Pleural disease
Paul F. Jenkins in Making Sense of the Chest X-ray, 2013
This chapter describes the radiographic appearances that result from the presence of air (pneumothorax), fluid (pleural effusion), pus (empyema) and solid tumour within the pleural cavity. Combinations of these ‘fillings’ occur and pleural fluid may be composed of transudate, exudate, blood and, rarely, chyle. The management of pleural disease can be difficult. There are serious potential diagnostic pitfalls and accurate radiographic interpretation is paramount in avoiding these. A dramatic increase in intrapleural pressure can subsequently occur, sometimes with relatively small volume change. The physiological effects of a pneumothorax are exaggerated in the presence of underlying lung disease, as are the symptoms that the patient experiences. Pleurisy complicating pneumococcal pneumonia is another example of painful accumulation of pleural fluid. The classical clinical presentation of pneumococcal pneumonia is of a rigor, then fever, quickly followed by pleuritic pain. Malignant pleural effusions can be painful but a more common presentation is with breathlessness.
Thoracic trauma
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
Pneumothorax is a surgical emergency and the diagnosis should be made on the basis of clinical evidence. Treatment should not be delayed while waiting for radiological confirmation. The pneumothorax should immediately be decompressed by inserting a large-bore cannula into the second intercostal space of the affected side, along the midclavicular line. Decompression converts the tension pneumothorax into a simple pneumothorax, which should be treated by thoracostomy and chest drain insertion. The site of drain insertion is selected between the anterior and midaxillary lines at the level of the fifth intercostal space. The drain is sutured in position using a silk or Prolene purse-string suture. The chest is auscultated, the tube examined for fogging, and the drainage bottle observed for a swing to the water meniscus or bubbling. A chest X-ray should then be obtained to confirm the position. The emergency-room thoracotomy is indicated in cases of penetrating trauma where there is electrical rhythm but no cardiac output (PEA).
Minimally Invasive Surgery
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Surgery may be prolonged and may require conversion to an open operation. Pneumothorax is possible, especially if the pleuro-peritoneal canals are patent. Pneumomediastinum, pneumoperi-cardium, pneumoscrotum and surgical emphysema can also occur. Cervical or peritoneal stimulation may cause vagally mediated bradycardia or asystole. Haemorrhage may not be immediately obvious, theatre lighting is often dimmed, and lasers may be used. A laryngeal mask airway, with spontaneous or assisted ventilation can be used for short procedures, but this is controversial due to the risk of regurgitation, and a 50% reduction in pulmonary compliance. Perioperative hypotension is common. Other procedures include fundoplication, appendicectomy, vagotomy and colorectal and splenic surgery. A capnothorax is produced, and a lung permitted to deflate by using a double lumen tracheal tube. Overinflation risks a tension pneumo-thorax and a pneumothorax can develop on the contralateral side.
Diagnosis and Treatment of Pneumothorax
Published in Hospital Practice, 2013
Many diagnostic and therapeutic options exist for the evaluation and treatment of patients with pneumothorax. Guidelines from US and European professional societies and individual expert opinions differ in the approach to patient care. Advances in diagnostic techniques, such as real-time thoracic ultrasound, have added to the evaluation strategy. It is important for medical trainees and providers to become familiar with techniques utilized worldwide as they may be encountered in clinical practice. We review current evidence, expert recommendations, and compare professional society guidelines discussing the various diagnostic and management options for patients with pneumothorax to assist physicians and trainees involved in the care of hospitalized and outpatient adults who have primary, secondary, and traumatic iatrogenic pneumothorax. Management of traumatic non-iatrogenic pneumothorax is beyond the scope of this article, thus, not reviewed here.
Recurrent spontaneous pneumothorax in pregnancy – a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Noman Lateef, Mustafa Dawood, Karn Sharma, Abubakar Tauseef, Muhammad Asadullah Munir, Erin Godbout
Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks’ gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2.5 kg female infant was delivered. We discuss spontaneous pneumothorax during pregnancy and review the literature.
ECG with alternating electric axis in relation to left-sided tension pneumothorax: a case report and review of the literature
Published in European Clinical Respiratory Journal, 2018
Diana Chabané Schmidt, Charlotte Andersson, Hans Henrik Schultz
The incidence of spontaneous pneumothorax has been estimated to 7.4–18.0/100,000 for men and 1.2–6.0/100,000 for women. The most common symptoms are sudden chest pain and dyspnoea. Due to chest pain many patients have an electrocardiogram (ECG) done in the acute setting. We present a case of unusual findings of electric alternans in the electrocardiogram (ECG) in a patient with a left-sided spontaneous pneumothorax. Reviewing the literature we found five former cases of pneumothoraxes with electric alternans in the ECG, all occurring in relation to left-sided pneumothorax.
Related Knowledge Centers
- Artificial Pneumothorax
- Pleura
- Pleural Cavity
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- Lung
- Pleural Diseases
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