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1.
J Cardiothorac Surg ; 15(1): 301, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028398

RESUMO

BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Pneumopericárdio/etiologia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumopericárdio/diagnóstico , Pneumotórax/diagnóstico , Pneumotórax/terapia , Radiografia Torácica , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios X
2.
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
3.
Respir Res ; 21(1): 236, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938445

RESUMO

BACKGROUND: Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia. METHODS: We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis. RESULTS: Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax. CONCLUSION: Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pneumotórax/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Evolução Fatal , Feminino , Interações Hospedeiro-Patógeno , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/diagnóstico , Pneumotórax/terapia , Pneumotórax/virologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Am J Trop Med Hyg ; 103(3): 1166-1169, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32662394

RESUMO

COVID-19 is a recent outbreak in China and rapidly spread worldwide. Lung consolidation is the most common radiologic finding of COVID-19 pneumonia. Pneumothorax has been rarely reported as a complication of severe COVID-19 pneumonia. Early recognition and management are detrimental to the outcome. We here report three cases of SARS-CoV-2 infection complicated by pneumothorax. In addition, we present a brief literature review.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/etiologia , Adulto , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumotórax/diagnóstico , Pneumotórax/terapia
5.
PLoS One ; 15(7): e0235624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634173

RESUMO

BACKGROUND: Spontaneous pneumothorax is a complication that occurs in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD); however, few studies on the clinical implications of pneumothorax for patients with CTD-ILD have been performed. OBJECTIVES: This study aimed to investigate the incidence and prognostic significance of pneumothorax and the risk factors for its onset in patients with CTD-ILD. METHODS: This study included 140 consecutive patients with CTD-ILD. Clinical characteristics, laboratory findings, pulmonary function test results, and chest high-resolution computed tomography (HRCT) images were retrospectively evaluated. RESULTS: A total of 18 patients (12.9%) developed pneumothorax during their clinical course. The cumulative incidence of pneumothorax from the time of CTD-ILD diagnosis was 6.5%, 8.7%, and 11.3% at 1, 3, and 5 years, respectively. The 10-year survival rate was significantly lower in patients with pneumothorax (29.6%) than that in those without pneumothorax (81.3%). The development of pneumothorax was significantly associated with poor prognosis (HR 22.0; p < 0.010). Furthermore, a lower body mass index, greater extent of reticular abnormalities on HRCT, and administration of methylprednisolone pulse therapy were significantly associated with the development of pneumothorax. CONCLUSION: Pneumothorax is a serious complication in the clinical course of patients with CTD-ILD and the onset of pneumothorax predicts a poor outcome.


Assuntos
Doenças do Tecido Conjuntivo/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Pneumotórax/diagnóstico , Idoso , Anti-Inflamatórios/uso terapêutico , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/tratamento farmacológico , Doenças do Tecido Conjuntivo/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pneumotórax/complicações , Pneumotórax/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Capacidade Vital
6.
Ned Tijdschr Geneeskd ; 1642020 May 07.
Artigo em Holandês | MEDLINE | ID: covidwho-250397

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
7.
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
11.
Artigo em Chinês | MEDLINE | ID: mdl-32062897

RESUMO

Objective: To explore the clinical features of pneumoconiosis complicated with spontaneous pneumothorax to improve the diagnosis and treatment of this disease. Methods: Analyze the clinical characteristics and treatment of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax in Hunan Prevention and Treatment Institute for Occupational Diseases from May 2016 to May 2018. Results: In 350 patients, 22 cases are pneumoconiosis stage I, accounting for 6.3%, 26 cases are pneumoconiosis stage Ⅱ, accounting for 7.4%, 302 cases were pneumoconiosis stage Ⅲ, accounting for 86.3%.168 cases were recurrent pneumothorax, the recurrence rate was as high as 48%.There were 232 cases occurred in winter and spring, accounting for 66.3%. Chronic obstructive pulmonary disease and pulmonary infection were 54.9% and 47.4%, respectively. 233 patients were treated with basic therapy such as high flow oxygen therapy, with an effective rate of 93.1%. 114 cases were treated with thoracic closed drainage, with an effective rate of 86%. Conclusion: Spontaneous pneumothorax is a common complication of pneumoconiosis with high recurrence rate. According to the different conditions to give different treatments in a timely manner can achieve better results.


Assuntos
Pneumoconiose/diagnóstico , Pneumotórax/diagnóstico , China , Humanos , Pneumoconiose/complicações , Pneumotórax/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Recidiva
12.
PLoS One ; 15(1): e0227518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923268

RESUMO

INTRODUCTION: Posttraumatic pneumothorax (PTX) is often overseen in anteroposterior chest X-ray. Chest sonography and Electrical Impedance Tomography (EIT) can both be used at the bedside and may provide complementary information. We evaluated the performance of EIT for diagnosing posttraumatic PTX in a pig model. METHODS: This study used images from an existing database of images acquired from 17 mechanically ventilated pigs, which had sustained standardized blunt chest trauma and had undergone repeated thoracic CT and EIT. 100 corresponding EIT/CT datasets were randomly chosen from the database and anonymized. Two independent and blinded observers analyzed the EIT data for presence and location of PTX. Analysis of the corresponding CTs by a radiologist served as reference. RESULTS: 87/100 cases had at least one PTX detected by CT. Fourty-two cases showed a PTX > 20% of the sternovertebral diameter (PTXtrans20), whereas 52/100 PTX showed a PTX>3 cm in the craniocaudal diameter (PTXcc3), with 20 cases showing both a PTXtranscc and a PTXcc3. We found a very low agreement between both EIT observers considering the classification overall PTX/noPTX (κ = 0.09, p = 0.183). For PTXtrans20, sensitivity was 59% for observer 1 and 17% for observer 2, with a specificity of 48% and 50%, respectively. For PTXcc3, observer 1 showed a sensitivity of 60% with a specificity of 51% while the sensitivity of observer 2 was 17%, with a specificity of 89%. By programming a semi-automatized detection algorithm, we significantly improved the detection rate of PTXcc3, with a sensitivity of 73% and a specificity of 70%. However, detection of PTXtranscc was not improved. CONCLUSION: In our analysis, visual interpretation of EIT without specific image processing or comparison with baseline data did not allow clinically useful diagnosis of posttraumatic PTX. Multimodal imaging approaches, technical improvements and image postprocessing algorithms might improve the performance of EIT for diagnosing PTX in the future.


Assuntos
Impedância Elétrica , Pneumotórax/diagnóstico , Traumatismos Torácicos/patologia , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Animais , Pneumotórax/etiologia , Pneumotórax/veterinária , Respiração Artificial , Suínos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/veterinária , Ultrassonografia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/veterinária
13.
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
14.
Int J Pediatr Otorhinolaryngol ; 131: 109885, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31981917

RESUMO

Subcutaneous emphysema is a rare complication of tonsillectomy.We report a case of post-tonsillectomy crepitus with radiographic extravasation of contrast from the tonsil fossa into the neck, subcutaneous emphysema, pneumomediastinum and small pneumothorax in a patient with Down Syndrome. Subsequent direct laryngoscopy showed no visible defect in the mucosal or muscle layers of the tonsil fossa. We explore common presenting symptoms, clinical course, and treatment of subcutaneous emphysema secondary to tonsillectomy.


Assuntos
Síndrome de Down/complicações , Enfisema Mediastínico/etiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Enfisema Subcutâneo/etiologia , Tonsilectomia/efeitos adversos , Pré-Escolar , Humanos , Laringoscopia , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Pescoço , Pneumotórax/diagnóstico , Pneumotórax/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/terapia
15.
Aerosp Med Hum Perform ; 91(2): 116-118, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31980052

RESUMO

Flower A. You're the flight surgeon: spontaneous pneumothorax. Aerosp Med Hum Perform. 2020; 91(2):116-118.


Assuntos
Aviação , Militares , Pilotos , Pneumotórax/diagnóstico , Medicina Aeroespacial , Diagnóstico Diferencial , Humanos , Masculino , Adulto Jovem
16.
Rev Mal Respir ; 37(1): 86-90, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31883816

RESUMO

INTRODUCTION: Because of its rarity and lack of specific symptoms, the diagnosis of Marfan's syndrome can be delayed. Though cardiovascular, skeletal and ophthalmological manifestations are the most frequent features, the respiratory system can also be involved. OBSERVATION: We report the case of a 35-year-old patient who presented with a large, right sided, encysted pyopneumothorax. The history revealed two episodes of spontaneous pneumothorax, cataract surgery ten years before his admission, and a similar case in the family. Clinical examination showed skeletal abnormalities of the wrist and thumb as well as deformity of the hindfoot with a flat foot. He had no characteristic thoracic deformity. Ophthalmologically, the right eye had a subluxed lens and the left eye had a totally subluxed cataract. CONCLUSION: The development of the third episode of pneumothorax led to the diagnosis of Marfan's syndrome thanks to the patient's combination of symptoms. To avoid diagnostic delay, criteria were established in 1996 and revised in 2010 to ensure an early diagnosis of this condition.


Assuntos
Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Recidiva
17.
Interact Cardiovasc Thorac Surg ; 30(3): 337-345, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858124

RESUMO

Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients. CLINICAL TRIAL REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.


Assuntos
Tubos Torácicos , Pleurodese/métodos , Pneumotórax/epidemiologia , Talco/farmacologia , Cirurgia Torácica Vídeoassistida/métodos , Saúde Global , Humanos , Incidência , Pneumotórax/diagnóstico , Pneumotórax/terapia
19.
Pan Afr Med J ; 33: 287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692942

RESUMO

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now.


Assuntos
Endometriose/diagnóstico , Pleurodese/métodos , Pneumotórax/diagnóstico , Adulto , Dor no Peito/etiologia , Drenagem/métodos , Feminino , Gana , Humanos , Menstruação/fisiologia , Pneumotórax/terapia
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