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1.
Kyobu Geka ; 74(4): 304-307, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-33831891

RESUMO

A 15-year-old boy who presented recurrent bilateral pneumothoraces after allogenic bone marrow transplantation for the treatment of myelodysplastic syndrome is presented. We performed bulla resection under the thoracoscopic surgery for three times. Pathological examination revealed irregular fibrous thickening of the visceral pleura and alveolar fibrosis, consistent with a diagnosis of pleuroparenchymal fibroelastosis (PPFE). Also the findings of bronchiolitis obliterans (BO) was noted and chronic graftversus-host disease( GVHD) was strongly suggested. Twenty-five months after the operation, bilateral living-donor lobar lung transplantation was performed and the diagnosis of GVHD was established.


Assuntos
Bronquiolite Obliterante , Doença Enxerto-Hospedeiro , Transplante de Pulmão , Pneumotórax , Adolescente , Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/complicações , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia
2.
Zentralbl Chir ; 146(1): 126-144, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33588508

RESUMO

A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.


Assuntos
Pneumopatias , Pneumotórax , Humanos , Pleura , Pneumotórax/etiologia , Pneumotórax/cirurgia , Recidiva , Cirurgia Torácica Vídeoassistida
3.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541955

RESUMO

A 46-year-old woman presented with a right pneumothorax at a regular medical examination during menstruation. The pneumothorax resolved without intervention; however, 6 months later, she was referred to our hospital due to chest pain and dyspnoea. A chest X-ray showed grade III pneumothorax and surgery was performed. During surgery, the patient was found to have pleural adhesions around the right upper lung, pores in the diaphragm and a blueberry spot in the pericardium. The margins of the upper lobe and diaphragm were covered with a polyglycolic acid sheet at the operation. Eight days after surgery, she was referred to our hospital again due to massive haemothorax. The reoperation suggested that the aforementioned blueberry spot in the pericardium was the source of bleeding. The spot was resected and shown to be oestrogen and progesterone receptor-positive, providing evidence of heterotopic endometriosis.


Assuntos
Endometriose/cirurgia , Hemotórax/cirurgia , Pericárdio/patologia , Pneumotórax/cirurgia , Reoperação , Dor no Peito/etiologia , Diafragma/cirurgia , Dispneia/etiologia , Feminino , Humanos , Menstruação , Pessoa de Meia-Idade , Doenças Pleurais/cirurgia , Recidiva
4.
Eur J Med Res ; 26(1): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557953

RESUMO

BACKGROUND: Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. CASE PRESENTATION: A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. CONCLUSION: This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.


Assuntos
Colo/patologia , Diafragma/lesões , Traumatismo Múltiplo/complicações , Pneumotórax/etiologia , Ciclismo , Colo/cirurgia , Diafragma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pneumotórax/cirurgia , Prolapso , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos Torácicos/etiologia
5.
J Cardiothorac Surg ; 15(1): 310, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046088

RESUMO

BACKGROUND: Spontaneous pneumothorax has been reported as a possibile complication of novel coronavirus associated pneumonia (COVID-19). We report two cases of COVID-19 patients who developed spontaeous and recurrent pneumothorax as a presenting symptom, treated with surgical procedure. An insight on pathological finding is given. CASE PRESENTATION: Two patients presented to our hospital with spontaneous pneumothorax associated with Sars-Cov2 infection onset. After initial conservative treatment with chest drain, both patients had a recurrence of pneumothorax during COVI-19 disease, contralateral (patient 1) or ipsilateral (patient 2) and therefore underwent lung surgery with thoracoscopy and bullectomy. Intraoperative findings of COVID-19 pneumonia were parenchymal atelectasis and vascular congestion. Lung tissue was very frail and prone to bleeding. Histological examination showed interstitial infiltration of lymphocytes and plasma cells, as seen in non specific interstitial pneumonia, together with myo-intimal thicknening of vessels with blood extravasation and microthrombi. CONCLUSIONS: Although rarely, COVID-19 may present with spontaneous pneumothorax. Lung surgery for pneumothorax in COVID-19 patients can be safely and effectively performed when necessary.


Assuntos
Betacoronavirus , Tubos Torácicos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/etiologia , Toracoscopia/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumotórax/diagnóstico , Pneumotórax/cirurgia , Radiografia Torácica , Recidiva , Tomografia Computadorizada por Raios X
6.
J Laparoendosc Adv Surg Tech A ; 30(8): 935-938, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32525726

RESUMO

Introduction: Thoracic surgery in children with coronavirus disease-19 (COVID-19) pulmonary disease is rare, as very limited virus-related lung lesions require intervention. However, some patients may suffer from other pulmonary abnormalities that can be worsened by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and they may consequently require lung surgery. COVID-19 affects the indications, surgical procedure, and postsurgical care of these patients. Background: We present a case of a 14-year-old girl with COVID-19 pulmonary disease and persistent air leak due to right apical bullae that required resection. Clinical, surgical, and safety implications are discussed. The role of thoracic minimally invasive surgery under COVID-19 conditions is also analyzed. Materials and Methods: The thoracoscopic procedure was scheduled earlier than normally expected. The surgery was performed in a COVID-19 reserved theatre with neutral pressure and only the necessary personnel was allowed inside. The use of the required personal protective equipment was supervised by an expert nurse before and after the intervention. Results: The surgeons used a three-port technique to resect the bullae with an endostapler and no mechanical pleural abrasion was added to the procedure. Electrocautery and CO2 insufflation were avoided, and a chest drain with a closed-circuit aspiration system was installed before removing the ports. The child was discharged home 3 days later after the removal of the chest drain. Conclusions: COVID-19 has an impact on the standard indications, surgical strategies and postoperative care of some conditions requiring intervention. Extra safety measures are needed in the operating room to limit the chance of transmission. Minimally invasive surgery for thoracic surgery remains safe if the current safety guidelines are followed closely.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/cirurgia , Toracoscopia/métodos , Adolescente , Feminino , Humanos , Pandemias , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologia , Tomografia Computadorizada por Raios X
7.
Ann Thorac Surg ; 110(5): e413-e415, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32353441

RESUMO

Several studies have been published describing the clinical and radiographic findings of coronavirus disease 2019-related pneumonia. Therefore, there is currently a lack of pathologic data on its effects in intubated patients. Pneumothorax may occur rarely and results from a combination of fibrotic parenchyma and prolonged high-pressure ventilation. Chest drainage represents first-line treatment. However, in cases of persistent pneumothorax, thoracoscopy and bleb resection may be feasible options to reduce air leak and improve ventilation. This report describes the cases of 2 patients with coronavirus disease 2019 who were successfully treated with thoracoscopy, bleb resection, and pleurectomy for persistent pneumothorax.


Assuntos
Betacoronavirus , Tubos Torácicos , Infecções por Coronavirus/complicações , Pleura/cirurgia , Pleurodese/métodos , Pneumonia Viral/complicações , Pneumotórax/cirurgia , Toracoscopia/métodos , Idoso , Infecções por Coronavirus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 99(16): e19704, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311952

RESUMO

General anesthesia with double-lumen endobronchial intubation is considered mandatory for thoracoscopic bullectomy. We assessed the safety and feasibility of thoracoscopic bullectomy for treatment of primary spontaneous pneumothorax (PSP) under intubating laryngeal mask airway (ILMA) with spontaneous breathing sevoflurane anesthesia combined with thoracic paravertebral block (TPB).From January 2018 to December 2018, some 34 consecutive patients with PSP were treated by thoracoscopic bullectomy under ILMA with spontaneous breathing sevoflurane anesthesia combined with TPB (study group). To evaluate the safety and feasibility of this new technique, these patients were compared with the control group consisting of 34 consecutive patients with PSP who underwent thoracoscopic bullectomy using tracheal intubation with controlled ventilation from January 2017 to December 2017. The demographic characteristics, intraoperative surgical and anesthetic results, and postoperative results were assessed.The 2 groups had comparable anesthetic time, operation time, chest drainage time, postoperative hospital stays, and hospitalization cost. Visual analogue score (VAS) scores at 3 hours at rest and at coughing were significantly lower in the study group than in the control group (mean, 0.9 vs 2.0 and 1.8 vs 4.0, P = .024 and P = .006, respectively). No differences were seen in PaO2 values between the 2 groups in the intraoperative stage and postoperative stage (P > .05, respectively). The pH value was significantly lower in the intraoperative stage (mean, 7.28 vs 7.40, P = .01) and higher in the postoperative stage (mean, 7.35 vs 7.33, P = .014) in the study group than in the control group. The PaCO2 value was significantly higher in the intraoperative stage in the study group than in the control group (mean, 57.0 mm Hg vs 42.0 mm Hg, P = .015). In the study group, no cough reflex was found, and the level of collapse of the operative lung was excellent in 31 cases and good in 3 cases.Our study demonstrated that thoracoscopic bullectomy for treatment of PSP can be safely and feasibly performed in highly selected patients under ILMA with spontaneous breathing sevoflurane anesthesia combined with TPB.


Assuntos
Intubação Intratraqueal , Pneumotórax/cirurgia , Respiração Artificial , Toracoscopia , Anestésicos Inalatórios/uso terapêutico , Estudos de Viabilidade , Feminino , Humanos , Intubação Intratraqueal/métodos , Pulmão/cirurgia , Masculino , Bloqueio Nervoso , Segurança do Paciente , Respiração Artificial/métodos , Sevoflurano/uso terapêutico , Toracoscopia/métodos , Resultado do Tratamento , Adulto Jovem
10.
Pneumologie ; 74(4): 217-221, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32274780

RESUMO

CPAP is the most common treatment for obstructive sleep apnea.Serious complications from this treatment are very rare. Pneumothorax following lung barotrauma under CPAP therapy has been described in case reports only in patients with pre-existing lung and thoracic diseases.A 68-year-old sleep apnea patient without pre-existing lung or thoracic diseases and with established CPAP therapy since many years was admitted to the hospital after a severe thoracic pain event with persistent shortness of breath. Chest radiograph and computed tomography showed an extensive right-sided pneumothorax with basal bullous emphysema. After surgical treatment of the secondary spontaneous pneumothorax, on the third postoperative day CPAP with reduced pressure was re-introduced with satisfactory sleep apnea findings and without pneumothorax recurrence.As possible cause of pneumothorax in the patient, alveolar inflammatory changes due to over-distention and increased pressure in the alveoli was assumed, which can occur after years of CPAP treatment with gradual pressure increase.In summary, in sleep apnea patients treated with CPAP for years, after sudden onset of thoracic pain and shortness of breath possible spontaneous pneumothorax should be considered.


Assuntos
Pneumotórax/etiologia , Respiração com Pressão Positiva/métodos , Enfisema Pulmonar/complicações , Enfisema Pulmonar/cirurgia , Síndromes da Apneia do Sono/terapia , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Masculino , Oxigênio/sangue , Pneumotórax/cirurgia , Respiração com Pressão Positiva/efeitos adversos , Apneia Obstrutiva do Sono , Toracoscopia
11.
J Vis Exp ; (157)2020 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-32225145

RESUMO

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.


Assuntos
Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Toracentese/métodos , Ultrassonografia/métodos , Consenso , Feminino , Humanos , Recém-Nascido , Masculino
12.
PLoS One ; 15(3): e0230419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226050

RESUMO

BACKGROUND: The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. METHODS AND FINDINGS: We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. CONCLUSIONS: Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.


Assuntos
Vesícula/fisiopatologia , Fumar Maconha/efeitos adversos , Pneumotórax/fisiopatologia , Fumar Tabaco/efeitos adversos , Adulto , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Cannabis/efeitos adversos , Feminino , Alucinógenos/efeitos adversos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/fisiopatologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/cirurgia , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Índice de Gravidade de Doença , Fumantes , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Ann Thorac Surg ; 110(3): e209-e211, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32097627

RESUMO

A 41-year-old woman was admitted with a recurrent pneumothorax coincident with menstruation 2 months after a first occurrence. Video-assisted thoracic surgery was performed for definitive diagnosis and pneumothorax treatment. Bluish diaphragmatic spots and three lung bullae were noted. A lung fistula was observed in one of the bullae, and the diaphragmatic lesion and bullae were resected. The bulla with air leakage and the diaphragmatic lesion were diagnosed as endometrial tissue by pathology. This case is rare as a fistula from a bulla with endometriosis was identified intraoperatively, suggesting the check-valve mechanism might be one of the etiologies of catamenial pneumothorax.


Assuntos
Pneumotórax/diagnóstico , Pneumotórax/cirurgia , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Endometriose/complicações , Endometriose/patologia , Feminino , Humanos
16.
J Surg Res ; 250: 135-142, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32044510

RESUMO

BACKGROUND: Few studies have analyzed pediatric spontaneous pneumothorax (SPTX) nationally. We sought to better define this patient population and explore the evolution of surgical management. METHODS: Patients (10-20 y old) with an International Classification of Diseases, Ninth Revision diagnosis of SPTX were identified within the Kids' Inpatient Database for the years 2006, 2009, and 2012. Diagnoses and procedures were analyzed by International Classification of Diseases, Ninth Revision codes. National estimates were obtained using case weighting. RESULTS: There were 11,792 pediatric SPTX hospitalizations, and patients were predominantly male (84.0%), non-Hispanic white (69.0%), with a mean age of 17.2 y (95% confidence interval, 17.2-17.3). Overall, 52.5% underwent tube thoracostomy as the primary intervention, and more than one-third had a major surgical procedure (34.9%). From 2006 to 2012, there was an increase in bleb excisions from 81.1% to 86.9% and an increase in mechanical pleurodesis from 64.2% to 69.0%. There was a significant change from a predominantly open thoracotomy approach in 2006 (76.1%) to a video-assisted thoracoscopic approach in 2012 (89.3%). CONCLUSIONS: Pediatric admission for SPTX results in tube thoracostomy in more than half of the cases and surgery in approximately one-third of the cases. Surgical intervention has changed to a more minimally invasive approach during the last decade, and counseling to patients and their families should reflect these updated management strategies. LEVEL OF EVIDENCE: III.


Assuntos
Pleurodese/tendências , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/tendências , Toracostomia/tendências , Adolescente , Fatores Etários , Tubos Torácicos , Criança , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pleurodese/estatística & dados numéricos , Pneumotórax/epidemiologia , Fatores Sexuais , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracostomia/instrumentação , Toracostomia/estatística & dados numéricos , Adulto Jovem
19.
J Cardiothorac Surg ; 15(1): 8, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915025

RESUMO

BACKGROUND: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. CASE PRESENTATION: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. CONCLUSIONS: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.


Assuntos
Embolização Terapêutica , Hematoma/etiologia , Hematoma/terapia , Pneumotórax/cirurgia , Artéria Subclávia , Aderências Teciduais/complicações , Idoso , Angiografia , Circulação Colateral , Hematoma/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
20.
Pediatr Surg Int ; 36(3): 383-389, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31993738

RESUMO

BACKGROUND: The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. METHODS: We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. RESULTS: 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). CONCLUSION: This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.


Assuntos
Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Feminino , Humanos , Masculino , Pneumotórax/diagnóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco
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