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1.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664116

RESUMO

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Assuntos
Infecções por Coronavirus/patologia , Endotélio Vascular/patologia , Pulmão , Pandemias , Pleura , Pneumonia Viral/patologia , Trombose/patologia , Trombose/parasitologia , Idoso , Betacoronavirus/isolamento & purificação , Biópsia/métodos , Tubos Torácicos/efeitos adversos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Pleura/cirurgia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumotórax/etiologia , Pneumotórax/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Toracoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(27): e21076, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629740

RESUMO

BACKGROUND AND OBJECTIVE: Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS: We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS: Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS: Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.


Assuntos
Biópsia Guiada por Imagem/instrumentação , Derrame Pleural/patologia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Empiema/epidemiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Pneumotórax/epidemiologia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Adulto Jovem
5.
Kyobu Geka ; 73(6): 423-426, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32475965

RESUMO

We report a case of a simultaneous bilateral pneumothorax (buffalo chest). A 75-year-old man who had undergone resection of an esophageal carcinoma had difficulty in breathing and lost consciousness. He was transported to our hospital and diagnosed as a simultaneous bilateral pneumothorax. He underwent bilateral chest drainages, and was hospitalized. Because of the continued air leak, an operation was performed. First, thoracoscopic bullectomy was performed from the left side. Changing the position, the water poured in the left thoracic cavity to test for air leaks flowed out to the right drain in large quantities;thus, a communication between both sides of the thoracic cavity became clear, although we could not find a pleural defect between the thoracic cavities.


Assuntos
Pneumotórax , Cavidade Torácica , Idoso , Drenagem , Neoplasias Esofágicas , Humanos , Masculino , Pleura , Cirurgia Torácica Vídeoassistida
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 508-512, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32527364

RESUMO

The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.


Assuntos
Parada Cardíaca , Pneumotórax , Humanos , Incidência , Ressuscitação
7.
Orv Hetil ; 161(25): 1063-1068, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516125

RESUMO

Tracheobronchial injury is an uncommon, but often life-threatening condition. It is mostly caused by blunt thoracic or neck trauma, difficult or prolonged intubation associated with nasogastric tube insertion. An early diagnosis and treatment can be lifesaver. The diagnosis is often late because of atypical symptoms and unspecific radiological signs, and due to the presence of severe coexistent injuries. Generally, the classic hallmark during physical examination is a progressive, extensive surgical emphysema. Radiological signs are often atypical, which makes the diagnosis more difficult. The most frequent signs found on computed tomography are also unspecific, mostly surgical emphysema, pneumomediastinum or pneumothorax may be noted. We present three patients suffering from airway laceration caused by car accident, difficult intubation, and prolonged utilization of nasogastric and endotracheal tube. All the patients had an overdistended endotracheal balloon herniated outside the extratracheal space along the rupture of the tracheal wall. These external balloons were all detected on radiography. This is a direct and pathognomic sign of airway injury, suggesting complete rupture in the tracheal wall. In our report, we would like to highlight the diagnostic role of an overinflated cuff. Orv Hetil. 2020; 161(25): 1063-1068.


Assuntos
Intubação Intratraqueal , Pneumotórax , Tomografia Computadorizada por Raios X/métodos , Traqueia/lesões , Humanos , Radiografia , Ruptura , Traqueia/diagnóstico por imagem
8.
J Infect Public Health ; 13(6): 887-889, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475804

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). As known, COVID-19 has become a global pandemic and serious health problem. Disease mainly affects lungs and common findings are fever cough and shortness of breath. Computerized tomography (CT) has an important role in initial evaluation and follow up of COVID-19. Main (CT) finding of the disease is bilateral extensive ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly involving the lower lobes. In this case report, we present a pneumothorax and subcutaneous emphysema case in a patient with COVID-19. To the best of authors' knowledge, it is the first illustrated case of pneumothorax accompanying COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/virologia , Enfisema Subcutâneo/virologia , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Feminino , Febre/virologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumotórax/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(20): e19948, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443296

RESUMO

There are limited systematic studies on hematologic disease complicated by air leak syndrome (ALS). Physicians in radiology departments and hematology departments have a limited awareness of ALS.The aim of this study was to explore the similarities and differences in clinical data between the clinical group and imaging group in patients with hematologic disease complicated by ALS.Clinical and CT data for 59 patients with hematologic disease complicated by ALS in our hospital were retrospectively reviewed. Patients were assessed by clinical grouping and image grouping. Data were compared between groups, and P < .05 was considered statistically significant.Dyspnea occurred more often in the allo-HSCT (allogeneic hematopoietic stem cell transplantation) group than that in the non-allo-HSCT group (68.8% vs 4.7%, P < .001), there were statistically significant differences in inducing factors between groups, and differences in other aspects were not statistically significant. Chest tightness and dyspnea occurred more often in the allo-HSCT with BO/BOOP (bronchiolitis Obliteran/bronchiolitis obliterans organizing pneumonia) group than those in the allo-HSCT without BO/BOOP group (80.0% vs 9.1%, P = .013), and differences in other aspects were not statistically significant. Chest pain occurred more often in the HPT (hydropneumothorax) group than that in the other 3 groups (pure pneumothorax [PT], pulmonary interstitial emphysema [PIE], complex ALS) (71.4% vs 11.1%, 0.0%, and 26.5%, P = .005); ALS thickness in the HPT group was greater than that in the other 2 groups (PIE and complex ALS) (19.7 vs 3.5 cm and 9.5 cm, P = .001); catheter drainage occurred more often in the HPT group than that in the other three groups (PT, PIE, complexALS) (64.3% vs 22.2%, 0.0%, and 2.9%, P = .001).ALS is a high risk in male patients who have a low BMI, have leukemia as a basic disease, and have basic lung diseases (eg, BO/BOOP). CT types are mainly complex ALS, HPT, and pure PT. In addition, clinical symptoms for patients in the HPT group are severe, and there is a high prevalence of catheter drainage.


Assuntos
Doenças Hematológicas/complicações , Enfisema Mediastínico/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Criança , Pneumonia em Organização Criptogênica/complicações , Feminino , Doenças Hematológicas/diagnóstico por imagem , Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Enfisema Mediastínico/etiologia , Pessoa de Meia-Idade , Pneumotórax/etiologia , Enfisema Pulmonar/etiologia , Estudos Retrospectivos , Adulto Jovem
10.
Medicine (Baltimore) ; 99(20): e20208, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443345

RESUMO

INTRODUCTION: Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax. PATIENT CONCERNS: Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%. DIAGNOSIS: This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography. INTERVENTIONS: He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given. OUTCOMES: He died on the twelfth day after admission. CONCLUSIONS: Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.


Assuntos
Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Idoso , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Humanos , Masculino
11.
Kyobu Geka ; 73(2): 124-126, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393720

RESUMO

A 67-year-old man had undergone thymectomy with partial resection of the left upper lobe and pericardium for thymic cancer. Four years later, he visited our hospital due to chest pain. Chest computed tomography revealed pneumopericardium. Nine months later, surgical treatment was performed due to the development of the left pneumothorax. Air leak was found from the bulla which was partially incarcerated into the pericardial space.


Assuntos
Pneumopericárdio , Pneumotórax , Neoplasias do Timo , Idoso , Humanos , Pulmão , Masculino , Neoplasias do Timo/cirurgia
12.
Gan To Kagaku Ryoho ; 47(1): 87-90, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32381869

RESUMO

A man in his late teens presented to our hospital with left-sided chest pain. CT showed a 12 cm sized anterior mediastinal tumor and tiny nodules in the bilateral lower lobe of the lungs. The patient also had elevated serum AFP and hCG levels. Pathological findings of the CT-guided biopsy specimen suggested a yolk sac tumor, and no testicular abnormality was seen on ultrasound. Following whole body examination, he was diagnosed with primary mediastinal non-seminomatous germ cell tumor. After sperm cryopreservation, 4 courses of BEP(bleomycin[BLM]plus etoposide[ETP]plus cisplatin[CDDP]) chemotherapy were administered to normalize the tumor markers. The mediastinal tumor shrank but was still widely in contact with the left pulmonary artery. He underwent mediastinal tumor resection and segmentectomy of the left upper lobe via a median sternotomy. The maximum tumor size was 9 cm in diameter, and pathological examination of the specimen revealed only an immature teratoma with no malignant findings. At the same time, both the lower lung nodules were resected and pathologically identified as intrapulmonary lymph nodes. No recurrence was observed, but 6 months after surgery, he made an emergency visit to our department due to dyspnea. Bilateral pneumothorax was detected, and chest tube insertion was rapidly performed that improved with only right chest drainage. Cytology of the right hemorrhagic pleural effusion showed no evidence of malignancy. It was possible that a postoperative right-to-left shunt of the anterior mediastinum was present, leading to bilateral pneumothorax.


Assuntos
Neoplasias do Mediastino/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas , Pneumotórax , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Quimioterapia de Indução , Masculino , Neoplasias do Mediastino/complicações , Mediastino , Recidiva Local de Neoplasia , Neoplasia Residual , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Pneumotórax/complicações
13.
BMJ Case Rep ; 13(5)2020 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-32423911

RESUMO

A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO2 of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. The chest radiograph demonstrated a left-sided tension pneumothorax. This was treated with emergency needle decompression, with good effect, followed by chest drain insertion. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/terapia , Adulto , Tubos Torácicos , Infecções por Coronavirus/diagnóstico , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumotórax/etiologia , Toracostomia
14.
Khirurgiia (Mosk) ; (4): 77-80, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352674

RESUMO

Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.


Assuntos
Enfisema Mediastínico/terapia , Tratamento de Ferimentos com Pressão Negativa , Pneumotórax/terapia , Enfisema Subcutâneo/terapia , Traqueia/lesões , Humanos , Enfisema Mediastínico/etiologia , Pescoço , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Vácuo
15.
Medicine (Baltimore) ; 99(18): e20175, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358406

RESUMO

RATIONALE: The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia. PATIENT CONCERNS: A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit. DIAGNOSES: Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall. INTERVENTIONS: The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment. OUTCOMES: At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department. LESSONS: COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.


Assuntos
Dor no Peito/etiologia , Infecções por Coronavirus/diagnóstico , Coronavirus , Cistos/diagnóstico por imagem , Dispneia/etiologia , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pulmão/patologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumotórax/patologia , Tórax
16.
Ned Tijdschr Geneeskd ; 1642020 May 07.
Artigo em Holandês | MEDLINE | ID: mdl-32395965

RESUMO

A 31-year-old non-smoking male patient admitted with and intubated for COVID-19 pneumonia experienced acute chest pain and dyspnea during his recovery period. He was diagnosed with a pneumothorax based on major bullae formation due to COVID-19. The bullae were not visible after extubation and developed rapidly within a few days.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Pneumotórax/diagnóstico , Adulto , Vesícula , Dor no Peito/diagnóstico , Infecções por Coronavirus/complicações , Dispneia/diagnóstico , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X
17.
Br J Anaesth ; 125(1): e28-e37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32312571

RESUMO

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Idoso , China , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Hipotensão/etiologia , Hipóxia/etiologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 99(15): e19656, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282716

RESUMO

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Punções/efeitos adversos , Idoso , Tubos Torácicos/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/instrumentação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/patologia , Pneumotórax/terapia , Punções/métodos , Estudos Retrospectivos , Sucção/efeitos adversos , Sucção/métodos , Tomografia Computadorizada por Raios X/métodos , Falha de Tratamento
20.
N Engl J Med ; 382(18): 1766, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32348651
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