Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage Due to Empyema / 대한중환자의학회지

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage Due to Empyema / 대한구급학회지

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Kirschner wire migration from subcapital humeral fracture site, causing hydropneumothorax / 中华创伤杂志(英文版)

Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.

Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Hidroneumotórax por tuberculosis en una mujer adulta / Hydropneumothorax due to tuberculosis in an adult woman

Se presenta el caso clínico de una paciente de 28 años de edad, que fuera remitida al Servicio de Neumología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar síntomas respiratorios (tos húmeda y expectoración mucosa) durante un período aproximado de 6 meses, además de síndrome general y, en ocasiones, febrícula. Posteriormente manifestó una disnea progresiva, que se volvió moderada ante los pequeños esfuerzos, unido a dolor torácico agudo en el lado izquierdo. Se determinó clínica y radiológicamente la existencia de hidroneumotórax; por lo que se le realizó una pleurotomía mínima baja y se inició el tratamiento antibacilar. Igualmente se efectuó la prueba de esputo para la búsqueda de bacilos ácido-alcohol resistentes, y se obtuvo codificación 8, de modo que fue confirmado el diagnóstico de tuberculosis pulmonar.

The case report of a 28 year-old patient is presented who was remitted to the Pneumology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba for presenting breathing symptoms (humid cough and mucous expectoration) during an approximate period of 6 months, besides general syndrome and, in occasions, slight fever. Later on she complained of progressive dyspnea which became moderate when making other small efforts, together with acute thoracic pain in the left side. It was determined clinically and radiologically the existence of an hydropneumothorax; for which a low minimum pleurotomy was carried out and the antibacillar treatment was applied. Equally the sputum test was carried out for finding acid-alcohol resistant bacilli, and code 8 was obtained, so the diagnosis of lung tuberculosis was confirmed.

Hemoneumotórax espontáneo: presentación de caso / Spontaneous Hemopneumothorax: A Case Report

El hemoneumotórax espontáneo es una condición inusual, caracterizada por la acumulación de aire y sangre en la cavidad pleural, no precedida por trauma. La radiografía de tórax es la herramienta principal en el diagnóstico de esta entidad. Se presenta el caso de un hombre de 22 años con hemoneumotórax espontáneo. El paciente se recuperó sin complicaciones luego de la cirugía.

Spontaneous hemopneumothorax is an unusual condition, characterized by the accumulation of air and blood in the pleural cavity, not preceded by trauma. Chest radiography is the main tool in the diagnosis of this entity. We present, a case of a 22-year-old male with spontaneous hemopneumothorax. The patient recovered after surgery with no complications.

Respiratory Complications Associated with Insertion of Small-Bore Feeding Tube in Critically Ill Patients / 대한구급학회지

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.

Endometriose pleural: achados na ressonância magnética / Pleural endometriosis: findings on magnetic resonance imaging

A endometriose é uma doença ginecológica benigna associada à dor pélvica e infertilidade que afeta principalmente mulheres em idade reprodutiva. A endometriose torácica afeta o parênquima pulmonar ou a pleura. Relatamos os casos de duas pacientes com endometriose pleural que apresentaram pneumotórax recorrente. Em ambos os casos, a ressonância magnética de tórax mostrou hidropneumotórax à direita e nódulos redondos, bem definidos, na superfície pleural à direita. A ressonância magnética é uma boa opção para a caracterização dos nódulos de endometriose pleural e de derrame pleural hemorrágico.

Endometriosis is a benign gynecological disorder associated with pelvic pain and infertility, primarily affecting women of reproductive age. Thoracic endometriosis affects the pulmonary parenchyma or pleura. We report the cases of two patients with pleural endometriosis who presented with recurrent pneumothorax. In both cases, magnetic resonance imaging (MRI) of the chest showed right hydropneumothorax and well-defined, rounded nodules on the pleural surface in the right hemithorax. We conclude that MRI is a good option for the characterization of pleural endometriotic nodules and hemorrhagic pleural effusion.

Pyopneumothorax secondary to aspergillus infection: a case report

A 32 -year- old male presented with complaints of fever, dry cough, breathlessness and right sided chest pain of two months duration. Chest radiograph showed right sided hydropneumothorax which revealed frank pus on diagnostic thoracocentesis, for which tube thoracostomy was done. Despite vigorous broad spectrum antibiotic coverage, postural drainage and chest physiotherapy, there was no clinical improvement. Further work up included serology, pleural fluid culture, closed as well as thoracoscopic guided pleural biopsy revealed growth of Aspergillus fumigatus. Patient was prescribed antifungal medication [Voriconazole] and subsequent thoracotomy with right sided pneumonectomy showed good clinical recovery

Boerhaave Syndrome Presenting as Abrupt Onset of Massive Hydropneumothorax

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.

Traumatic rupture of diaphragm with flail chest mimicking tension hydropneumothorax.

Traumatic rupture of diaphragm though not rare, presents as complication of penetrating and blunt injuries of chest and abdomen. Preoperative diagnosis of diaphragmatic injury is difficult because of the complex shape of the thin diaphragmatic muscle, the horizontal in-plane orientation of one diaphragmatic dome, and the often associated traumatic abnormalities in the lung bases. Failure to detect this underlying injury is associated with significant morbidity and mortality because of delayed visceral herniation, strangulation or both. We report a case of left-sided post traumatic rupture of diaphragm presenting as tension hydropneumothroax following a road traffic accident. It was managed as tension hydropneumothorax during initial resuscitation by intercostal tube drainage. Lack of improvement in the clinical condition led to the suspicion of diaphragmatic rupture. The patient was managed successfully by operative repair of diaphragm and manual reduction of hernial contents

Manifestações pleuropulmonares catameniais: relato de três casos / The pulmonary catamenial manifestations: three cases reports

As manifestações pulmonares catameniais apresentam-se de maneira variada. Podem ser identificadas como quadro de dor torácica, hidrotórax, hidropneumotórax ou pneumotórax, que acontecem durante o período menstrual. O pneumotórax catamenial, a manifestação mais freqüente, é um tipo pouco comum de pneumotórax espontâneo no qual há acúmulo recorrente de ar na cavidade torácica durante a menstruação. Foi descrito inicialmente em 1958 por Maurer et al. Incide principalmente entre a terceira e a quarta décadas de vida. Várias hipóteses são aventadas para explicar as possíveis causas dessa afecção. Também são várias as controvérsias acerca do tratamento mais adequado.

Sonography of the lungs and pleura

The role of Transthoracic Sonography in the evaluation of chest diseases has already been accepted throughout the world. Though Ultrasound [US] is not widely established as a routine method, but the advantages of low-cost, bedside availability and lack of ionizing radiation exposure has made it an indispensable diagnostic tool in the modern pulmonary medicine. US supplements the conventional chest X-ray and computed tomography and closes the gap between them. Besides, it is invaluable in the interventional procedures of chest and pleural space and it is suited to critically ill patients in need of bedside investigations. This article reviews the sono-graphic morphology of the pleural and peripheral pulmonary diseases

Serial CT Findings of Paragonimus Infested Dogs and the Micro-CT Findings of the Worm Cysts

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.

Interlobar hydropneumothorax.

We report a case of interlobar hydropneumothorax in a 42-year-old male with chronic obstructive pulmonary disease and a history of tuberculosis in the past. The diagnosis was suspected from chest roentgenograms that showed an incompletely circumscribed air containing space with a fluid level. The diagnosis was confirmed by computed tomography. This unusual presentation of hydropneumothorax with striking radiological features prompted us to report this case.

Nocardial hydropneumothorax.

Pleural involvement in nocardiosis is rarely reported from India. A case of hydropneumothorax due to Nocardia asteroides in a patient with diabetes mellitus is reported. Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung. Bronchoscopy may be useful if multiple sputum examinations are negative in diagnosing pulmonary nocardiosis.