Edema pulmonar por reexpansión. Reporte de Caso / Pulmonary edema due to re-expansion. Case Report

Introducción. El edema pulmonar por reexpansión es una complicación poco frecuente, secundaria a una rápida reexpansión pulmonar posterior al drenaje por toracentesis o toracostomía cerrada. Al día de hoy, se ha descrito una incidencia menor al 1 % tras toracostomía cerrada, con mayor prevalencia en la segunda y tercera década de la vida. Su mecanismo fisiopatológico exacto es desconocido; se ha planteado un proceso multifactorial de daño intersticial pulmonar asociado con un desequilibrio de las fuerzas hidrostáticas. Caso clínico. Presentamos el caso de un paciente que desarrolló edema pulmonar por reexpansión posterior a toracostomía cerrada. Se hizo una revisión de la literatura sobre esta complicación. Resultados. Aunque la clínica sugiere el diagnóstico, la secuencia de imágenes desempeña un papel fundamental. En la mayoría de los casos suele ser autolimitado, por lo que su manejo es principalmente de soporte; sin embargo, se han reportado tasas de mortalidad que alcanzan hasta el 20 %, por tanto, es importante conocer los factores de riesgo y las medidas preventivas. Conclusión. El edema pulmonar de reexpansión posterior a toracostomía es una complicación rara en los casos con neumotórax, aunque es una complicación que se puede presentar en la práctica diaria, por lo cual debe tenerse en mente para poder hacer el diagnóstico y un manejo adecuado.

Introduction. Re-expansion pulmonary edema is a rare complication secondary to rapid pulmonary re-expansion after drainage by thoracentesis and/or closed thoracostomy. As of today, an incidence of less than 1% has been described after closed thoracostomy, with a higher prevalence in the second and third decades of life. Its exact pathophysiological mechanism is unknown; a multifactorial process of lung interstitial damage associated with an imbalance of hydrostatic forces has been proposed. Clinical case. We present the case of a patient who developed pulmonary edema due to re-expansion after closed thoracostomy, conducting a review of the literature on this complication. Results. Although the clinic suggests the diagnosis, the sequence of images plays a fundamental role. In most cases, it tends to be a self-limited disease, so its management is mainly supportive. However, mortality rates of up to 20% have been recorded. Therefore, it is important to identify patients with major risk factors and initiate preventive measures in these patients. Conclusions. Re-expansion pulmonary edema after thoracostomy is a rare complication in cases with pneumothorax; however, it is a complication that can occur in daily practice. Therefore, it must be kept in mind to be able to make the diagnosis and an adequate management.

Neumotórax espontáneo persistente como manifestación primaria de sarcoma sinovial pleuropulmonar primario: a propósito de un caso / Persistent spontaneous pneumothorax as a primary manifestation of primary synovial sarcoma of the lung: a case report

El sarcoma sinovial pleuropulmonar (SSPP) es un tumor primario de pulmón, maligno, infrecuente en pediatría (prevalencia 0,1-0,5 %) que afecta predominantemente a adolescentes y adultos jóvenes. Se ha descrito una sobrevida global cercana al 30 % a los 5 años. Se reporta el caso de un paciente de 12 años de edad, previamente sano, que presentó tos, dolor torácico y disnea de comienzo súbito, como manifestación inicial de neumotórax izquierdo, el que persistió a los 4 días y requirió resección quirúrgica de lesión bullosa pulmonar. Se realizó diagnóstico histológico de sarcoma sinovial pleuropulmonar confirmado por estudio molecular, que evidenció la translocación cromosómica entre el cromosoma X y el 18: t(X;18) (p11.2;q11.2) de la pieza quirúrgica extirpada. Ante pacientes con neumotórax persistente o recidivante, es importante descartar causas secundarias, entre ellas, sarcoma sinovial pleuropulmonar. Su ominoso pronóstico determina la necesidad de arribar a un diagnóstico temprano e implementar un tratamiento agresivo

Pleuropulmonary synovial sarcoma (PPSS) is a primary malignancy of the lung, uncommon in pediatrics (prevalence: 0.1­0.5%) that predominantly affects adolescents and young adults. Overall survival has been reported to be close to 30% at 5 years. Here we report the case of a previously healthy 12-year-old male patient who presented with cough, chest pain, and dyspnea of sudden onset as initial manifestation of left pneumothorax, which persisted after 4 days and required surgical resection of pulmonary bullous lesion. A histological diagnosis of pleuropulmonary synovial sarcoma was made and confirmed by molecular study, which showed chromosomal translocation between chromosomes X and 18: t(X;18) (p11.2;q11.2) in the surgical specimen removed. In patients with persistent or recurrent pneumothorax, it is important to rule out secondary causes, including pleuropulmonary synovial sarcoma. Such poor prognosis determines the need for early diagnosis and aggressive treatment.

Red neural artificial para predecir factores de riesgo asociados a complicaciones postoperatorias secundarias al tratamiento del neumotórax / Artificial neural network to predict risk factors associated with postoperative complications secondary to pneumothorax treatment

Introducción. Debido a la ausencia de modelos predictivos estadísticamente significativos enfocados a las complicaciones postoperatorias en el manejo quirúrgico del neumotórax, desarrollamos un modelo, utilizando redes neurales, que identifica las variables independientes y su importancia para reducir la incidencia de complicaciones. Métodos. Se realizó un estudio retrospectivo en un centro asistencial, donde se incluyeron 106 pacientes que requirieron manejo quirúrgico de neumotórax. Todos fueron operados por el mismo cirujano. Se desarrolló una red neural artificial para manejo de datos con muestras limitadas; se optimizaron los datos y cada algoritmo fue evaluado de forma independiente y mediante validación cruzada, para obtener el menor error posible y la mayor precisión con el menor tiempo de respuesta. Resultados. Las variables de mayor importancia según su peso en el sistema de decisión de la red neural (área bajo la curva 0,991) fueron el abordaje por toracoscopia video asistida (OR 1,131), el uso de pleurodesis con talco (OR 0,994) y el uso de autosuturas (OR 0,792; p<0,05). Discusión. En nuestro estudio, los principales predictores independientes asociados a mayor riesgo de complicaciones fueron el neumotórax de etiología secundaria y el neumotórax recurrente. Adicionalmente, confirmamos que las variables asociadas a reducción de riesgo de complicaciones postoperatorias tuvieron significancia estadística. Conclusión. Identificamos la toracoscopia video asistida, el uso de autosuturas y la pleurodesis con talco como posibles variables asociadas a menor riesgo de complicaciones. Se plantea la posibilidad de desarrollar una herramienta que facilite y apoye la toma de decisiones, por lo cual es necesaria la validación externa en estudios prospectivos

Introduction. Due to the absence of statistically significant predictive models focused on postoperative complications in the surgical management of pneumothorax, we developed a model using neural networks that identify the independent variables and their importance in reducing the incidence of postoperative complications. Methods. A retrospective single-center study was carried out, where 106 patients who required surgical management of pneumothorax were included. All patients were operated by the same surgeon. An artificial neural network was developed to manage data with limited samples. The data is optimized and each algorithm is evaluated independently and through cross-validation to obtain the lowest possible error and the highest precision with the shortest response time. Results. The most important variables according to their weight in the decision system of the neural network (AUC 0.991) were the approach via video-assisted thoracoscopy (OR 1.131), use of pleurodesis with powder talcum (OR 0.994) and use of autosutures (OR 0.792, p<0.05). Discussion. In our study, the main independent predictors associated with a higher risk of complications are pneumothorax of secondary etiology and recurrent pneumothorax. Additionally, we confirm that the variables associated with a reduction in the risk of postoperative complications have statistical significance. Conclusion. We identify video-assisted thoracoscopy, use of autosuture and powder talcum pleurodesis as possible variables associated with a lower risk of complications and raise the possibility of developing a tool that facilitates and supports decision-making, for which external validation in prospective studies is necessary

Ocorrência de pneumotórax como evento adverso relacionado assistência à saúde / Ocorrência de pneumotórax como evento adverso relacionado assistência à saúde / Presence of pneumorax as an adverse event related to health care

Introdução: O acesso venoso central é definido como a colocação de um cateter com sua extremidade posicionada na veia cava ou no átrio direito, tendo diversas funções no manejo do paciente em estado crítico. Pneumotórax causado durante a inserção do cateter é um incidente que resulta em dano ao paciente, sendo assim considerado um evento adverso relacionado à assistência médica. Objetivo: Analisar a ocorrência de pneumotórax como evento adverso relacionado à assistência à saúde após a inserção de um cateter venoso central. Método: Trata-se de um estudo quantitativo, transversal e analítico. Depois de realizar o cálculo amostral para obtenção da amostra, pacientes submetidos à inserção de cateter venoso central na instituição pesquisada no período de abril até setembro de 2022 foram incluídos na pesquisa, a coleta de dados utilizou dados secundários. Resultados: Uma amostra de 103 pacientes foi obtido, dos quais 10 (9,7%) dos pacientes apresentaram pneumotórax relacionado à inserção de cateter venoso central. de pneumotórax. A ocorrência de pneumotórax e o fato de o profissional que inseriu o cateter ser residente. A ocorrência de pneumotórax teve associação significativa (p 0,03) levando ao aumento do tempo de internação. Conclusão: O os resultados encontrados demonstram uma significativa ocorrência do evento adverso relacionado à assistência à saúde pneumotórax, após a inserção do Cateter Venoso Central (CVC). Estratégias voltadas para a segurança do paciente são fundamentais e devem ser perseguidas constantemente.

Introduction: Central venous access is defined as the placement of a catheter with its end positioned in the superior vena cava or in the right atrium, having several functions in the management of the patient in critical condition. Pneumothorax caused during catheter insertion is an incident that results in harm to the patient, thus considered an adverse event related to health care. Objective: To analyze the occurrence of pneumothorax as adverse events related to health care after insertion of a central venous catheter. Method: This is a quantitative, cross-sectional, analytical study. After performing the sample calculation to obtain the sample, patients who underwent insertion of a central venous catheter at the researched institution from April to September 2022 were included in the research, data collection used secondary data. Results: A sample of 103 patients was obtained, of which 10 (9.7%) of the patients had pneumothorax related to the insertion of a central venous catheter. of pneumothorax. The occurrence of pneumothorax and the fact that the professional who inserted the catheter was a resident. The occurrence of pneumothorax had a significant association (p 0.03) leading to increased length of stay. Conclusion: The results found demonstrate a significant occurrence of the adverse event related to pneumothorax health care, after the insertion of the Central Venous Catheter (CVC). Strategies aimed at patient safety are fundamental and must be pursued constantly.(AU)

Introducción: El acceso venoso central se define como la colocación de un catéter con su extremo posicionado en la vena cava superior o en la aurícula derecha, teniendo varias funciones en el manejo del paciente en estado crítico. El neumotórax causado durante la inserción del catéter es un incidente que resulta en daño para el paciente, por lo que se considera un evento adverso relacionado con la atención a la salud. Objetivo: Analizar la ocurrencia de neumotórax como eventos adversos relacionados con la atención a la salud después de la inserción de un catéter venoso central. Método: Se trata de un estudio cuantitativo, transversal, analítico. Después de realizar el cálculo de la muestra para la obtención de la muestra, se incluyeron en la investigación los pacientes que se sometieron a la inserción de un catéter venoso central en la institución investigada de abril a septiembre de 2022, la recolección de datos utilizó datos secundarios. Resultados: Se obtuvo una muestra de 103 pacientes, de los cuales 10 (9,7%) de los pacientes presentaron neumotórax relacionado con la inserción de un catéter venoso central. La ocurrencia de neumotórax y el hecho de que el profesional que insertó el catéter fuera residente. La ocurrencia de neumotórax tuvo una asociación significativa (p 0,03) que condujo a una mayor duración de la estancia. Conclusión: Los resultados encontrados demuestran una ocurrencia significativa del evento adverso relacionado con la atención de salud del neumotórax, después de la inserción del Catéter Venoso Central (CVC). Las estrategias dirigidas a la seguridad del paciente son fundamentales y deben ser seguidas constantemente.(AU)

Fecopneumothorax secondary to a late traumatic diaphragmatic injury

Traumatic diaphragmatic hernias were first described by Ambroise Paré in 1579, who reported the case of an artillery captain, that presented an intestinal perforation that had caused a diaphragmatic hernia (Bhatti and Dawani, 2015). The timely diagnosis of a traumatic diaphragmatic hernia can be a challenge, which requires extensive knowledge of the kinematics of trauma, as well as clinical and radiological evidence (Petrone et al., 2017). We present the case of a 60-year-old male who presented blunt abdominal trauma due to a traffic accident, causing an undetected diaphragmatic hernia in his initial evaluation; months after de incident goes to the emergency room (ER) with hemodynamic instability and septic shock. A diagnosis of complicated diaphragmatic hernia and fecopneumothorax is made, for which he undergoes surgery.

Factores clínicos asociados a complicaciones pulmonares y extrapulmonares en pacientes con fibrosis quística. Un estudio observacional de centro único / Clinical factors associated with pulmonary and extrapulmonary complications in patients with cystic fibrosis. A single-center observational study

Introducción: La fibrosis quística (FQ), afecta el epitelio exocrino, formando una mucosidad espesa que obstruye los conductos de los diferentes órganos, siendo el pulmón y páncreas los más afectados. El objetivo del presente estudio fue determinar la asociación entre los factores clínicos y las complicaciones, así como la supervivencia de pacientes con FQ atendidos en un centro de referencia pediátrica en México. Métodos: El presente estudio observacional, longitudinal, fue realizado en el Instituto Nacional de Pediatría en México, de abril del 2012, a abril del 2022. Con una muestra no probabilística ingresaron al estudio niños con fibrosis quística. Las variables fueron: demográficas, complicaciones pulmonares, extrapulmonares y mortalidad. Se realiza la asociación con chi-cuadrado y la supervivencia con Kaplan-Meir. Resultados: Se analizan 71 pacientes, lactantes menores 41 casos (62%), pre-escolares 12 casos (16.9%). Fueron 40 hom-bres (56.3%). 57 casos (80.3%) tuvieron exacerbación infecciosa, 11 casos (15.5%) aspergi-losis broncopulmonar, 9 casos (12.7%) con hipertensión pulmonar, 5 casos (7%) con neumotórax, 12 casos (16.9%) con ventilación mecánica, 70 casos (98.5) con insuficiencia pancreática, 10 casos (14%) con enfermedad hepatobiliar. Hubo asociación de complica-ciones extrapulmonares con el fenotipo F508. La supervivencia global fue de 150 meses. En pacientes con ventilación mecánica invasiva la supervivencia fue de 55 meses (P<0.001), en pacientes con ventilación mecánica no invasiva fue de 106 meses (P<0.001), en pacientes con neumotórax fue de 25 meses P<0.001, en pacientes con aspergilosis bronco-pulmonar alérgica fue de 125 meses P<0.01. Conclusión: la mayor compli-cación extrapulmonar de pa-cientes con FQ es la insuficien-cia pancreática. La presencia de neumotórax disminuye la supervivencia.

Introduction: Cystic fibrosis (CF) affects the exocrine epithelium, forming a thick mucus that obstructs the ducts of the different organs, with the lungs and pancreas being the most affected. This study aimed to determine the association between clinical factors and complications, as well as the survival of CF patients treated at a pediatric reference center in Mexico. Methods: This observational, longitudinal study was conducted at the National Institute of Pediatrics in Mexico from April 2012 to April 2022. Children with cystic fibrosis were entered into the study with a nonprobabilistic sample. The variables were demographic, pulmonary and extrapulmonary complications and mortality. The association was made with chi-square and survival with Kaplan- Meir. Results: Seventy-one patients were analyzed, including 41 infants (62%) and 12 preschoolers (16.9%). There were 40 men (56.3%). Fifty-seven cases (80.3%) had an infectious exacerbation, 11 cases (15.5%) had allergic bronchopulmonary aspergillosis, 9 cases (12.7%) had pulmonary hypertension, 5 cases (7%) had pneumothorax, 12 cases (16.9%) had mechanical ventilation, 70 cases (98.5%) had pancreatic insufficiency, and 10 cases (14%) had hepatobiliary disease. There was an association of extrapulmonary complications with the F508 phenotype. Overall survival was 150 months. In patients with invasive mechanical ventilation, survival was 55 months (P<0.001); in patients with noninvasive mechanical ventilation, it was 106 months (P<0.001); in patients with pneumothorax, it was 25 months (P<0.001); and in patients with allergic bronchopulmonary aspergillosis, it was 125 months (P<0.01). Conclusion: The most significant extrapulmonary complication in CF patients is pancreatic insufficiency. The presence of pneumothorax markedly decreases survival.

Neumotórax espontáneo bilateral en primigestante adolescente, reporte de un caso / Spontaneous bilateral pneumothorax in a primigestant adolescent, a case report

El neumotórax espontáneo es una patología extremadamente rara durante la gestación. Se define como la presencia de aire dentro de la cavidad pleural que puede generar principalmente dolor torácico y disnea. Esta patología tiene unas bajas incidencia y prevalencia en el embarazo, pero es relevante por una alta tasa de recurrencia, con un buen pronóstico para la madre y el feto si es tempranamente diagnosticada y oportunamente manejada. Se relaciona con factores de riesgo como las maniobras de Valsalva efectuadas durante el trabajo de parto, además de con comorbilidad como el tabaquismo, y con el biotipo longilíneo, entre otros, por lo que son muy importantes una adecuada anamnesis y la evaluación de la exploración física. El obstetra debe sospecharlo ante la clínica de dolor torácico asociado a disnea en gestantes en el trabajo de parto y el parto, y tenerlo en cuenta como diagnóstico diferencial. Es de vital importancia tener un manejo multidisciplinario compuesto por ginecoobstetra, internista, neumólogo y neonatólogo, incluido el apoyo por una unidad de cuidado intensivo para evitar complicaciones materno-perinatales que se puedan asociar al neumotórax espontáneo.

Spontaneous pneumothorax is an extremely rare pathology during pregnancy. It is defined as the presence of air inside the pleural cavity that can mainly generate chest pain and dyspnea. This pathology has a low incidence and prevalence in pregnancy, but a high rate of recurrence with a good prognosis for the mother and the fetus if it is diagnosed early and managed early. It is related to risk factors such as Valsalva maneuvers performed during labor, in addition to comorbidities such as smoking, longilinear biotype, among others, so it is very important to have an adequate history and evaluation of the physical examination. The obstetrician must be attentive to chest pain symptoms associated with dyspnea in pregnant women during labor and delivery, suspect this pathology and take it into account as a differential diagnosis. It is vitally important to have a multidisciplinary management composed of the gynecologist-obstetrician, internist, pulmonologist, neonatologist, including the support of an intensive care unit to avoid maternal-perinatal complications that may be associated with spontaneous pneumothorax.

Effect of meteorological factors on first episode and recurrence of primary spontaneous pneumothorax

SUMMARY OBJECTIVE: In this study, we evaluated the clinical characteristics and seasonal distribution of patients with primary spontaneous pneumothorax and examined the relationships between meteorological factors and pneumothorax development overall and in terms of first episode and recurrence. METHODS: The hospital records of 168 pneumothorax patients treated in our clinic between January 2016 and December 2020 were reviewed retrospectively. A cluster was defined as two or more patients with pneumothorax presenting within three consecutive days. Meteorological factors were compared between days with and without pneumothorax patients. This comparison was based on meteorological data from the day of symptom onset (D), the day before symptom onset (D1), and the difference between those days (D-D1). Meteorological data from the index day (D) were also compared between patients with first episode and recurrence of pneumothorax. RESULTS: The study included 149 (88.7%) men and 19 (11.3%) women. The mean age was 25.02±6.97 (range, 17-35; median, 26) years. Of note, 73 (43.4%) patients underwent surgery. The highest number of patients presented in November (n=19, 11.3%). In terms of season, most presentations occurred in autumn. Humidity was significantly lower on recurrence days compared with first episode (p=0.041). CONCLUSION: Our results indicated that meteorological factors (i.e., atmospheric pressure, humidity, wind speed, temperature, and precipitation) were not associated with pneumothorax development. By comparing the patients with first episode and recurrence, the humidity was significantly lower in the recurrence group.

Prolonged SARS-CoV-2 RNA shedding in a young man recovering from traumatic pneumothorax

We describe a case of prolonged SARS-CoV-2 RNA shedding in an HIV-negative 21-year-old man recovering from abdominal and thoracic trauma. Nasopharyngeal (NP) swabs collected at 12 time points over a 95-day span all tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Genotyping revealed canonical beta-variant E484K and N501Y mutations at earlier time points. Human rhinovirus, coronavirus NL63 and respiratory syncytial virus B were detected at different time points by RT-PCR. Full blood analysis at time point 9 (day 82) showed leukopenia with lymphocytosis. The patient's NP swab tested negative for SARS-CoV-2 by RT-PCR 101 days after the first positive test. The prolonged duration of SARS-CoV-2 RNA shedding in the context of trauma presented here is unique and has important implications for COVID-19 diagnosis, management and policy guidelines

Disección aérea masiva tras CPRE: reporte de caso y revisión de la literatura / Massive air dissection after ERCP: case report and literature review

Introducción. Por ser un procedimiento de mínima invasión, la colangiopancreatografía retrógrada endoscópica (CPRE) es el procedimiento más utilizado para el manejo de la patología litiásica biliar. Sin embargo, puede presentar complicaciones que comprometen la vida del paciente. Caso clínico. Paciente masculino de 63 años es llevado a CPRE por una coledocolitiasis recidivante gigante. Durante el procedimiento presentó una disección aérea masiva con neumotórax bilateral a tensión, secundarios a una perforación duodenal, que derivó en una fístula bilio-retroperitoneal. Se trató de forma conservadora con una adecuada evolución. Discusión. Se han descrito pocos casos de neumotórax como complicación de la CPRE. Se considera que este es el primer caso publicado de neumotórax a tensión manejado exitosamente de forma conservadora. Conclusión. El diagnóstico temprano de las disecciones aéreas es el único predictor independiente que podría cambiar el curso clínico de esta patología y su manejo dependerá de la experticia del cirujano y del estado clínico del paciente.

Introduction. Because it is a minimally invasive procedure, endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used procedure for the management of biliary lithiasic pathology. However, it can present complications that compromise the life of the patient. Clinical case. A 63-year-old male patient is taken to ERCP for a giant recurrent choledocholithiasis. During the procedure presented a massive air dissection with bilateral tension pneumothorax, secondary to a duodenal perforation, which led to a bilio-retroperitoneal fistula. It was treated conservatively with adequate evolution.Discussion. Few cases of pneumothorax have been described as a complication of ERCP. This is considered to be the first published case of tension pneumothorax successfully managed conservatively. Conclusion. Early diagnosis of air dissections is the only independent predictor that could change the clinical course of this pathology, and its management will depend on the expertise of the surgeon and the clinical status of the patient.

Application of CT-guided Localization with Medical Glue for Single and Two or More Small Pulmonary Nodules before Video-assisted Thoracic Surgery / 中国肺癌杂志

BACKGROUND@#The localization of pulmonary nodules is related to whether the lesions can be found and removed accurately and quickly. It is an important link for the success of minimally invasive video-assisted thoracic surgery (VATS). This study investigated the feasibility of medical glue localization under VATS video-assisted thoracoscopic computed tomography (CT) guidance for single pulmonary nodule and more than two pulmonary nodules, and compared with the accuracy and safety of single nodule localization.@*METHODS@#A retrospective analysis of the clinical data of patients who underwent unilateral CT-guided medical glue localization before VATS from November 2018 to March 2021 were performed, the patients was divided into multiple pulmonary nodules group (localized nodules ≥2) and single pulmonary nodule group according to the number of localized nodules. The localization time, success rate and complication rate of the two groups were compared.@*RESULTS@#There were 126 nodules in the two groups, including 62 in single pulmonary nodule group and 64 in multiple pulmonary nodules group. The average single nodule localization time was (13.23±4.5) min in single pulmonary nodule group and (10.52±2.8) min in multiple pulmonary nodules group, the difference between the two groups is statistically significant (P<0.05). The localization success rate of single pulmonary nodule group and multiple pulmonary nodules group were 100% and 98.4% separately, the difference between the two groups was not statistically significant (P>0.05). All VATS were successfully completed after localization. The incidence of pneumothorax was higher in multiple pulmonary nodules group than in single pulmonary nodule group (P=0.07).@*CONCLUSIONS@#Compared with localization of single lung nodule, unilateral CT-guided medical glue localization for multiple pulmonary nodules before VATS is also feasible and accuracy, it is worthy of clinical application. But the higher rate of pneumothorax should be paid attention to.

Postoperative management of spontaneous pneumothorax in arthroscopic shoulder superior capsular reconstruction: A case report and review of literature / 中华创伤杂志(英文版)

Arthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears, but spontaneous pneumothorax after surgery is very rare. The present case was a 66-year-old female with irreparable rotator cuff tears of the right shoulder, treated with the arthroscopic shoulder superior capsular reconstruction. The general anesthesia and operation went smoothly, but the patient experienced stuffiness in the chest and shortness of breath after recovery from anesthesia. Thoracic CT scans showed spontaneous pneumothorax in the right side, which was successfully treated by the conservative treatments (oxygen therapy) according to multidisciplinary team. Prompt and accurate early-stage diagnosis is necessary in controlling postoperative complications and standardized treatment is the key to relieve the suffering. Spontaneous pneumothorax after arthroscopic shoulder surgery has been rarely reported in previous literatures.

Infiltrados Pulmonares con Neumotórax espontáneo: un desafío diagnóstico durante la pandemia de Covid 19 / Pulmonary infiltrates with spontaneous pneumothorax: a diagnostic challenge during the Covid 19 pandemic

Se presenta el caso de un paciente masculino de 60 años de edad, tabaquista de 135 paquetes/año con síntomas respiratorios agudos e infiltrados pulmonares bilaterales, en contexto de pandemia y cuyo diagnostico definitivo fue adenocarcinoma de pulmón, presentando durante su evolución neumotórax espontaneo. Arribar al diagnóstico definitivo puede llegar a ser un gran desafío por la similitud en la presentación radiológica como en los síntomas respiratorios atribuibles a COVID-19 y la dificultad para llevar a cabo los procedimientos diagnósticos. La sospecha de una neoplasia de pulmón, cuando se acompaña de un neumotórax debe incluirse dentro de los diagnósticos diferenciales, aunque se trate de una entidad poco frecuente.

We present the case of a 60-year-old male, a 135-pack/year smoker with acute respiratory symptoms and bilateral pulmonary infiltrates, in the context of a pandemic and whose definitive diagnosis was lung adenocarcinoma, presenting during his evolution spontaneous pneumothorax. Arriving at the definitive diagnosis can become a great challenge due to the similarity in the radiological presentation and in the respiratory symptoms attributable to COVID-19 and the difficulty in carrying out the diagnostic procedures. The suspicion of a lung neoplasm, when accompanied by a pneumothorax, should be included in the differential diagnoses, although it is a rare entity.

Neumotórax espontáneo / Spontaneous pneumothorax

Introducción: El neumotórax espontáneo es la causa más frecuente de ingreso urgente en los servicios de cirugía torácica. Objetivo: Caracterizar a pacientes ingresados con diagnóstico de neumotórax espontáneo. Métodos: Se realizó un estudio descriptivo de 93 pacientes con diagnóstico clínico y radiológico de neumotórax espontáneo, se establecieron las variables del estudio y se utilizaron frecuencias absolutas y porcentajes. Para la asociación de las variables se empleó el estadígrafo ji cuadrado con un nivel de confiabilidad del 95 por ciento. Resultados: Predominó el neumotórax espontáneo primario (65,5 por ciento), el sexo masculino fue el más afectado (80,6 por ciento), con mayor frecuencia en el hemitórax derecho (72,2 por ciento) y el tabaquismo como antecedente (83,9 por ciento). La pleurostomía mínima fue el tratamiento definitivo en el 72 por ciento de los pacientes. La complicación más frecuente después de la pleurostomía, fue la fuga persistente de aire. El tratamiento quirúrgico con pleurodesis mecánica, ofreció un 100 por ciento de efectividad. La mortalidad quirúrgica fue nula. Conclusiones: El neumotórax espontáneo predomina en el sexo masculino en una proporción de 4,2:1, en pacientes menores de 40 años de edad. El antecedente patológico personal que más se asocia es la enfermedad pulmonar obstructiva crónica. El síntoma predominante es el dolor torácico. El neumotórax espontáneo primario fue más frecuente y el hemitórax derecho el más afectado. El tabaquismo está presente como antecedente en ambos tipos de neumotórax espontáneo. La modalidad de tratamiento más utilizada es la pleurostomía mínima(AU)

Introduction: Spontaneous pneumothorax is the most frequent cause of urgent admission to thoracic surgery services. Objective: To characterize patients admitted with a diagnosis of spontaneous pneumothorax. Methods: A descriptive study of 93 patients with a clinical and radiological diagnosis of spontaneous pneumothorax was carried out, the study variables were established and absolute frequencies and percentages were used. For the association of the variables, the chi square statistic was used with a confidence level of 95 percent. Results: Primary spontaneous pneumothorax predominated (65.5 percent), the male sex was the most affected (80.6 percent), with greater frequency in the right hemithorax (72.2 percent) and smoking as the antecedent (83.9 percent). Minimal pleurostomy was the definitive treatment in 72 percent of the patients. The most frequent complication after pleurostomy was persistent air leak. Surgical treatment with mechanical pleurodesis offered 100 percent effectiveness. There was not surgical mortality. Conclusions: Spontaneous pneumothorax predominated in males in a ratio of 4.2: 1, in patients under 40 years of age. The most associated personal pathological history was chronic obstructive pulmonary disease. The predominant symptom was chest pain. Primary spontaneous pneumothorax was more frequent and the right hemithorax the most affected. Smoking was present as a history in both types of spontaneous pneumothorax. The most widely used treatment modality was minimal pleurostomy(AU)

Hallazgos tomográficos posoperatorios en pacientes con traumatismos torácicos / Tomographic postoperative findings in patients with thoracic trauma

Introducción: El trauma torácico se encuentra entre las primeras causas de muerte, fundamentalmente en personas jóvenes. Objetivos: Caracterizar a una población operada por traumatismos torácicos según variables clinicoepidemiológicas y describir los hallazgos tomográficos posquirúrgicos. Métodos: Se llevó a cabo un estudio observacional y descriptivo de 48 pacientes atendidos en el Servicio de Radiología del Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, de enero del 2016 a diciembre del 2018, a los cuales se les realizó tomografía computarizada multidetector. Resultados: Los traumas torácicos predominaron en personas jóvenes del sexo masculino, asociadas fundamentalmente a acciones violentas que provocaron traumas abiertos. La contusión pulmonar resultó ser el hallazgo tomográfico inicial más frecuente, en tanto, el neumotórax persistente y el hemotórax coagulado constituyeron los hallazgos tomográficos más influyentes en la decisión de una reintervención quirúrgica. Conclusiones: La tomografía es un medio diagnóstico que permite una descripción detallada del estado posoperatorio de los órganos afectados, con un alto valor orientativo para decidir procedimientos quirúrgicos posteriores.

Introduction: The thoracic trauma is among the first causes of death, fundamentally in young people. Objectives: To characterize a population operated due to thoracic trauma according to clinical epidemiological variables and describe the postsurgical tomographic findings. Methods: An observational and descriptive study of 48 patients assisted in the Radiology Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018, to whom a multidetector computed tomography was carried out. Results: The thoracic traumas prevailed in young male people, fundamentally associated with violent actions that caused open traumas. The lung contusion was the most frequent initial tomographic finding, as long as, the persistent pneumothorax and the coagulated hemothorax constituted the most influential tomographic findings in the decision of a surgical reintervention. Conclusions: Tomography is a diagnostic means that allows a detailed description of the postoperative state in the affected organs, with a high orientative value to decide later surgical procedures.

Comportamiento de las neumonías graves en el Hospital Pediátrico Borrás-Marfán. 2015-2019 / Behavior of severe pneumonia at Borrás-Marfán pediatric hospital. 2015-2019

Introducción: Las neumonías constituyen un grave problema de salud al ser causa frecuente de morbilidad y mortalidad infantil en el mundo. Objetivo: Describir el comportamiento de las neumonías graves en un grupo de pacientes ingresados en la Unidad de Terapia Intensiva Pediátrica (UTIP) del Hospital Pediátrico Docente Borrás-Marfán. Material y Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, en 223 pacientes que ingresaron en el servicio de terapia intensiva mencionado, entre agosto de 2015 y diciembre de 2019, con diagnóstico de neumonía grave. Se caracterizó la muestra según variables demográficas, complicaciones, procederes invasivos realizados, aislamiento microbiológico, antibióticos utilizados y estadía en el servicio. Para el análisis de los resultados se empleó la estadística descriptiva. Resultados: El grupo de edades más representativo fue el de 1-4 años, con un ligero predominio de varones. Las complicaciones más frecuentes fueron el derrame pleural, el neumatocele y el neumotórax. Requirieron toracocentesis el 40,81 por ciento de los casos y pleurotomía el 33,18 por ciento. El principal germen aislado fue el Streptococcus Pneumoniae y la mayoría de los pacientes necesitaron dos antibióticos para el tratamiento. Conclusiones: En el período estudiado, la principal complicación de la neumonía fue el derrame pleural y se realizó toracocentesis y pleurotomía en aproximadamente la mitad de los casos con buenos resultados. El uso de dos antibióticos en la mayoría de los pacientes según los protocolos establecidos resultó efectivo(AU)

Introduction: Pneumonia is a serious health problem because it is a frequent cause of infant morbidity and mortality worldwide. Objective: To describe the behavior of severe pneumonia in a group of patients admitted to the Pediatric Intensive Care Unit (PICU) of Borrás-Marfán Pediatric Hospital. Material and Methods: An observational, descriptive and retrospective study was conducted in 223 patients with the diagnosis of severe pneumonia admitted to the aforementioned intensive care service from August 2015 to December 2019. The sample was characterized according to demographic variables, complications, invasive procedures performed, microbiological isolation, type of antibiotics used, and the number of days spent in the hospital. Descriptive statistics was used for the analysis of results. Results: The most representative age group was 1-4 years, with a slight predominance of males. The most frequent complications were pleural effusion, pneumatocele and pneumothorax. In this group, 40.81 percentof the cases required thoracentesis and 33.18 percent underwent pleurotomy. The main isolated germ was the Streptococcus Pneumoniae and most of the patients needed treatment with two antibiotics. Conclusions: During the period studied, the principal complication of pneumonia was the pleural effusion. Approximately half of the cases underwent thoracentesis and pleurotomy and good results were achieved. The use of two antibiotics according to established protocols were effective, too(AU)

Barotrauma en COVID-19: Asociación de neumotórax y uso de cánula nasal de alto flujo / Barotrauma in COVID-19: Association between pneumothorax and high flow nasal cannula use

La cánula nasal de alto flujo (CNAF) es una alternativa en la oxigenoterapia de pacientes en insuficiencia respiratoria aguda hipoxémica, especialmente en contexto de pandemia por SARS-CoV-2. Existen muchos beneficios, con distintos niveles de evidencia y muy pocos efectos adversos reportados a su uso descritos en adultos. Se presenta el caso de un paciente con enfermedad pulmonar obstructiva crónica, que cursando con una neumonía grave por SARS-CoV-2, mientras recibía terapia con CNAF, desarrolló un neumotórax. Esta complicación asociada a la terapia con CNAF es poco reportada en la literatura, lo que motiva este reporte.

High Flow Nasal Cannula (HFNC) is an alternative to deliver oxygen in patients with hypoxemic acute respiratory failure, especially in the context of SARS-CoV-2 outbreak. There are plenty of benefits described, with different evidence levels and very few adverse effects published in adults until now. We report the case of a patient with chronic obstructive pulmonary disease, presenting with SARS-CoV-2 severe pneumonia that while receiving oxygen with HFNC developed pneumothorax. This complication associated with HFNC has not been commonly described, which motivates this report.

Neumotórax espontáneo bilateral metastásico. Inusual manifestación de metástasis pulmonar / Spontaneous metastatic bilateral pneumothorax. Unusual manifestation of lung metastasis

Resumen Objetivo: Comunicar el caso de una paciente de 77 años tratada de un angiosarcoma de cuero cabelludo, que evoluciona con neumotórax bilateral, cuyo estudio histopatológico informa enfermedad metastásica. Materiales y Método: Revisión de ficha clínica electrónica, registro informático de imagenología e informes de biopsias. Seguimiento ambulatorio en policlínico de cirugía. Resultados: Se realiza manejo por videotoracoscopía bilateral, con bulectomía más pleurodesis. Discusión: El neumotórax secundario por enfermedad metastásica es poco frecuente, aproximadamente 1% a 2% de los casos. De los tumores que más frecuentemente metastizan al pulmón se encuentran los sarcomas. Conclusión: El neumotórax metastásico es poco frecuente y requiere un alto índice de sospecha. Su manejo va a depender del pronóstico y de las condiciones generales del paciente.

Aim: To report the case of a 77-year-old patient treated for angiosarcoma of the scalp, who evolves with bilateral pneumothorax, whose histopathological study reports metastatic disease. Materials and Method: Review of electronic clinical record, computerized imaging record and biopsy reports. Outpatient follow-up at the polyclinic of surgery. Results: Management was performed by bilateral videothoracoscopy, with bulectomy plus pleurodesis. Discussion: Secondary pneumothorax due to metastatic disease is rare, approximately 1 to 2% of cases. Sarcomas are among the tumors that most frequently metastasize to the lung. Conclusion: Metastatic pneumothorax is infrequent and requires a high index of suspicion. Its management will depend on the prognosis and the general conditions of the patient.

Neumotórax espontáneo y enfisema bulloso bilateral / Spontaneous pneumothorax and bilateral bullous emphysema

Introducción. El objetivo de este artículo fue reportar el caso de un paciente con antecedente de enfisema bulloso bilateral que le ocasionó un neumotórax persistente de difícil tratamiento. Caso clínico. Se trata de un paciente de 50 años de edad con diagnóstico de neumotórax asociado con un enfisema bulloso bilateral, en quien estaba contraindicado el tratamiento quirúrgico. El cuadro clínico comenzó con dolor en el hemitórax derecho y disnea, que se fue intensificando hasta el punto de no tolerar el decúbito. En la radiografía de tórax se observó colapso del pulmón derecho con múltiples bulas en ambos pulmones, por lo que se practicó una pleurotomía mínima alta derecha. La evolución del paciente no fue favorable por persistir el neumotórax, lo cual llevó al uso de un tratamiento alternativo. Discusión. En los pacientes con neumotórax persistente por enfisema bulloso bilateral sin indicación quirúrgica, el talco es una alternativa menos invasiva para lograr una sínfisis pleural con buenos resultados, método cuya utilidad se demuestra

Introduction. The aim of this report was to present the case of a patient with a history of bilateral bullous emphysema that causes a persistent pneumothorax that was difficult to treat. Clinical case. This is a 50-year-old patient diagnosed with pneumothorax associated with bilateral bullous emphysema, in whom surgical treatment being contraindicated. The clinical picture began with pain in the right hemithorax and dyspnea, which intensified to the point of not tolerating decubitus. In the chest X-ray, collapse of the right lung was observed with multiple bullae in both lungs, therefore a right upper minimum pleurotomy was performed. The patient's evolution was not favorable due to persisting pneumothorax, which led to the use of an alternative treatment. Discussion. In patients with persistent pneumothorax due to bilateral bullous emphysema without surgical indication, talc is a less invasive alternative to achieve a pleural symphysis with good results, a method whose utility is demonstrated

Iatrogenic Tension Pneumothorax after Fiberoptic-guided Intubation in a Pediatric Patient: A Case Report

@#<p style="text-align: justify;">Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.<br /><br />This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.</p>