Spontaneous pneumothorax
Alisa McQueen, S. Margaret Paik in Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Symptoms of a pneumothorax include acute onset of chest pain and shortness of breath. Diagnosis of spontaneous pneumothorax is often clinically suspected based on history and physical examination, and confirmed by an erect posterior–anterior (PA) chest radiograph. The treatment options for spontaneous pneumothorax in a clinically stable patient include observation alone, observation with 100% high-flow oxygen delivery via mask, simple aspiration, large or small bore pleural catheter, and placement of a thoracostomy tube. Multiple formulas and guidelines exist as to which intervention is necessary based on the size of the pneumothorax. The existing adult guidelines call for those patients who are clinically stable with a large primary spontaneous pneumothorax (>20%) to have placement of a pleural catheter or appropriately sized chest tube; those who continue to have symptoms or are clinically unstable must be admitted to the hospital with high-flow oxygen administration.
Birt–Hogg–Dubé Syndrome
Dongyou Liu in Handbook of Tumor Syndromes, 2020
There are limited data on the risk of pneumothorax during air travel or scuba diving. Patients have complained of chest pressure (52%), anxiety (9%–50%), headache (3%–31%), shortness of breath (4%–28%), chest pain (6%–28%), nausea (4%–20%), fatigue (3%–7%), oxygen desaturation by handheld pulse oximetry (4%), palpitations (2.8%), peripheral cyanosis (2%), abnormal chills (1.4%), and dizziness (0.7%) during air travel. Symptoms were similar between patients with and without a previous spontaneous pneumothorax. The flight-related pneumothorax risk has been calculated to range between 0.12%–0.63% per flight during or within 1 month after air travel. Patients with a prior pleurodesis are less likely to develop a flight-related pneumothorax [44,99]. Patients may develop a pneumothorax up to 1 month after air travel, and accordingly, they should be informed to consult a physician if they experience any symptoms such as dyspnea or chest pain during or shortly after a flight. If experiencing such symptoms before air travel, they should be advised to seek medical consultancy and to have a clinical checkup before flying [44,99]. There are no firm guidelines on the interval from a spontaneous pneumothorax to air travel. Recommendations vary from no time to 3 weeks after radiographic remission.
Torso trauma
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
This condition usually results from blunt trauma associated with multiple rib fractures, and is defined as three or more ribs fractured in two or more places. The blunt force typically also produces an underlying pulmonary contusion. The diagnosis is made clinically in patients who are not ventilated, not by radiography. To confirm the diagnosis the chest wall can be observed for paradoxical motion of a chest wall segment. On inspiration, the loose segment of the chest wall is displaced inwards and therefore less air moves into the lungs. On expiration, the segment moves outwards (paradoxical respiration). Voluntary splinting of the chest wall occurs as a result of pain, so mechanically impaired chest wall movement and the associated lung contusion all contribute to the hypoxia. There is a high risk of developing a pneumothorax or haemothorax. The CT scan, with contrast to display the vascular structures and a 3-D reconstruction of the chest wall, is the gold standard for diagnosis of this condition.
Complications after 100 sessions of cone-beam computed tomography-guided lung radiofrequency ablation: a single-center, retrospective experience
Published in International Journal of Hyperthermia, 2020
Myung Sub Kim, Hyun Pyo Hong, Soo-Youn Ham, Dong-Hoe Koo, Du-Young Kang, Tae Yoon Oh
Pneumothorax is the most frequent complication after percutaneous lung RFA, with incidences ranging from 11% to 52% [16–18,25–28]. A recent meta-analysis by Kennedy et al. stated that there are several risk factors for pneumothorax, including increased age, male gender, no history of lung surgery, number of tumors ablated, and increased length of electrode depth [29]. In addition, several studies have reported in common that pulmonary emphysema was a risk factor for pneumothorax [16,26–28]. In our study, pneumothorax occurred in 15% of the patients and six of these cases required percutaneous catheter drainage. These results compare favorably with recent large-scale studies and meta-analysis suggesting that pneumothorax occurs in 37% to 38.4% of the procedure, with the need for aspiration or chest tube drainage in 29% to 31.9% [18,29]. The number of tumors ablated at one session was significantly associated with pneumothorax in our study. Moreover, about 73% of the pneumothorax cases occurred in first 50 ablation sessions, indicating that there may be a learning curve to reduce this complication.
Diagnosing complications and co-morbidities of fibrotic interstitial lung disease
Published in Expert Review of Respiratory Medicine, 2019
George A. Margaritopoulos, Maria A. Kokosi, Athol U. Wells
The diagnosis of lung cancer is generally prompted by CT findings. Clinicians should have a low threshold for repeat imaging in those patients who experience clinical worsening despite stable pulmonary function or develop symptoms atypical for the underlying ILD. Lung cancer often manifests as a mass-like lesion within or near areas of fibrosis; distinction between malignancy and areas of confluent fibrosis may be difficult, especially when previous imaging is unavailable. In some centers, annual HRCT is performed to screen for cancer, but this approach has yet to be validated. Histological diagnosis is often obtained by percutaneous CT-guided biopsy due to the peripheral location of the tumors. Bronchoscopy is also a consideration but is not well tolerated in patients with advanced fibrosis. The risk for pneumothorax is high in severe disease; hence, diagnostic procedures need to be carefully considered. Discussion in the appropriate MDT setting is pivotal in order to make realistic decisions on the prognosis, suitability for treatment for cancer (surgery, chemotherapy, radiotherapy) and suitable diagnostic algorithm. Accurate decision-making requires patient involvement with acceptance of the increased short-term risks associated with both diagnostic procedures and treatment.
Transthoracic ultrasound-guided biopsy in the hands of chest physicians – a stepwise approach
Published in European Clinical Respiratory Journal, 2019
Ida Skovgaard Christiansen, Paul Frost Clementsen, Uffe Bodtger, Therese Maria Henriette Naur, Pia Iben Pietersen, Christian B Laursen
The treatment of pneumothorax consists of oxygenation and insertion of a pleural chest tube, for example, a 7F tube, followed by aspiration. When defining a management strategy, the size of the pneumothorax is less important than the degree of clinical compromise. The differentiation of a ‘large’ from a ‘small’ pneumothorax is the presence of a visible rim of >2 cm between the lung margin and the chest wall at the level of the hilum. This is easily measured on a chest X-ray, but accurate size is best measured by CT [24–26]. Using lung ultrasound, whether the lung point is located anteriorly or posteriorly to the midaxillary line correlates to a small or large pneumothorax, respectively [27]. Tension pneumothorax is a medical emergency that should be treated immediately with needle decompression followed by pleural drainage without waiting for supplemental x-ray or other investigations.
Related Knowledge Centers
- Chest Pain
- Hypotension
- Shortness of Breath
- Thoracic Wall
- Tissue
- Atelectasis
- Hypoxia
- Pleural Cavity
- Lung
- Obstructive Shock
- Shortness of Breath