Challenges in diagnosis and treatment of pneumothorax and giant bullae

2021 ◽  
Vol 31 (4) ◽  
pp. 499-504
Author(s):  
E. A. Korymasov ◽  
A. S. Benian ◽  
Ju. V. Bogdanova ◽  
K. M. Kolmakova ◽  
M. A. Medvedchikov-Ardiia ◽  
...  
Keyword(s):  
Pulmonary Emphysema ◽  
Pleural Cavity ◽  
Diagnostic Errors ◽  
Pleural Drainage ◽  
Correct Interpretation ◽  
Surgical Department ◽  
Radiological Data ◽  
Giant Bulla ◽  
Chest Disease ◽  
Giant Bullae

Spontaneous pneumothorax is the most common acute chest disease. Often, giant bullae give the impression of the presence of air in the pleural cavity. Inadequate differential diagnosis leads to vain drainage of the pleural cavity, damage to the lung with its collapse and pneumothorax.The aim. Analyze diagnostic and tactical mistakes in patients with pulmonary emphysema, which manifests with giant bullae, and outline the ways to prevent complications.Methods. The analysis of the treatment of 1,636 patients with pulmonary emphysema and its complications undergoing treatment in the thoracic surgical department of the Samara Regional Clinical Hospital named after V.D.Seredavin in the period from 2001 to 2018 is presented.Results. Giant bulla were diagnosed in 35 (2.1%) patients, 16 of them were hospitalized ungently. In 6 patients, the diagnosis of a giant bulla of the lung was correct, and the patients were referred to the thoracic surgical department. In 10 patients, a giant bulla of the lung was regarded as pneumothorax, and pleural drainage was performed before referral to the thoracic surgical department.Conclusion. The correct interpretation of the radiological data and comparison with the clinical picture allows avoiding diagnostic errors and the associated danger and complications.

scholarly journals Estimation of the efficiency of the use of «early» valve bronchoblocation at complications after thoracoscopic operations in patients with bullous emphysema

2019 ◽  
Vol 178 (4) ◽  
pp. 15-19
Author(s):  
E. A. Drobyazgin ◽  
Yu. V. Chikinev ◽  
A. Yu. Litvintsev ◽  
K. I. Shcherbina ◽  
V. F. Khusainov ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Pulmonary Emphysema ◽  
Pleural Cavity ◽  
Blocking Effect ◽  
Bronchial Blocker ◽  
Pleural Drainage ◽  
Air Leakage ◽  
Blocking Group ◽  
Air Discharge

The OBJECTIVE of the study was to evaluate the effectiveness of the use of «early» (up to 3 days) valve bronchial blocking in the complication of postoperative period in patients with bullous emphysema. MATERIAL AND METHODS. For the period from 2009 to 2017, 32 patients with bullous pulmonary emphysema had a long (more than 3 days) air leakage from the pleural cavity. Depending on the time of the valve bronchial blocker installation, the patients were divided into 2 groups: 1 group («late» blocking): the valve bronchial blocker was placed later than 3 days after the operation (11 patients); 2 group («early» blocking): the valve bronchial blocker was placed for 2–3 days from the operation (21 patients). RESULTS. During the first two days, air discharge through the pleural drainage was discontinued in 16 patients of the «early» blocking group and in 2 patients of the «late» blocking group (р=0.0022). The duration of air leakage in the «early» blocking group was 1.59 days less (44.91 %) than in patients of the «late» blocking group (р=0.0024). The positive blocking effect was fixed in 85.71 % (18) of the patients of the group with «early» blocking, which was 3.6 times higher than in the patients of the «late» blocking group (р= 0.04). The frequency of repeated intervention in the «early» blocking group was 3.81 times less than in the «late» blocking group (54.54 % vs. 14.28 %) (р=0.08). CONCLUSION. «Early» valve bronchoblocation (performed on the 2–3rd day of the postoperative period) had an indisputable advantage in comparison with bronchial blocking performed at the time of more than 3 days postoperative period, allowing reliably faster lung dilatation and eliminating air discharge through drainage from the pleural cavity, without resorting to repeated interventions, which was important, both for the surgeon and for the patient.

FEATURES OF PLEURAL CAVITY DRAINAGE IN PATIENTS WITH ACUTE NONSPECIFIC PLEURAL EMPYEMA

2020 ◽  
pp. 39-42
Author(s):  
D. V. Minukhin ◽  
O. I. Tsyvenko ◽  
A. Yu. Korolevska ◽  
L. G. Tarasenko ◽  
D. Yu. Melnyk ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Pleural Drainage ◽  
Main Method ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Minor Surgery ◽  
Surgical Manipulation

Most authors considered pleural cavity drainage to be the main method of treatment of acute pleural empyema using minor surgery. Despite the simplicity of drainage of the pleural cavity, the number of complications after this surgical manipulation, according to the reports of some authors, varies from 3 to 8 %. The complications of pleural drainage in the patients with acute nonspecific pleural empyema have been studied and the technique of pleural drainage "blindly" has been introduced, which allows drainage to be located along the chest wall. At the first stage of the four−stage study, the complications of pleural drainage in 38 patients with acute nonspecific pleural empyema were analyzed, at the second stage a device for drainage of the pleural cavity "blindly" was developed to place drainage in parallel to the chest wall, at the third stage patients were tested; on IV −− drainage of the pleural cavity of 34 patients was performed according to the proposed method. The reason for the development of drainage complications in the pleural cavity of patients with acute pleural empyema was the inadequate location of drainage in the pleural cavity, drainage of the pleural cavity was carried out in general hospitals without the use of thoracoscopic equipment. Curved thoracoport with trocar for a blind drainage of the pleural cavity "blindly" was developed and introduced into clinical practice. This technique eliminates the involuntary location of the drainage in the pleural cavity, installing it along the chest wall, and is safe. Complications associated with drainage of the pleural cavity according to the developed method using a curved thoracoport with a trocar, inadequate location of drainage, were not observed in patients. Key words: acute pleural empyema, pleural cavity drainage, curved trocar.

scholarly journals Isolated Right-Sided Posttraumatic Diaphragmatic Hernia

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Ibrahim Amadou Magagi ◽  
Oumarou Habou ◽  
Harissou Adamou ◽  
Ousseini Adakal ◽  
Mahamoud Omid Ali Ada ◽  
...  
Keyword(s):  
Diaphragmatic Rupture ◽  
Pleural Drainage ◽  
Surgical Department ◽  
Computed Tomographic ◽  
Traumatic Diaphragmatic Rupture ◽  
Abdominal Content ◽  
Pedestrian Accident ◽  
Computed Tomographic Scan ◽  
Diagnostic Difficulties ◽  
Thoracic And Abdominal

Diaphragm is a compliant musculoaponeurotic barrier located between thoracic and abdominal cavities. Traumatic diaphragmatic rupture is a rare clinicopathological entity. We report a case of right-sided posttraumatic hernia in a child following blunt trauma to highlight diagnostic difficulties and therapeutic specific aspects. A 10-year-old boy was admitted to the emergency surgical department with thoracic trauma following pedestrian accident. At admission a haemothorax was suspected and treated by pleural drainage. The diagnosis of a right-sided diaphragmatic rupture was made after computed tomographic scan forty-eight hours later. At surgery, a reduction of herniated abdominal content and a suture of diaphragmatic defect were performed. The postoperative recoveries were uneventful and the patient was followed up for 12 months without symptoms. The possibility of a diaphragmatic rupture should be kept in mind and sought after any trauma of the thoracoabdominal junction as the diagnosis can be challenging in emergency department.

Conservative treatment of postoperative chylothorax: a case report

2018 ◽  
Vol 29 (4) ◽  
pp. 417-419 ◽  
Author(s):  
Sachinkumar Wagh ◽  
Sanjay Deshmukh ◽  
Shrikant Ankolikar
Keyword(s):  
Conservative Treatment ◽  
Pleural Cavity ◽  
Pleural Drainage ◽  
Case Presentation ◽  
Thoracic Duct Ligation ◽  
Effective Manner ◽  
Duct Ligation ◽  
Elective Surgical Procedure ◽  
Chronic Sequelae

Abstract Background Chylothorax is a well-documented complication of thoracic trauma and is associated with high rates of morbidity and mortality. Treatment for chylothorax includes conservative measures (total parenteral nutrition, pleural drainage, and pleurodesis) and surgery (thoracic duct ligation). Case presentation We present the case of a 65-year-old man who developed chylothorax after an elective surgical procedure. In this report conservative treatment aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, started immediately upon diagnosis, effectively reduces the need for reoperation and long-term hospitalization, and it might prevent further sequelae of chylothorax. Conclusions The chylothorax was successfully treated conservatively, which may reduce the need for reoperation.

scholarly journals Kraujo krešumo sistemos pokyčiai sergant paveldimąja plaučių emfizema

2005 ◽  
Vol 3 (1) ◽  
pp. 0-0
Author(s):  
Vytis Bajoriūnas ◽  
Romaldas Rubikas ◽  
Paulius Gradauskas ◽  
Diana Samiatina ◽  
Algirdas Vilčinskas ◽  
...  
Keyword(s):  
Pulmonary Emphysema ◽  
Spontaneous Pneumothorax ◽  
Blood Clotting ◽  
Pleural Cavity ◽  
University Hospital ◽  
The Family ◽  
Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin ◽  
Medical University

Vytis Bajoriūnas, Romaldas Rubikas, Paulius Gradauskas, Diana Samiatina, Algirdas Vilčinskas, Leonas JasulaitisKauno medicinos universitetoTorakalinės chirurgijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected], [email protected] Įvadas Pateikiami penkių gydytų pacientų ligos istorijų duomenys, aprašoma kraujo krešumo sistemos patologija sergant paveldima plaučių emfizema. Ligoniai ir metodai 2000–2003 metais Torakalinės chirurgijos klinikoje gydyti penki vienos giminės nariai, sirgę spontaninio pneumotorakso komplikuota plaučių emfizema. Įgimta plaučių emfizema šeimoje sirgo ir šiuo metu serga 12 žmonių. Visi ligoniai buvo operuoti. Atliktos torakotomijos, rezekuota pažeista plaučio dalis, atlikta dalinė arba visiškoji pleurektomija, drenuota pleuros ertmė. Rezultatai Pooperaciniu laikotarpiu visiems ligoniams padidėjo kraujavimas į pleuros ertmę. Netekto kraujo tūris buvo papildomas hemotransfuzija, šviežiai šaldytos plazmos infuzijomis. Dėl kraujavimo į pleuros ertmę ar susidariusio hemotorakso buvo atliktos trys retorakotomijos. Pakartotinių operacijų metu buvo rastas įvairaus dydžio hemotoraksas (600–1100 ml), difuzinis kraujavimas iš krūtinės sienos be aiškaus vieno kraujavimo židinio. Visi pacientai pasveiko. Išvada Turimi duomenys yra būdingi įgimtam alfa-1 antitripsino sintezės defektui. Reikšminiai žodžiai: plaučių emfizema, spontaninis pneumotoraksas, pooperacinės komplikacijos, antitrombinas III Malfunction of blood clotting associated with hereditary pulmonary emphysema Vytis Bajoriūnas, Romaldas Rubikas, Paulius Gradauskas, Diana Samiatina, Algirdas Vilčinskas, Leonas JasulaitisClinic of Thoracic Surgery,Kaunas University of Medicine,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected], [email protected] Background / objective There were five members of one family suffering from pulmonary emphysema complicated with spontaneous pneumothorax, treated at Kaunas Medical University Hospital since 2000 till 2003. The data from the case histories of all the patients are presented and the possible reasons for blood clotting dysfunction are discussed. Patients and methods Twelve members of the family have been or still are suffering from congenital pulmonary emphysema. Five members of the family were operated on. The surgey involved thoracotomy, resection of the damaged section of a lung, partial or total pleurectomy, pleural cavity drainage. Results All the patients underwent surgery, and in all cases the postoperative intrapleural bleeding was uncommonly intensive. In three cases rethoracotomies were performed. All patients survived. Conclusion The presented data characterise congenital alpha-1-antitrypsin deficiency. Keywords: pulmonary emphysema, spontaneous pneumothorax, post-operative complications, antithrombin

Hepatischer Hydrothorax ohne Aszites

1991 ◽  
Vol 30 (03) ◽  
pp. 104-106
Author(s):  
H. Schöder ◽  
M. Friedrich
Keyword(s):  
Clinical Improvement ◽  
Intraperitoneal Injection ◽  
Pleural Cavity ◽  
Pleural Drainage ◽  
Hepatic Hydrothorax ◽  
Chemical Pleurodesis ◽  
Diuretic Treatment ◽  
Tin Colloid

A case of hepatic hydrothorax without clinical ascites is reported. The diagnosis was confirmed by intraperitoneal injection of 99mTc-tin colloid: scintigraphic images taken between 5 min and 18 h p.i. demonstrated a oneway transdiaphragmatic flow into the pleural cavity. The therapy consisted of diuretic treatment, pleural drainage and chemical pleurodesis, and resulted in prompt clinical improvement.

scholarly journals Case Report: Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax

2020 ◽  
Vol 56 (4) ◽  
pp. 320
Author(s):  
Anastasia Tjan ◽  
I Made Dwija Putra Ayusta ◽  
Dewa Gde Mahiswara
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Severe Disease ◽  
Chest Ct ◽  
Fluid Level ◽  
Tube Insertion ◽  
X Ray ◽  
Giant Bulla ◽  
Chest X Ray ◽  
Giant Bullae

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and right hydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression. 

Upper Limbs Trauma in Pediatrics

2017 ◽  
Vol 21 (03) ◽  
pp. 167-174 ◽  
Author(s):  
Claudia Piccolo ◽  
Michele Galluzzo ◽  
Margherita Trinci ◽  
Stefania Ianniello ◽  
Michele Tonerini ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Upper Extremities ◽  
Skeletal Growth ◽  
Upper Limbs ◽  
Correct Interpretation ◽  
Imaging Studies ◽  
Delayed Complications ◽  
Chronic Injuries

A correct interpretation of musculoskeletal imaging studies of children requires an in-depth knowledge of normal skeletal growth and physiologic changes in growing bones. During childhood the growing bones are more prone to acute and chronic injuries because of the imbalance between osseous structures and tendons and ligaments, so physeal injuries are the most commonly encountered types of lesions. This review addresses acute and chronic injuries involving the upper extremities in the pediatric population. These injuries may be subtle to recognize or atypical. The radiologist has to choose the most appropriate technique that can best recognize the problem and establish the correct diagnosis, thus avoiding diagnostic errors and potential delayed complications.

scholarly journals Comparison of Single and Double Chest Tube Drainage Management in Patients Undergoing Thoracotomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Elnori ◽  
H H Elsayed ◽  
A M Mostafa ◽  
M M M Kamal
Keyword(s):  
Chest Tube ◽  
Pleural Cavity ◽  
Chest Tube Drainage ◽  
Pleural Drainage ◽  
Inclusion Criteria ◽  
Chest Tubes ◽  
Single Tube ◽  
Tube Drainage ◽  
Specialized Hospital ◽  
Significant Difference

Abstract Background chest tube is the most commonly performed surgical procedure in thoracic surgery practice. It is defined as insertion of (chest tube) into the pleural cavity to drain air, blood, bile, pus, chyle or other fluids. Aim of the Work comparison of single and double chest tube drainage management in patients undergoing thoracotomy in the form of pain score, hospital stay, total drainage, residual collection after removal of chest tube and need for another chest tube at Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital (ASUSH). Patients and Methods this study was conducted on patients who undergone thoracotomy at the Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital throughout the last 6 months from March 2018 till August 2018. Data was collected retrospectively from 40 patients, 20 patients in each group. In the 20 patients in the ‘single-tube group', only one chest tube was inserted, and in the 20 patients in the ‘double-tube group', two chest tubes were inserted. Pre-, intra- and postoperative variables in both groups were compared. Results 40 patients met all inclusion criteria. The pre- and intraoperative characteristics of the patients were similar in both groups with no significant differences. The single-tube group was found to have a lesser amount of total pleural drainage than the double-tube group but there was no significant difference 202.50 cc vs 297.50 cc, respectively; (p > 0.05). Conclusion our results showed that the single chest tube drainage is more effective, reduces postoperative pain, hospitalization times and duration of drainage in patients who undergo thoracotomy.

scholarly journals THE CHOICE OF SURGICAL TACTICS FOR BOERHAAVE SYNDROME IN COMBINATION WITH BILATERAL PLEURAL EMPYEMA (CLINICAL CASE)

2021 ◽  
pp. 39-46
Author(s):  
V. A. Gankov ◽  
D. Yu. Shestakov ◽  
V. V. Manshetov ◽  
E. A. Tseimakh ◽  
E. V. Kovalev ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Posterior Mediastinum ◽  
Complete Healing ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Surgical Access ◽  
Left Pleural Cavity ◽  
Boerhaave Syndrome

Introduction. Boerhaave syndrome is a rare, difficult to diagnose and formidable disease with a high mortality rate. For the treatment of this pathology, many variants of interventions have been proposed. Some surgeons prefer to use a thoracotomic access, others – a laparotomic transhiatal one. In the domestic literature there are scant observations of usement of minimally invasive technologies.Clinical observation. The patient was admitted to the surgical department for emergency indications. In the admission department spontaneous left side hydropneumothorax was diagnosted. Drainage of the left pleural cavity was performed. On the second day, a spontaneous rupture of the esophagus was diagnosed. Video-laparotranschiatal drainage of the posterior mediastinum, drainage of the left subhepatic space, Maydl jejunostomy was performed. In the postoperative period, intensive conservative therapy was carried out, massive lavage of the mediastinum and the left pleural cavity with antiseptic solutions. For a long time, there was a large drainage debit. Because of treatment the dynamics were positive. On the 45th day the drainage of the pleural cavity was removed. By the 66th day complete healing of the esophageal defect and removal of the mediastinal drainage.Discussion. Due to the difficulties in diagnosis, a spontaneous rupture of the esophagus was detected a day later. The applied surgical access and technique allowed to provide adequate drainage and sanitation of the posterior mediastinum and left pleural cavity. The subsequent tactics of managing the patient ensured his recovery. The trauma of the video-laparotranschiatal access is less, in comparison with open surgical interventions. We consider the experience of using video endoscopic technologies for Boerhaave syndrome positive and promising.

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