ABSTRACT
Mediastinal herniation can occur either due to traction as in the case of lung shrinkage in tuberculosis and chronic bronchostenosis or pulsion as a result of hydropneumothorax, empyema necessitans, and chronic infective etiology. We are reporting a case of left sided trans-mediastinal herniation of right lung in a patient with underlying right pulmonary tuberculosis, presenting with empyema thoracis. Empyema thoracis in pulmonary tuberculosis may either be a cause of trans-mediastinal herniation of lung or be a co-existent condition when the herniation occurs due to hydropneumothorax. Due to the presence of infection in pleural space, a prosthesis cannot be used. Due to the proximity of hernia sac to heart and major vessels, its plication is better avoided. Hence, treatment of such a case can be done by applying negative pressure for a few post-operative days till the dead space has been obliterated. Trans-mediastinal herniation of lung with underlying empyema thoracis requiring decortication can be successfully treated with the application of intermittent strong negative pressure (after completing decortication) in the pleaural cavity near mediastinum to gradually deliver the herniated lung to its normal position followed by application of negative pressure in the post op period through one of the ICDTs (intercostal drainage tubes) to avoid unnecessary post-operative complications or reherniation.
ABSTRACT
Background: Spontaneous pneumothorax is a respiratory emergency, which we come across in clinical practice. It needs quick diagnosis and prompt treatment. Its immediate and prompt management can save a life of the patient. Delayed management can produce serious implication on respiratory function. The objective was aimed to study profile of patients of spontaneous pneumothorax. Methods: This was a prospective descriptive study conducted among purposively selected 100 patients of pneumothorax at a GMERS Medical College and Hospital, Dharpur-Patan of North Gujarat region, India between February 2013 and January 2015 after taking written informed consent. A predesigned semi-structured performa was used. Detailed demographic and clinical data were recorded. Patients were treated with simple needle aspiration or Intercostal drainage tube (ICDT) as per the standard practice at our institute. Data was statistically analyzed using SPSS software (trial version). Results: Based on the total number of admissions to our hospital during the study period, the annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Out of 100 patients 84 patients were above the age of 40 years. 96 % of the patients were male. Dyspnea was the most common symptom at the onset and was present in all patients. History of smoking was present in 88% of the patients. Past history of COPD and tuberculosis were found in 58% and 34% of the patients respectively. Radiological evidence showed right sided pneumothorax in 50% of the patients whereas 48% had left sided pneumothorax. 86% of the patients were treated with Intercostal drainage tube. Among all patients treated with ICDT, 6% of the patients had surgical emphysema while 10% of the patients had secondary infection of pleural space leading to hydro pneumothorax. Conclusion: Spontaneous pneumothorax in India is more often secondary to an underlying lung disease. COPD and pulmonary tuberculosis remains the common causes of SP. Smoking is an important risk factor for the development of pneumothorax. X-Ray chest is one of the most important investigations for diagnosis of pneumothorax & underlying etiological factors.