DOCSLIB.ORG

Empyema Necessitans and a Persistent Air Leak Associated with Rupture of an Anaerobic Lung Abscess Due to Bacteroides Varun Sharma,1 Kevin G Blyth1,2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Empyema Necessitans and a Persistent Air Leak Associated with Rupture of an Anaerobic Lung Abscess Due to Bacteroides Varun Sharma,1 Kevin G Blyth1,2 Thorax Online First, published on August 28, 2017 as 10.1136/thoraxjnl-2017-210462 Chest clinic Thorax: first published as 10.1136/thoraxjnl-2017-210462 on 28 August 2017. Downloaded from CASE BASED DISCUSSIONS Empyema necessitans and a persistent air leak associated with rupture of an anaerobic lung abscess due to bacteroides Varun Sharma,1 Kevin G Blyth1,2 INTRODUCTION a small left apical pneumothorax. A further repeat Here we report an unusual case of ruptured physical examination (6–8 hours post-admission) 1Pleural Disease Unit, Queen lung abscess, complicated by both a persistent air revealed classical features of subcutaneous emphy- Elizabeth University Hospital, leak and empyema necessitans. This combination sema, which had been absent on admission. Oxygen Glasgow, UK of problems, in a patient with significant co-mor- requirements increased to 60% and the patient was 2Institute of Infection, Immunity & Inflammation, University of bidities presented major diagnostic difficulties and transferred to the Medical High Dependency Unit Glasgow, Glasgow, UK challenging pleural intervention issues . The case (MHDU). Her antibiotics were changed to intrave- based discussion presented also highlights a number nous co-amoxiclav and oral clindamycin. A more Correspondence to of important learning points that can be generalised comprehensive skin examination revealed multiple Dr Varun Sharma, Department to the assessment and management of patients with tender, inflamed skin lesions in the axillae and on of Respiratory Medicine, Queen severe pleuro-pulmonary infections, including the the lateral aspects of the chest wall bilaterally, many Elizabeth University Hospital, 1345 Govan Road, Glasgow minority associated with an acute air-leak. of which were concealed beneath folds of adipose G51 4TF, UK; vsharma3@ nhs. tissue. CT scanning of thorax and abdomen was net requested and a surgical opinion. The differential CASE BASED DISCUSSIONS diagnosis at this time was recorded as Boerhaave’s Received 1 May 2017 Varun Sharma (VS): A morbidly obese (120 kg, body Revised 15 July 2017 syndrome, pneumonia or necrotising fasciitis Accepted 7 August 2017 mass index 49) 43-year-old female presented to secondary to HS complicated by a pleurocutaneous the Queen Elizabeth University Hospital Glasgow, fistula. obtunded and in acute respiratory distress. She Kevin G Blyth (KGB): The clinical presentation had been bed or chairbound for 2 years due to is most consistent with acute bacterial pneumonia chronic pain, primarily related to severe hidrade- with increasing oxygen requirements related to nitis suppurativa (HS). Other past medical history this. However, the development of rapidly evolving included poorly controlled Insulin-dependent type subcutaneous emphysema is highly concerning and Chest clinic http://thorax.bmj.com/ 2 diabetes mellitus (glycated haemoglobin (HbA1c) must indicate rupture of a gas-containing structure level 107 mmol/mol on admission), asthma and in the thorax. Transfer to MHDU is entirely appro- non-alcoholic fatty liver disease. She reported a priate and should include an early discussion with cough productive of large volumes of purulent, the patient, her family and critical care colleagues foul-smelling sputum and severe pain, particularly regarding the ceiling of care given her extensive localised to the axillae and lateral chest walls. The comorbidities and poor functional status. Boer- patient was tachycardic (147 bpm), tachypnoeic haave’s syndrome was first reported in 1724 and and hypoxic. Oxygen saturations were recorded describes acute, spontaneous, oesophageal rupture. on September 24, 2021 by guest. Protected copyright. at 85% on air. Examination revealed accessory The term ‘spontaneous’ differentiates Boerhaave’s muscle use, reduced air entry, dullness to percus- from iatrogenic oesophageal rupture, which sion and bronchial breathing at the right lung base. accounts for 85%–90% of cases and both are asso- The patient did not tolerate a full skin examination ciated with high mortality.1 However, Boerhaave’s due to pain, and reported multiple drug allergies, syndrome typically includes a history of significant including suxamethonium and metronidazole, prior vomiting. In addition, the majority of adults but no penicillin allergy. Treatment for probable with Boerhaave’s present with left-sided pleuropul- community-acquired pneumonia was initiated monary complications,1 including (hydro-) pneu- (intravenous amoxicillin and oral clarithromycin) mothorax, pneumomediastinum, subcutaneous pending chest radiography. Initial laboratory inves- emphysema and pneumonia. The current case is not tigations revealed a C reactive protein level over typical of Boerhaave’s, since the clinical findings 300 mg/L and marked hypoalbuminaemia (14 g/L). appear bilateral and predominantly right sided, and Over the next few hours, the patient reported facial there is no history of prior vomiting. Necrotising swelling. On repeat clinical assessment, no stridor fasciitis complicating HS appears very unlikely, or airway compromise was noted. Antibiotic allergy given the absence of any skin defects associated was suspected, and intravenous hydrocortisone and with a visible or audible air leak. chlorphenamine were administered. However, her VS: CT imaging reported right lower lobe To cite: Sharma V, Blyth KG. Thorax Published Online First: facial swelling worsened and a chest radiograph, consolidation, an adjacent right hydropneu- [please include Day Month acquisition of which has been delayed, revealed mothorax and a left apical pneumothorax (see Year]. doi:10.1136/ significant subcutaneous emphysema, right-sided figure 1A). The upper lobe of the right lung was thoraxjnl-2017-210462 pleural effusion, right lower zone consolidation and fully inflated. Extensive subcutaneous emphysema Sharma V, Blyth KG. Thorax 2017;0:1–3. doi:10.1136/thoraxjnl-2017-210462 1 Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd (& BTS) under licence. Chest clinic Thorax: first published as 10.1136/thoraxjnl-2017-210462 on 28 August 2017. Downloaded from Chest clinic http://thorax.bmj.com/ on September 24, 2021 by guest. Protected copyright. Figure 1 CT images (lung settings (A), mediastinal settings (B) acquired in a female patient with empyema necessitans (EN) and a persistent air leak related to a ruptured right lower lobe lung abscess. Extensive subcutaneous emphysema is highlighted in panel A (white asterix), which also shows right lower lobe lung consolidation (black arrow), an adjacent hydropneumothorax, a small left pneumothorax and a pneumomediastinum. Panel B shows a defect in the parietal pleura and subpleural tissues (white arrow), resulting in discharge of infected pleural fluid into the subcutaneous tissues (EN, white asterix). was confirmed on both sides of the chest, extending into the bubbling, and no significant volume of pleural fluid had been neck and associated with pneumomediastinum. A gastrograffin drained. The two recent CT scans were reviewed. The second swallow 24 hours after MHDU admission failed to identity an CT (acquired during left-sided drain insertion) revealed an unre- oesophageal leak, making Boerhaave’s syndrome unlikely. With ported new defect in the lateral surface of the parietal pleura and the diagnosis uncertain and the patient’s subcutaneous emphy- a modest increase in the size of the right effusion (see figure 1b). sema worsening, a left apical 12F intercostal drain (ICD) was A diagnosis of empyema necessitans (EN) was made, likely asso- sited under CT guidance on day 3 of the admission. A referral ciated with a ruptured right lower lobe lung abscess. Incidentally, was made to the pleural disease team on day 4. a risk factor supporting this is the patient’s poor diabetic control. KGB: At first review on day 4, the patient was tachypnoeic Given the declining clinical situation, immediate insertion of and in pain, despite strong opiate analgesia. Intravenous sedation a large bore ICD was deemed necessary for air-leak control. was being used for distress related to expanding subcutaneous However, the patient’s body habitus, the extent of her HS and emphysema, which was now precluding eye-opening and verbal subcutaenous emphysema suggested that this would be techni- communication. Oxygen saturations were 94% on a non-re- cally challenging, and would require additional sedation. The breathing trauma mask. The left-sided ICD was swinging but not risks associated with this were explained to the patient and her 2 Sharma V, Blyth KG. Thorax 2017;0:1–3. doi:10.1136/thoraxjnl-2017-210462 Chest clinic Thorax: first published as 10.1136/thoraxjnl-2017-210462 on 28 August 2017. Downloaded from husband, who provided informed written consent. Intensive care considered in patients presenting late with severe pulmonary or agreed to admit the patient if her respiratory function deterio- pleural infection, particularly if severe chest pain is reported. rated further during large bore drain insertion. The patient was Second, earlier review by a respiratory specialist with experi- placed into the left lateral decubitus position and sedated using ence in complex pleural disease may have led to a less fraught bolused intravenous midazolam (13 mg in total over 50 min). definitive drainage procedure than was ultimately necessary. After extensive blunt dissection, the parietal pleura was eventu- Specifically, an early although technically challenging diagnostic ally opened and a 24F ICD placed to the right apex.
Load more

Recommended publications
  • Imaging: Results and Hospital Course: • Patient Initially Presented to RMH on 8/20/2019
    Introduction / HPI: Imaging: Results and Hospital Course: • Patient initially presented to RMH on 8/20/2019. He was treated for RLE 27 yo male with past medical history of IVDA presented to cellulitis with a washout; as well as, IV Cefazolin for MSSA + Blood Roxborough Memorial Hospital (RMH) with right leg swelling for 5 cultures. Blood cultures remained positive x4; spurring a TTE, which was days and shortness of breath. The patient stated that 5 days prior he negative for vegetations. CXR preformed demonstrated concern for septic was using heroin and injecting the needle into his right medial foot. He embolic, spurring a Chest CT with reported finding of said that the following day he noticed a blister forming and sliced it hydropneumothorax. Patient was transferred to TJUH on 8/28 for the with a knife that he cleaned with soap and water. The next day he possibility of needing cardiothoracic surgery capabilities. noticed swelling of his foot with progressing redness and pain traveling up his leg to his knee. He described the pain as a 5 out of 10 when at • He was admitted to the TJUH SICU. Subsequently the patient had rest and a 7 out of 10 when walking on it. He stated that he has been multiple episodes of bloody BM’s and his Hgb dropped to 6.9. He taking 1 tablet of Motrin per day for last 3 days with minimal received 2 units pRBC’s with appropriate hemodynamic response. GI was relief. He endorsed shortness of breath when at rest and exertion, chest consulted, whom preformed an EGD and colonoscopy on 9/9.
    [Show full text]
  • Malignant Pleural Mesothelioma Presenting with a Spontaneous
    Rev Port Pneumol. 2012;18(2):93—95 www.revportpneumol.org CASE REPORT Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: A report of 2 cases a a a,b,∗ H.Z. Saleh , E. Fontaine , H. Elsayed a Cardiothoracic Department, Liverpool Heart and Chest Hospital, Liverpool, UK b Thoracic Surgery Department, Ain Shams University, Cairo, Egypt Received 10 February 2011; accepted 26 April 2011 KEYWORDS Abstract Malignant pleural mesothelioma (MPM) originates in the mesothelial cells that line Mesothelioma and the pleural cavities. Most patients initially experience the insidious onset of chest pain or hydropneumothorax; shortness of breath and have a history of asbestos exposure. It rarely presents as spontaneous Challenging diagnosis pneumothorax. We report here two cases where malignant pleural mesothelioma presented with a spontaneous hydropneumothorax and was only discovered following surgery. We emphasise the need for a chest CT-scan preoperatively in older patients presenting with a secondary pneumo/hydropneumothorax. © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVE O Mesotelioma Pleural Maligno apresentando-seapresenta-se com um hidropneumotórax espontâneo: descrição de 2 casos Mesotelioma e Um relatório sobre 2 casos hidropneumotórax; Diagnóstico Resumo O Mesotelioma Pleural Maligno (MPM) tem origem nas células mesoteliais que desafiante revestem as cavidades pleurais.da pleura. A maioria dos pacientes sente, inicialmente, uma dor torácica insidiosa ou dispneia e tem umumahistorial história de exposic¸ão a abestos. Raramente apresenta-se como um pneumotórax espontâneo.DescrevemosRegistamos dois casos em que o mesotelioma pleural maligno se apresentou com um hidropneumotórax espontâneo e só foi descoberto após a cirurgia.
    [Show full text]
  • Cerebral Air Embolism After Indwelling Pleural Catheter Insertion in A
    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-244006 on 29 July 2021. Downloaded from Cerebral air embolism after indwelling pleural catheter insertion in a chronic hydropneumothorax secondary to epithelioid mesothelioma Dissanayake Mudiyanselage Chanaka Jayawardena , Rakesh K Panchal, Sanjay Agrawal, Indrajeet Das Respiratory Medicine, Glenfield SUMMARY The patient was Eastern Cooperative Oncology Hospital, Leicester, UK A 75- year- old man with a history of epithelioid Group performance status 0 and was under the mesothelioma and a right-sided indwelling pleural ambulatory pleural service but managed his pleural Correspondence to catheter (IPC) presented with a history of a purulent fluid collections independently in the community. The Dr Dissanayake Mudiyanselage Chanaka Jayawardena; drainage via the IPC. The pleural fluid cultured Klebsiella IPC had been inserted 3½ years ago for a right- Chanj858@ gmail. com oxytoca and Enterococcus faecalis. He was treated with sided loculated hydropneumothorax that had a course of oral fluoroquinolone followed by uneventful developed after a radical extended pleurectomy, Accepted 13 July 2021 IPC replacement. One and half hours postprocedure, decortication and diaphragmatic patch surgery for the patient had a witnessed drop in conscious level mesothelioma. The rationale for the IPC was recur- accompanied by seizure like activity. Acute stroke was rent effusions and associated infections requiring suspected and a CT head was performed. CT head repeat chest drains in the area of the postoperative revealed multiple serpiginous pockets of air along the hydropneumothorax. cerebral fissure, with features that were highly suggestive The patient was asymptomatic and apyrexial. of cerebral air embolism and multiple wedge-shaped The pleural fluid cultured Klebsiella oxytoca and areas of infarction involving the cerebral hemispheres.
    [Show full text]
  • Supermicar Data Entry Instructions, 2007 363 Pp. Pdf Icon[PDF
    SUPERMICAR TABLE OF CONTENTS Chapter I - Introduction to SuperMICAR ........................................... 1 A. History and Background .............................................. 1 Chapter II – The Death Certificate ..................................................... 3 Exercise 1 – Reading Death Certificate ........................... 7 Chapter III Basic Data Entry Instructions ....................................... 12 A. Creating a SuperMICAR File ....................................... 14 B. Entering and Saving Certificate Data........................... 18 C. Adding Certificates using SuperMICAR....................... 19 1. Opening a file........................................................ 19 2. Certificate.............................................................. 19 3. Sex........................................................................ 20 4. Date of Death........................................................ 20 5. Age: Number of Units ........................................... 20 6. Age: Unit............................................................... 20 7. Part I, Cause of Death .......................................... 21 8. Duration ................................................................ 22 9. Part II, Cause of Death ......................................... 22 10. Was Autopsy Performed....................................... 23 11. Were Autopsy Findings Available ......................... 23 12. Tobacco................................................................ 24 13. Pregnancy............................................................
    [Show full text]
  • Pneumothorax Following Thoracentesis a Systematic Review and Meta-Analysis
    REVIEW ARTICLE Pneumothorax Following Thoracentesis A Systematic Review and Meta-analysis Craig E. Gordon, MD, MS; David Feller-Kopman, MD; Ethan M. Balk, MD, MPH; Gerald W. Smetana, MD Background: Little is known about the factors related to but this was nonsignificant within studies directly com- the development of pneumothorax following thoracente- paring this factor (OR, 0.7; 95% CI, 0.2-2.3). Pneumotho- sis. We aimed to determine the mean pneumothorax rate rax was more likely following therapeutic thoracentesis (OR, following thoracentesis and to identify risk factors for pneu- 2.6; 95% CI, 1.8-3.8), in conjunction with periprocedural mothorax through a systematic review and meta-analysis. symptoms (OR, 26.6; 95% CI, 2.7-262.5), and in associa- tion with, although nonsignificantly, mechanical ventila- Methods: We reviewed MEDLINE-indexed studies from tion (OR, 4.0; 95% CI, 0.95-16.8). Two or more needle January 1, 1966, through April 1, 2009, and included stud- passes conferred a nonsignificant increased risk of pneu- ies of any design with at least 10 patients that reported mothorax (OR, 2.5; 95% CI, 0.3-20.1). the pneumothorax rate following thoracentesis. Two in- vestigators independently extracted data on the pneu- Conclusions: Iatrogenic pneumothorax is a common mothorax rate, risk factors for pneumothorax, and study complication of thoracentesis and frequently requires methodological quality. chest tube insertion. Real-time ultrasonography use is a modifiable factor that reduces the pneumothorax rate. Results: Twenty-four studies reported pneumothorax rates Performance of thoracentesis for therapeutic purposes and following 6605 thoracenteses. The overall pneumothorax in patients undergoing mechanical ventilation confers a rate was 6.0% (95% confidence interval [CI], 4.6%-7.8%), higher likelihood of pneumothorax.
    [Show full text]
  • Risk Factors and Treatment of Pneumothorax Secondary to Granulomatosis with Polyangiitis: a Clinical Analysis of 25 Cases Xuhua Shi, Yongfeng Zhang and Yuewu Lu*
    Shi et al. Journal of Cardiothoracic Surgery (2018) 13:7 DOI 10.1186/s13019-018-0695-8 REVIEW Open Access Risk factors and treatment of pneumothorax secondary to granulomatosis with polyangiitis: a clinical analysis of 25 cases Xuhua Shi, Yongfeng Zhang and Yuewu Lu* Abstract Objectives: To investigate the risk factors and treatment strategies for pneumothorax secondary to granulomatosis with polyangiitis (GPA). Method: Retrospective analysis of cases with pneumothorax secondary to GPA from our own practice and published on literature. Results: A total of 25 patients, 18 males and 7 females, mean age 44 ± 15.7 years, were analyzed. Diagnosis included pneumothorax (11 cases), hydropneumothorax (n = 5), empyema (n = 8) and hemopneumothorax (n = 1). 88% (22/25) patients showed single/multiple pulmonary/ subpleural nodules with/without cavitation on chest imaging. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Corticosteroids and immunosuppressive agents were used in 16 cases. Five cases received steroid pulse therapy, of which 4 patients survived. Pleural drainage was effective in some patients. Seven patients underwent surgical operations. In the 10 fatal cases, infection and respiratory failure were the most common cause. Lung biopsy/ autopsy showed lung/pleural necrotizing granulomatous vasculitis, breaking into the chest cavity, pleural fibrosis, bronchial pleural fistula, etc. The mean age in the death group was greater than the survival group (53 ± 12.9 years vs 40.1 ± 14.7 years, p = 0.05), the ineffective pleural drainage was also higher in the death group (5/5 vs 0/7, p =0.01). Conclusions: Pneumothorax was seen in the active GPA, due to a variety of reasons, and gave rise to high fatality rate.
    [Show full text]
  • Advanced Medical Interventions in Pleural Disease
    SERIES PLEURAL DISEASES Advanced medical interventions in pleural disease Rahul Bhatnagar1,9, John P. Corcoran2,3,9, Fabien Maldonado4, David Feller-Kopman5, Julius Janssen6, Philippe Astoul7 and Najib M. Rahman2,3,8 Number 2 in the Series “Pleural Diseases” Edited by Najib Rahman and Ioannis Psallidas Affiliations: 1Academic Respiratory Unit, University of Bristol, Bristol, UK. 2Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK. 3University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK. 4Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA. 5Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, MD, USA. 6Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. 7Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France. 8NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. 9These authors contributed equally. Correspondence: John P. Corcoran, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, OX3 7LE, UK. E-mail: [email protected] ABSTRACT The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy.
    [Show full text]
  • Case Report Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient
    Hindawi Case Reports in Critical Care Volume 2020, Article ID 8896923, 6 pages https://doi.org/10.1155/2020/8896923 Case Report Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient Lucas Rehnberg ,1 Robert Chambers,1 Selina Lam,2 Martin Chamberlain,3 and Ahilanandan Dushianthan1 1General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UK 2Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UK 3Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UK Correspondence should be addressed to Lucas Rehnberg; [email protected] Received 22 July 2020; Revised 6 August 2020; Accepted 3 September 2020; Published 19 September 2020 Academic Editor: Kenneth S. Waxman Copyright © 2020 Lucas Rehnberg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We present this case of a young woman with SARS-CoV-2 viral infection resulting in coronavirus 2019 (COVID-19) lung disease complicated by a complex hydropneumothorax, recurrent pneumothorax, and pneumatoceles. A 33-year-old woman presented to the hospital with a one-week history of cough, shortness of breath, and myalgia, with no other significant past medical history. She tested positive for COVID-19 and subsequently, her respiratory function rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. She had severe hypoxic respiratory failure requiring a protracted period on the mechanical ventilator with different ventilation strategies and multiple cycles of prone positioning.
    [Show full text]
  • Ambulatory Treatment in the Management of Pneumothorax: a Systematic Review of the Literature Fraser John H Brims,1,2 Nick a Maskell3
    Thorax Online First, published on March 20, 2013 as 10.1136/thoraxjnl-2012-202875 Pleural disease ORIGINAL ARTICLE Thorax: first published as 10.1136/thoraxjnl-2012-202875 on 20 March 2013. Downloaded from Ambulatory treatment in the management of pneumothorax: a systematic review of the literature Fraser John H Brims,1,2 Nick A Maskell3 ▸ Additional material is ABSTRACT published online only. To view Introduction Spontaneous pneumothorax (SP) is Key messages please visit the journal online (http://dx.doi.org/10.1136/ broken down into primary (PSP: no known underlying thoraxjnl-2012-202875). lung disease), secondary (SSP: known lung disease) and from trauma or iatrogenic pneumothorax (IP). Current 1Respiratory Department, Sir What is the key question? Charles Gairdner Hospital, treatments include a conservative approach, needle ▸ Controversy exists with the optimal Perth, Western Australia, aspiration, chest drain, suction and surgery. A Heimlich management of pneumothorax, and Heimlich Australia valve (HV) is a lightweight one-way valve designed for 2 valves (HV) with an intercostal catheter may Division of Surgery and the ambulatory treatment of pneumothorax (with an offer an alternative to current conventional Interventional Sciences, University College London, intercostal catheter). therapy. We performed a systematic review to London, UK Methods We performed a systematic review across nine examine the existing data for effectiveness and 3Academic Respiratory Unit, electronic databases for studies reporting the use of HV for safety for the use of HV in spontaneous and School of Clinical Sciences, adults with pneumothorax. Randomised controlled trials iatrogenic pneumothorax. University of Bristol, Bristol, UK (RCT), case control studies and case series were included, unrestricted by year of publication.
    [Show full text]
  • Unusual Initial Presentation of ABPA As
    PRACACLINICAL ORYGINALNA VIGNETTES Unusual initial presentation of ABPA as hydropneumothorax Juvva Kishan Srikanth, Nitesh Gupta, Sumita Agrawal, Shibdas Chakrabarti, Pranav Ish Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjung Hospital, New Delhi, India A 48-year-old female with bronchial asthma presented with right-sided pleuritic chest pain since 20 days followed by cough with expectoration and shortness of breath since 15 days. She was not compliant with her asthma medications. On examination, the patient was febrile with tachycardia, tachypnea, hypotension and room air saturation of 85%. Respiratory system examination revealed tracheal deviation to the left, reduced chest expansion and decreased breath sounds in the entire right hemithorax and the presence of succussion splash. Chest X-ray PA view showed right hydropneumothorax. High-resolution computed tomography (HRCT) scan of the thorax demonstrated right-sided loculated hydropneumothorax with collapse of the underlying lung (Figure 1A). Intercostal drainage (ICD) tube insertion was performed and the pleural fluid aspirate showed exudative, lymphocytic fluid with low ADA. The patient was initiated on broad-spectrum antibiotic therapy. Follow-up HRCT scan demonstrated complete resolution of hydropneumothorax, and ICD tube was removed. Also, the presence of underlying bronchiectasis (varicose type) was documented on the right side (Figure 1B). On further evaluation the patient was found to have peripheral eosinophilia (A.E.C. = 3800/µL). The Af-IgE (0.58 kU/L), total IgE (2157 IU/mL) and Af-IgG (141 mgA/L) were positive; thereby confirming allergic bron- chopulmonary aspergillosis (ABPA) as per ISHAM criteria [1]. Alternative etiologies of hydropneumothorax were ruled out by negative sputum and pleural fluid analysis for tubercular, bacterial and fungal cultures.
    [Show full text]
  • JOURNAL Previously Revista Portuguesa De Pneumologia
    JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 ISSN 2531-0429 www.journalpulmonology.org Portada_25_3.indd 1 29/10/19 14:56 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org Volume 25. Especial Congresso 3. Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 Contents Oral communications . 1 Commented posters . 45 Exposed posters . 122 00 Sumario 25-3.indd 1 29/10/19 14:58 Pulmonol. 2019;25(Esp Cong 3):1-44 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org ORAL COMMUNICATIONS 35th Congress of Pulmonology Praia da Falésia – Centro de Congressos Epic Sana Algarve, 7th‑9th November 2019 CO 001. NONSPECIFIC VENTILATORY PATTERN: Conclusions: Interpretation of PFT using fixed percentages may EVALUATION BY FIXED PERCENTAGES VERSUS LIMITS lead to an overvaluation of functional changes, particularly in fe- OF NORMALITY male gender and older ages. This work attests the importance of using LLN versus fixed percentage as recommended in international C. Rijo, M. Silva, T. Duarte, S. Sousa, P. Duarte guidelines. Centro Hospitalar de Setúbal, EPE-Hospital de São Bernardo.
    [Show full text]
  • Dana Buus, CNP Avera Medical Group Pulmonary and Sleep Medicine I Have No Conflicts of Interest to Disclose
    Don’t Get Caught in a Pleural Jam! Dana Buus, CNP Avera Medical Group Pulmonary and Sleep Medicine I have no conflicts of interest to disclose. Discuss causes and treatment of pneumothoraces Understanding a pleural effusion Discuss transudative effusions Discuss exudative effusions Discuss other pleural disorders A. Dextrocardia B. Pneumothorax C. Pneumonia D. Rib fractures http://www.fprmed.com/Pages/Trauma/Simple_Pneumothorax.html B. Pneumothorax Pneumothorax An accumulation of air into the pleural space, causing a collapse of the lung. Sudden shortness hemodynamic of breath instability chest pain hypoxemia absent breath respiratory alkalosis sounds subcutaneous emphysema Primary spontaneous pneumothorax Secondary spontaneous pneumothorax Iatrogenic Pneumothorax occurs spontaneously in a patient without known lung disease usually happens in men 25-50% reoccurrence rate with most happening in the first year Risk Factors: smoking, family history, Marfan syndrome, thoracic endometriosis caused as a complication of underlying lung disease (COPD, CF, lung CA, necrotizing pneumonia, PCP, TB) Caused by an invasive procedure: Biopsy Central line placement Thoracentesis Bronchoscopy with transbronchial biopsy Pleural biopsy Mechanical ventilation Treatment of Pneumothoraces Oxygen Observation in asymptomatic patients with <3cm between lung and chest wall on CXR Removal of air from pleural space needle aspiration (primary spontaneous PTX) chest tube placement If persistent airleak for >3 days in PSP, then recommended VATS and pleurodesis, blood patch http://dxline.org/medic/term/video-assisted-resection/ PSP: 25-50% over 1-5 yr follow-up period with highest risk within the first 30 days SSP: reoccurrence is common and frequently life threatening. One study with 50% reoccurrence over 3 yrs. Both PSP and SSP should undergo procedure to prevent reoccurrences: VATS, thoracotomy or chemical pleurodesis.
    [Show full text]