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.

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)

Neumotórax catamenial. presentación de un caso / Pneumotórax catamenial. apresentação do caso / Catamenial pneumothorax. case presentation

Se reportó un caso de paciente femenina, mestiza de 29 años de edad con antecedentes de hipotiroidismo y conización por neoplasia intraepitelial cervical grado II, que realizó tres neumotórax en un plazo de 2 años, estando en reposo y durante el segundo día del ciclo menstrual. Es ingresada en la sala de Neumología del Hospital General "Dr. Juan Bruno Zayas Alfonso", con el diagnóstico probable de neumotórax secundario a endometriosis pleural. Se le realizó videotoracoscopia y laparoscopia con toma de muestra para estudio histológico. Se estableció el diagnóstico definitivo de neumotórax catamenial, se le hizo pleurodesis química con talco, tratamiento hormonal y antiinflamatorios no esteroideos (AINES), con lo que presentó una evolución satisfactoria(AU)

A case of a 29-year-old female, mixed race patient with a history of hypothyroidism and conization due to cervical intraepithelial neoplasia grade II was reported, who performed three pneumothorax within 2 years, being at rest and during the second day of the menstrual cycle. She is admitted to the Pulmonology ward of the General Hospital Dr. Juan Bruno Zayas Alfonso, with the probable diagnosis of pneumothorax secondary to pleural endometriosis. He underwent videotoracoscopy and laparoscopy with sampling for histological study. The definitive diagnosis of catamenial pneumothorax was established, chemical pleurodesis was made with talc, hormonal treatment and nonsteroidal anti-inflammatory drugs (NSAIDs), which presented a satisfactory evolution(AU)

Foi relatado o caso de uma paciente do sexo feminino, 29 anos, de raça mista, com história de hipotireoidismo e conização por neoplasia intraepitelial cervical grau II, que realizou três pneumotórax em 2 anos, estando em repouso e durante o segundo dia do ciclo menstrual. Ela é internada na enfermaria de Pneumologia do Hospital Geral "Dr. Juan Bruno Zayas Alfonso", com provável diagnóstico de pneumotórax secundário à endometriose pleural. Foi submetido a videotoracoscopia e laparoscopia com amostragem para estudo histológico. Foi estabelecido o diagnóstico definitivo de pneumotórax catamenial, realizada pleurodese química com talco, tratamento hormonal e antiinflamatórios não esteróides (AINEs), que apresentaram evolução satisfatória(AU)

Caracterización de lesionados con hemoneumotórax traumático en el Hospital Universitario "General Calixto García" (2012 - 2014) / Characterization of injured patients with traumatic hemo-pneumothorax at General Calixto García University Hospital (2012-2014)

Introducción: el trauma torácico constituye una causa frecuente de mortalidad temprana y tardía que ocurre en 25 por ciento del total de lesionados. Objetivo: caracterizar el comportamiento clínico-epidemiológico de los lesionados con diagnóstico de hemoneumotórax traumático. Métodos: se realizó un estudio observacional descriptivo, longitudinal retrospectivo, que incluyó 357 lesionados con diagnóstico de hemoneumotórax traumático, ingresados en el servicio de cirugía general del Hospital Universitario General Calixto García desde el 1 de enero de 2012 hasta 31 de diciembre de 2014. Se incluyeron variables como: edad, sexo, causa del trauma, atención médica prehospitalaria y hospitalaria, índice de gravedad de la lesión, lesiones asociadas, estadía hospitalaria y estado al egreso. Resultados: predominó el sexo masculino (78,1 por ciento ) y la edad de 20 a 39 años (26,0 por ciento ). Los accidentes de tránsito fueron la principal causa del trauma y la gravedad se incrementó por la presencia de traumas raquimedulares y choque hipovolémico. Los lesionados clasificados como moderados según el índice de gravedad de la lesión fueron 53,3 por ciento. Los lesionados que llegaron al hospital una a dos horas de ocurrido el trauma fueron 41,2 por ciento. La estadía hospitalaria con mayor número de egresados vivos fue entre cuatro y cinco días. Los fallecimientos ocurrieron en su mayoría después de los siete días. Las lesiones asociadas y la descompensación de las enfermedades crónicas fueron las responsables del mayor número de fallecidos (n= 46 12,9 por ciento). Conclusiones: las características clínico-epidemiológicas de los lesionados con hemoneumotórax traumático coinciden con las reportadas por estudios nacionales e internacionales(AU)

Introduction: thoracic trauma is a common cause for early and late mortality, occurring in 25 percent of all injured patients. Objective: to characterize the clinical and epidemiological behavior of the injured patients with traumatic hemo-pneumothorax. Methods: a descriptive, retrospective, longitudinal study was carried out, involving 357 injured patients diagnosed with traumatic hemo-pneumothorax and admitted to the general surgery service at General Calixto García University Hospital from January 1, 2012 until December 31, 2014. The variables included were age, sex, cause for trauma, pre-hospital and hospital care, severity rate of injury, associated injuries, hospital stay and discharge status. Results: there was a predominance of males (78.1 percent ) and of ages 20-39 years (26.0 percent ). Traffic accidents were the main cause for trauma and severity increased by the presence of hypovolemic shock trauma and spinal cord injuries. According to the injury severity index, 53.3 percent of the injured patients were classified as moderate. 41.2 percent of the injured patients arrived at the hospital 1-2 hours after the trauma. The hospital stays for highest number of admitted alive was between four and five days. The deaths occurred mostly after seven days. Associated injuries and decompensation of chronic diseases were causes for the largest amount of deaths (12.9 percent , n= 46). Conclusions: the clinical and epidemiological characteristics of the injured patients with traumatic hemo-pneumothorax match those reported by national and international studies(AU)

Pneumotórax no trauma torácico fechado: abordagem inicial e tratamento / Pneumotorrax in closed thoracic trauma: initial approach and treatment

O pneumotórax é uma das complicações mais comuns do trauma torácico fechado. O objetivo deste artigo é fazer uma revisão sobre o pneumotórax secundário ao trauma torácico fechado em adultos, com ênfase na abordagem inicial e no seu tratamento.

Pneumothorax is one of the most common complications of blunt thoracic trauma. The aim of this article is to review the initial evaluation and management of blunt thoracic trauma in adults.

Gastrotórax a tensión como causa de muerte por shock obstructivo: Caso clínico / Tension gastrothorax as a cause of death by obstructive shock - case report

Introduction: Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type. Objective: Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax. Case report: A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm. Conclusions: The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.

Introducción: El gastrotórax a tensión se produce por la herniación del estómago hacia el tórax, debido a un defecto congénito del diafragma, siendo el más frecuente la hernia diafragmática de Bochdaleck (HDB). Objetivo: Ejemplificar que, como diagnóstico diferencial del paciente con shock obstructivo y neumotórax a tensión, se debe considerar el gastrotórax a tensión. Caso clínico: Lactante masculino de 10 meses de edad, previamente sano, que evolucionó con dificultad respiratoria aguda, aumento de volumen de hemitórax izquierdo, ausencia de ruidos respiratorios e hiper-resonancia ipsilateral, saturación del 76%, piel fría y llenado capilar mayor de 5 segundos, seguido de un paro cardio-respiratorio. Debido a sospecha clínica de neumotórax se realizó descompresión mediante punción con aguja en conjunto con maniobras, con reversión del paro cardíaco, pero con persistencia de la inestabilidad respiratoria y hemodinámica, radiografía sugerente de hernia diafragmática. Se ingresó a cirugía confirmando la presencia de una hernia diafragmática de 5 cm. Conclusiones: La evolución del presente caso ilustra la dificultad para diferenciar un gastrotórax a tensión de un neumotórax a tensión en el contexto de paciente grave en la sala de urgencias, por lo que debe de tenerse un alto índice de sospecha para su identificación.

Primary spontaneous haemopneumothorax: An overlooked emergency.

Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.

Spontaneous pneumothorax during pregnancy: case report and literature review

Pneumothorax during pregnancy is a rare and potentially serious complication for both mother and fetus. Due to an increased need for oxygen during pregnancy and delivery, pneumothorax affects fetal oxygen supply, since it causes hypoxia in the mother. The authors describe a case of pneumothorax during pregnancy and conduct a literature review.

Incidencia del neumotórax en el Hospital Julio Trigo López / Incidence of pneumothorax in Julio Trigo Hospita

Objetivos: determinar el comportamiento del neumotórax como urgencia en el Hospital Julio Trigo López, en el período comprendido entre 1995-2004. Métodos: se realizó un estudio descriptivo, retrospectivo de corte transversal. Se analizaron las historias clínicas de los 555 pacientes con neumotórax en el Hospital Julio Trigo López en el período comprendido entre 1995 a 2004. El universo estuvo constituido por los 555 pacientes con diagnóstico de neumotórax, que fueron atendidos en nuestro hospital durante el período señalado. Resultados: el neumotórax es más frecuente en el sexo masculino (75,1 por ciento), y los grupos de edades afectados con más frecuencia se encontraron entre 21 y 40 años (52 por ciento). El 78 por ciento de los pacientes con neumotórax espontáneo son fumadores, y de los 43 pacientes que no tienen hábito de fumar, 37 de ellos tienen antecedentes de afecciones respiratorias, con predominio del enfisema, el asma bronquial y la bronquiectasia. Los neumotórax espontáneos fueron menos frecuentes en 195 pacientes (35,1 por ciento) en relación con los neumotórax traumáticos, que se presentaron en 360 pacientes (64,9 por ciento), y de ellos, 127 presentaron hemoneumotórax. Hubo 62 pacientes (11 por ciento) con complicaciones, y fueron las más frecuentes: la persistencia del cuadro (4,7 por ciento) y el shock hipovolémico (3,4 por ciento). Conclusiones: existe una relación directa entre las enfermedades crónicas respiratorias y los neumotórax espontáneos. Los neumotórax espontáneos recidivantes están relacionados con el hábito de fumar, la edad avanzada y con las afecciones respiratorias crónicas(AU)

Objectives: to determine the behavior of pneumothorax as emergency in Julio trigo Hospital from 1995 to 2004. Methods: a cross-sectional, retrospective and descriptive study was conducted. The medical records from 555 patients with pneumothorax admitted in above mentioned hospital between 1995-2004. Universe included 555 patients diagnosed with pneumothorax, seen in our hospital during the above period. Results: the pneumothorax is more frequent in male sex (75.1 percent ) and in age groups between 21 and 40 years old (52 percent). The 78 percent of patients presenting with spontaneous pneumothorax are smokers and from the 43 non-smokers patients 37 of them have backgrounds of respiratory affections with predominance of emphysema, the bronchial asthma and bronchiectasis. The spontaneous pneumothorax were less frequent in 195 patients (35.1 percent) related to those traumatic pneumothorax ones present in 360 patients (64.9 percent) and from them, 127 had hemo-pneumothorax. There were 62 patients (11 percent) with complications and the more frequent ones included: the persistence of this situation (4.7 percent) and hypovolemic shock (3.4 percent). Conclusions: the is a close relationship among the respiratory chronic diseases and the spontaneous pneumothorax. The relapsing spontaneous types are related to smoking, old age and chronic respiratory affections(AU)

Complicações em pacientes com fibrose cística / Complication of cystic fibrosis

A Fibrose Cística é uma doença genética, complexa, que compromete principalmente os aparelhos respiratório e digestivo. O diagnóstico precoce e o avanço das estratégias terapêuticas têm levado a um marcado aumento da sobrevida; no entanto, as complicações respiratórias e digestivas têm contribuído significativamente para importante morbimortalidade especialmente nos pacientes adultos. A progressão da doença respiratória pode causar complicações tais como hemoptise, pneumotórax e reações de hipersensibilidade pela colonização da via aérea por fungos. A doença gastrintestinal pode também ser complicada pela síndrome da obstrução intestinal distal.

Cystic Fibrosis is a complex genetic disease that damages especially the respiratory and the digestive systems. An early diagnosis and the advances in therapeutic strategies have led to a remarkable increase in survival rates. However, respiratory and digestive complications still contribute significantly to important mortality, especially in adult patients. The progress of respiratory disease may result in complications such as hemoptysis, pneumothorax and hypersensibility reactions due to fungi colonization of the airways. The gastrintestinal disease has also led to complications such as the distal intestinal obstruction disease.

Detección rápida de neumotórax mediante efast en pacientes con trauma múltiple / Rapic detection of pneumotorax through efast in patients with multiple trauma

El propósito de este estudio es evaluar la eficacia para diagnósticar apropiadamente neumotórax en pacientes con trauma multisistémico mediante eFAST realizado por cirujanos y residentes de cirugía en la Unidad de Trauma-Shock Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo. Se realizó un estudio prospectivo, observacional, descriptivo y transversal, durante el período comprendido entre enero 2008 y marzo 2009. Las variables estudiadas fueron: edad, sexo, mecanismo del trauma, lesiones asociadas estabilidad hemodinámica, tiempo de ralización de radiografías y el eFAST, sensibilidad, especificidad, valor predictivo negativo y positivo del eFAST con relación a las radiografías de tórax. Imágenes complementarias y conducta seguida. Un total de 169 eFAST fueron realizados en un período de 14 meses 36 casos (21,3%) fueron positivos para neumotórax, la edad promedio fue 32,67 ± 14,3 (15-84), el sexo masculino prevaleció con un 142 casos (84%), Mecanismo de trauma: colisión 84 casos (49,7%), trauma directo 22 casos (13%), lesiones asociadas: abdomen 59 casos(134,9%), 144 casos (85,2%) se encontraban hemodinámicamente estables 144 casos (85,2%). El tiempo de realización de las radiografías tuvo un promedio de 40,17 minutos ± 12,5 (20-90), el eFAST 2,94 ± 0,5 (2-5), eFAST obtuvo una sensibilidad de un 92,11% y una especificación de 99,24% mediante la combinación del análisis de la linea pleural en tiempo real y el signo de la estratósferas/arena de playa en modo movimiento/tiempo para diagnósticar neumotórax en pacientes con trauma torácico. El eFAST es una herramienta confiable que permite diagnósticar rápidamente neumotórax en pacientes con trauma multiple, portátil, facit, con una precisiòn diagnóstica comparables con la radiografía del tórax y que aporta información fundamental que permite orientar los esfuerzos del equipo quirúrgico en el manejo de estos pacientes.

The purpose of this study is to assess the effectiveness to properly diagnose pneumothorax in patients with multisystem trauma through eFAST performed by surgeons and surgery residents at the Trauma-Shock Unit of the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo. There was performed a prospective,observational, descriptive and cross-sectional study, during the period between January 2008 and March 2009, the studied variales were age, sex, mechanism of trauma, injury associated, hemodynamic stability, time realization of Rx and eFAST, sensitivity, specificity, positive and negative predictive value of the eFAST in relation to the chest X ray, additional images and conduct. A total of 169 eFAST were made in a period of 14 months 36 cases (21.3%) were positive for pneumothorax, the average, age was 32, 67 ± 14,3 (15-84), male prevailed with a 142 cases (84%). Mechanism of trauma 84 collisión cases (49.7%), trauma direct 22 cases (13%), injuries associated: abdomen 59 cases (34.9%), 144 cases (85.2%) were hemodynamically stable 144 cases (85.2%). Time of realization of X rays averaged 40, 17 minutes ± 12, 5 (20-90), eFAST 2,94 ± 0,5 (2-5), eFAST obtained a sensitivity of 92,11% and a specificity of 99,24 through a combination of the analysis of the pleural line in real time and the sign of the stratosphere/sand beach in motion/time mode to diagnose pneumothorax in patients with chest trauma. The eFAST is a reliable tool chat allows to quickly diagnose pneumothorax in patients with multiple trauma; portable, easy, accurately diagnosed comparable with chest X rays and that provides fundamental information allowing to guide the efforts of the surgical team in the management of these patients.

Manejo de una perforación inveterada de esófago torácico con parche pediculado de diafragma: informe de caso y revisión de literatura / Management of delayed thoracic esophageal perforation with pedicled diaphragmatic patch: case presentation and review

Introducción. La perforación de la porción intra-torácica del esófago es una condición potencialmente mortal y un desafío clínico. Caso. Presentamos el caso de un paciente masculino de 41 años de edad con neumotórax total izquierdo y antecedente de siete días antes haber sido sometido a instrumentación endoscópica del esófago para remoción de cuerpo extraño (trozo de carne), sufriendo perforación desapercibida del órgano. Se confirmó una fístula esófago-pleural por perforación desapercibida a 33 cms. de la arcada dental. Fue intervenido,realizándole empiemectomía, lavado y parche pediculado de diafragma por vía postero-lateral izquierda y gastrostomía. Una esofagoscopia realizada en el 20° día post-operatorio mostró cicatrización adecuada sin fuga ni estrechez. Conclusión. Se destaca el éxito del procedimiento a pesar de la evolución prolongada de la perforación en este caso...

Pneumomediastino espontâneo após esforço vocal: relato de caso / Spontaneous pneumomediastinum following vocal effort: a case report

Neste estudo é relatado o caso de um paciente do sexo masculino, 14 anos de idade, que após fazer grande esforço vocal, durante uma partida de futebol, desenvolveu quadro agudo de dor torácica. As radiografias de tórax e a tomografia computadorizada evidenciaram pneumomediastino, com pequeno pneumotórax bilateral. Os exames clínico, laboratoriais e radiológicos não demonstraram qualquer fator predisponente, ficando o caso classificado como pneumomediastino espontâneo.

The present article reports the case of a 14-year-old male patient who developed acute chest pain following increased vocal effort during a soccer game. Chest radiography and computed tomography demonstrated pneudomediastinum with small bilateral pneumothorax. Clinical, laboratory and radiological studies did not demonstrate any predisposing factor, and the case was classified as spontaneous pneudomediastinum.

Does the expiratory view in chest X-rays contribute to the diagnosis of suspected pneumothorax in the emergency department?

To evaluate the contribution of chest X-ray's [expiratory view] in the diagnosis of pneumothorax. In addition, to evaluate the clinical significance, and the need for emergency interventions, for those pneumothoracies that are missed when reading 2 views, inspiratory and lateral only, versus 3 views, inspiratory, expiratory and lateral. One-hundred and sixty-five groups of three X-ray chest views [inspiratory, lateral and expiratory] that had been ordered to rule-out pneumothorax, over a 2 year period at St. Joseph's Hospital Emergency Department in Hamilton, Ontario, Canada. In the first part of the study, the 2 views, inspiratory and lateral, were reviewed independently by two emergency staff and two emergency residents; expiratory view was excluded. In the second part of the study, at least 6 weeks later, the same four physicians reviewed the three views. Charts were reviewed for patients that were had a pneumothorax, according to the radiologist's diagnosis, and were missed by any of the four readers. Clinical significance and interventions were documented, i.e. admission for observation, needle aspiration and chest tube insertion. Using Kappa and correlation analysis, the agreement between the physicians and radiologist is significantly greater when three views are read relative to when only two views are read. Of all pneumothoracies, 28.5% were missed when the two views were used compared to 19% when three views were used. These results suggest that we still need 3 views to rule-out clinically significant pneumothrax in the emergency department. However, 2 views may be enough if a radiologist reads them

Estratégia diagnóstica no paciente com dor torácica. Parte 1: como conciliar rapidez e eficiência no diagnóstico diferencial? / Diagnostic techniques for patients with acute chest pain. Part 1: how to conciliate speed and efficiency in differential diagnosis?

A dor torácica é um dos sintomas mais temidos pelos médicos emergencistas, pois, muitas vezes, o diagnóstico diferencial é difícil e onoroso, e depende da experiência do profissional. Entre os possíveis diagnósticos podemos citar o infarto agudo do miocárdio, o aneurisma dissecante da aorta, o tromboembolismo pulmonar, o pneumotórax e a ruptura de esôfago como os de maior gravidade. Nesses casos, a abordagem tanto diagnóstica como terapêutica deverá ser a mais rápida possível, tendo implicação direta na sobrevida desses pacientes. Nesse sentido, a realização de exames de imagem torna-se crucial, como o ecocardiograma, a tomografia computadorizada, a ressonância nuclear magnética e a cineangiocoronariografia. Assim, se o diagnóstico for feito em tempo hábil e se houver profissional qualificado para o tratamento clínico ou cirúrgico, a mortalidade e as complicações serão minimizadas.

Echinococcal tension pneumothorax in a pregnant woman

Pulmonary hydatid cyst in pregnancy is a very rare pathology and its diagnosis and treatment is stilt a complex of problem. We report a rare case of ruptured giant pulmonary hydatid cyst presenting with tension pneumothorax during pregnancy. According to our knowledge this is the first report of such a case. A 21 -year old pregnant woman was admitted to our hospital with complaints of left-sided chest pain, cyanosis and dyspnea. Chest radiograph showed tension pneumothorax, mediastinal shift, and tracheal displacement. Echocardiography revealed perforated hydatid cyst adjacent to pericardium. She was taken to the operating room immediately. During operation, a giant perforated hydatid cyst [12x10cm] was found, outside the pericardium displacing and compressing the left lower lobe. Histopathological examination confirmed the diagnosis. Approximately 5 months later she had a spontaneous vaginal delivery. Both the patient and her baby were healthy. Perforated pulmonary hydatid cyst should be kept in mind in the differential diagnosis of tension pneumothorax in a pregnant woman and surgical intervention should be performed promptly

Tension Pneumothorax after Endoscopic Retrograde Pancreatocholangiogram

We report a case of tension pneumothorax after an endoscopic sphincterotomy. A 78-yr-old woman presented with progressing dyspnea. She had undergone an endoscopic retrograde cholangiopancreatogram three days before due to acute cholecystitis. She underwent endoscopic sphincterotomy for stone extraction, but the procedure failed. On arrival to our hospital, she complained about severe dyspnea and she had subcutaneous emphysema. A computed tomogram scan revealed severe subcutaneous emphysema, right-side tension pneumothorax, and pneumoretroperitoneum. Contrast media injected through a transnasal biliary drainage catheter spilled from the second portion of the duodenum. A second abdominal computed tomogram showed multiple air densities in the retroperitoneum and peritoneal cavity, which were consistent with panperitonitis. We recommended an emergent laparotomic exploration, but the patient's guardians refused. She died eventually due to septic shock. Endoscopic retrograde cholangiopancreatogram is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the neck soft tissue, eventually causing pneumothorax. Early recognition and appropriate management is crucial to an optimal output of gastrointestinal perforation and pneumothorax.

Produção de pneumotórax em cães e manejo por toracoscopia paraxifóide transdiafragmática / Production of pneumothorax in dogs and treatment by transdiaphragmatic paraxiphoid thoracoscopy

O presente estudo foi desenvolvido com o objetivo de avaliar a técnica de toracoscopia paraxifóide transdiafragmática no diagnóstico e no tratamento do pneumotórax produzido experimentalmente em cães. Para tanto, foram utilizados 11 cães que foram submetidos à produção de pneumotórax grave a partir da aplicação de 10mLkg-1 de ar em cada hemitórax até apresentarem descompensação hemodinâmica. Concomitantemente, foram aferidas a correlação entre a pressão venosa central (PVC) e o volume de ar introduzido (mL kg-1), bem como FC, FR, TPC, SpO2 e coloração das mucosas. O pneumotórax foi tratado pela aplicação de dreno torácico por meio de um trocarte inserido no lado direito (seis animais) ou esquerdo (cinco animais) do apêndice xifóide por meio do diafragma. A introdução em volume igual ou superior a 50ml kg-1hemitórax-1 de ar causou descompensação cardiorrespiratória e elevação da PVC acima de 10cm H2O em todos os pacientes. A técnica proposta permitiu apropriado exame da cavidade torácica e aplicação do dreno com efetiva drenagem, sem a ocorrência de complicações trans e pós-operatórias, condição confirmada pela toracoscopia intercostal aos 15 dias de pós-operatório. Conclui-se que o modelo de produção do pneumotórax e a técnica de colocação de dreno proposta para o manejo dessa doença são adequados para cães.

The aim of the present study was to assess the use of transdiaphragmatic paraxiphoid thoracoscopy for the diagnosis and treatment of experimentally induced pneumothorax in dogs. Severe pneumothorax was induced in 11 dogs by the insufflation of 10mL kg-1of air into each hemithorax until they became hemodynamically unstable. The correlation between central venous pressure (CVP) and the volume of injected air (mL kg-1) was determined, and was considered too heart rate, respiratory frequency, capillary refill time, oxygen saturation and the color of mucous membranes. Pneumothorax was treated with chest tube drainage with the placement of a trocar into the right side (six dogs) or into the left side (five dogs) of the xiphoid appendix through the diaphragm. The introduction of air volume equal to or greater than 50ml kg-1hemitórax-1 caused cardiorespiratory decompensation and increased the CVP to levels higher than 10cmH2O in all patients. Transdiaphragmatic paraxiphoid thoracoscopy allowed for adequate examination of the chest cavity and for effective drainage without any intraoperative and postoperative complications, as confirmed by intercostal thoracoscopy 15 days after surgery. The method for induction of pneumothorax and the chest tube placement technique proposed for its management are appropriate to be used in dogs.