma were included. Non-contrast CT chest scans were used as an initial screening tool and compared with traditional chest radiographs. Data collected included patient demographics, mechanism of injury, diagnostic findings, and treatment decisions. Imaging was performed using a GE Optima 16-slice scanner (Medsystems Sp. z o.o., Lublin, Poland). Results The study included 246 patients, of whom 210 (85.4%) were males. The most common age group was 50 years or older, comprising 71 (28.9%) of the sample. The predominant mechanism of trauma was road traffic accidents, reported by 188 (76.4%) patients. Hemopneumothorax was detected in 121 (49.2%) patients on CT scans compared to 34 (13.8%) patients on chest radiographs. On chest radiograph, the pneumothorax component was missed in 43 (17.5%) patients, and the hemothorax component was not detected in 21 (8.5%) patients. Patient management included conservative management in 30 (12.2%) cases and surgical intervention in the form of unilateral tube thoracostomy in 173 (70.3%) patients or bilateral tube thoracostomy in 43 (17.5%) patients. Conclusion Our study supports the use of non-contrast CT scans as a reliable diagnostic tool for blunt chest trauma, consistent with current literature. This approach facilitates prompt management decisions, particularly for initiating tube thoracostomy based on findings of pneumothorax and hemothorax. The rarity of mediastinal great vessel trauma further justifies minimizing routine contrast use, thereby enhancing the efficiency of trauma evaluations.

Are Adolescents With Chest Wall Deformity Potential Primary Spontaneous Pneumothorax Patients?

INTRODUCTION: Chest wall deformities often become apparent with growth spurts during adolescence. Alterations in the structure of the chest wall can result in the development of pulmonary bullae and blebs, which may lead to spontaneous pneumothorax. There are limited data on this subject in the literature. In this study, it is aimed to investigate the presence of bullae and bleb in patients with anterior and posterior chest wall deformities. METHODS: Computed tomography scans of adolescent idiopathic scoliosis, pectus carinatum, and pectus excavatum patients were analyzed. The presence of bullae and/or bleb (BB) was recorded as "present" or "absent." RESULTS: One hundred fifty patients with chest wall deformity have been included in the study. BB has been detected in 55 (36.7%) of the patients. Surgical procedures were performed in 45 (30%) of the patients due to chest wall deformity. BB was present in 12 (26.7%) of these patients. A statistically significant difference has been found between the presence of complications and the presence of BB in surgical patients (P < 0.001). In patients who developed complications, there was a statistically significant difference between the presence of BB and the duration of chest tube follow-up (P = 0.031), as well as between the presence of BB and the length of hospitalization (P = 0.006). CONCLUSIONS: A significant proportion (36.7%) of patients with chest wall deformity had BB. Chest wall deformities and primary spontaneous pneumothorax (PSP) may have common etiologic factors. It should be kept in mind that patients with chest wall deformities may be potential PSP patients. Medical counseling about PSP should be considered for these patients.

A unique presentation of pericardial epithelioid angiosarcoma with multifaceted complications.

Introduction and importance: Angiosarcomas are rare tumors of endothelial origin and may arise in any organ. Epithelioid angiosarcomas are a subtype of angiosarcoma that are rapidly progressive and typically fatal. Case presentation: The authors report a case of a 25-year-old previously healthy female who presented initially for dyspnea and palpitations, on further evaluation she was found to have large bilateral pleural effusions and cardiac tamponade. Clinical discussion: Pericardiocentesis and thoracentesis were performed alongside biopsies that revealed atypical cellular proliferation.Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed avid uptake in the anterior mediastinum, perivascular, paratracheal, subcarinal and pleural lymph nodes with large FDG uptake in the bilateral pleural effusion.Mediastinoscopy was done and biopsies showed an overtly malignant, epithelioid neoplasm with foci of vaso-formation; Keeping with high-grade epithelioid angiosarcoma of the pericardium.She received six cycles of weekly paclitaxel, but imaging for abdominal pain incidentally showed evidence of metastasis to the liver and spine so she was switched to Adriamycin-Ifosfamide for which she received one cycle so far.Her hospital course was complicated by high-output pleural effusions, chylothorax, left atrial thrombus formation and an intensive care unit stay for septic shock. Conclusion: Pericardial epithelioid angiosarcoma has been reported rarely in the literature. The authors aim to report a case of extensive metastatic pericardial epithelioid angiosarcoma in a young patient; which we believe can be an addition to the literature of a malignancy associated with poor prognosis and no definitive proven treatment regimen.

Pulmonary Mycobacterium avium complex infection with vascular Ehlers-Danlos syndrome: A case report.

A female patient developed multiple intestinal perforations at 31 and 43 years of age. Because of her family history of pneumothorax and intestinal perforation, Ehlers-Danlos syndrome (EDS) was suspected when she visited our hospital at 52 years. She was diagnosed with vascular Ehlers-Danlos syndrome (vEDS) and developed bilateral external iliac artery dissection. A CT scan at the time of admission revealed granular and infiltrative shadows in both lungs with bronchiectasis. The patient was also diagnosed with Mycobacterium avium complex (MAC) pulmonary disease, and drug susceptibility to clarithromycin was confirmed. After treatments with rifampicin, ethambutol, and clarithromycin were started, the acid-fast bacilli cultures taken from sputum were negative, and respiratory symptoms partially improved after about 1 month. vEDS is reportedly associated with lung diseases, such as pneumothorax and cystic lung lesions, but there are few reports of respiratory infections with vEDS. Moreover, there are no reports of complications associated with MAC disease. We report a case of vEDS with rare complications and suggest the possible mechanism of infection.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures.

BACKGROUND: Congenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management. CASE PRESENTATION: A two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child's condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications. CONCLUSION: This case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Risk Factors and Outcomes Associated with Pneumothorax in Very Preterm Infants.

BACKGROUND/OBJECTIVES: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). METHODS: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995-2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA). RESULTS: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5-4.7) with its incidence inversely proportional to GA: 9.9% in 23-25 w and 2.1% in 30-31 w (p < 0.001), but stable over the years 1995-1999 (5.2%) and 2015-2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3-3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7-4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2-11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7-9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995-1999 and 11.7% 2015-2019, p < 0.001), we found no significant difference in pneumothorax-related deaths. CONCLUSION: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI.

Bronchial foreign body presenting as pneumothorax and pneumomediastinum in a young child.

Pneumomediastinum (PM) and subcutaneous emphysema (SCE) following foreign body aspiration are very rare. Pneumomediastinum (PM) occurs due to alveolar rupture, whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature, but in some cases, it might be fatal. Therefore, proper assessment and management are required to limit the life-threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered. There is also a rare possibility of spontaneous expectoration of a foreign body dislodged in the trachea.

Risk prediction model for pneumothorax or pleural effusion after microwave ablation in patients with lung malignancy.

Background: Although microwave ablation (MWA) has been shown to be an effective treatment for lung malignancies (LM), there is no effective way to predict pneumothorax or pleural effusion after MWA so that timely measures can be taken to prevent it. Methods: This study comprised LM patients undergoing MWA at Affiliated Hospital of Nantong University from January 2013 to September 2023. Patients before May 2023 constituted the training set (n = 340), while data from May to September served as the test set (n = 58). Unformatted and formatted data extracted from electronic medical records (EMR) were utilized for model construction. Predictors for pneumothorax or pleural effusion were determined through univariate analysis and backward stepwise regression in the training set. Six ML algorithms were employed to create four models based on the research timeframe. Evaluation of the four models was performed using receiver operating characteristic (ROC) analysis, area under the ROC curve (AUC), and 10-fold cross validation. Findings: A total of 398 patients (216 aged 70 or above, 271 males) were included, with 23.37 % (93/398) experiencing pneumothorax and 33.42 % (133/398) developing pleural effusion. Across all four predictive models, Logistic Regression (LR) demonstrated optimal predictive performance in the test set, with AUC values of 0.727 for Model Ⅰ, 0.876 for Model Ⅱ, 0.895 for Model Ⅲ, and 0.807 for Model Ⅳ. Interpretation: ML models effectively predict post-MWA pneumothorax or pleural effusion.

A case of adenocarcinoma presenting with cystic lesion and recurrent pneumothoraces.

BACKGROUND: In this paper, a rare case is reported, where the patient is a 74-year-old man. He suffered from recurrent pneumothorax within half a year and experienced a relapse after receiving conservative treatments. CASE PRESENTATION: Diagnostic workup revealed a cystic lesion in the right middle lobe, which has been interpreted as a bulla during the initial chest CT scan. Due to recurrent pneumothorax and poor response to the conservative treatments, the patient underwent bullectomy and pleurodesis. The pathology showed that the wall of the cystic lesion was invasive adenocarcinoma. CONCLUSIONS: This case highlights the importance of monitoring cystic lesions in the lungs, especially in patients with a history of smoking and emphysema.

A Complex Case of Laryngospasm Secondary to COVID-19 Infection in a 40-Year-Old Male.

COVID-19 is a novel viral infection with a wide variety of clinical manifestations ranging from asymptomatic cases to severe respiratory illness. Laryngospasm is a spontaneous sustained closure of the laryngeal muscles leading to acute airway obstruction. We report a case of a 40-year-old male with a history of nephrolithiasis who underwent laparoscopic pyeloplasty and developed laryngospasm as a consequence of contracting COVID-19. The case was further complicated by the development of pneumothorax and pleural effusion during the postoperative period. The patient was managed with supplemental oxygen, antibiotics, antiviral therapy, and close monitoring. He recovered without any additional complications. This case highlights the potential initial clinical manifestation and the importance of early diagnosis and treatment of COVID-19 infection in surgical patients.

Bilateral Pneumothorax After Unilateral Subclavian Vein Cannulation for Pacemaker Implantation: A Case Report.

Ipsilateral pneumothorax is a common complication of pacemaker implantation due to transvenous lead placement. We report a case of bilateral pneumothorax after unilateral subclavian vein cannulation for pacemaker implantation. An 85-year-old woman underwent dual-chamber pacemaker implantation for symptomatic atrioventricular block. The transvenous leads were inserted through the left subclavian vein under fluoroscopy and contrast venography, and bilateral pneumothorax was noted the day after implantation, although echocardiography and computed tomography showed no pericardial effusion or lead extrusion. A chest tube was placed in the left chest cavity, which was removed one week later without complications.