Neumotórax bilateral espontáneo como forma de presentación de histiocitosis de células de Langerhans / Bilateral spontaneous pneumothorax as a setting of Langerhans cell histiocytosis

La histiocitosis de células de Langerhans pulmonar es una patología intersticial en la que existe un acumulo de células histiocíticas específicas a nivel pulmonar. El neumotórax espontáneo es una complicación reconocida de histiocitosis de células de Langerhans pulmonar y es secundario a la destrucción del parénquima pulmonar con cambios quísticos asociados. Reportamos el caso de un niño de 2 años con neumotórax espontáneo bilateral recurrente, con una tomografía axial computada de tórax con infiltrado intersticial, fibrosis, lesiones quísticas e imágenes bullosas. El diagnóstico fue establecido por examen histológico e inmunohistoquímica de tejido de biopsia pulmonar con anticuerpos CD1 y S100 positivos. El niño recibió tratamiento con prednisona y etopósido, con buena respuesta clínica y tomográfica.

Pulmonary Langerhans cell histiocytosis is an interstitial lung disease that results from the accumulation of specific histiocytic cells in the lung. Spontaneous pneumothorax is a recognized feature of pulmonary Langerhans cell histiocytosis and results from destruction of lung parenchyma with associated cystic changes. We report on a 2-year-old boy with recurrent bilateral spontaneous pneumothorax; a computed tomography scan showed marked interstitial changes, fibrosis, cystic spaces and bilateral bullae. The diagnosis was confirmed by the histology and the immunohistochemistry examination of the pulmonary biopsy with CD1 and S100 positive antibodies. The child was treated with prednisone and etoposide, and had a good clinical response and favorable changes in the second thoracic CT scan.

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.

Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis.

Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model. Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found. Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica / Necrotizing pneumonia in children submitted to thoracoscopy due to pleural empyema: incidence, treatment and clinical evolution

OBJETIVO: Analisar a incidência de pneumonia necrosante (PN) em crianças submetidas a toracoscopia e comparar pacientes com e sem PN em relação às diferentes apresentações e evolução clínica. MÉTODOS: Estudo retrospectivo de crianças portadoras de empiema e submetidas a toracoscopia. A toracoscopia foi realizada em pacientes não submetidos a drenagem torácica prévia e evidência de derrame septado ou pneumotórax, assim como naqueles submetidos previamente a drenagem torácica e pneumotórax persistente ou febre e secreção purulenta. Baseado na presença de PN durante a toracoscopia, os pacientes foram divididos em dois grupos: com PN e sem PN. RESULTADOS: Participaram do estudo 52 pacientes. Dos 24 pacientes com PN, 19 (79 por cento) foram submetidos a drenagem torácica anterior à toracoscopia, 11 (46 por cento) apresentaram pneumotórax, e 16 (67 por cento) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo de drenagem e de hospitalização foram, respectivamente, 18 e 19 dias. Dos 28 pacientes sem PN, 10 (36 por cento) foram submetidos a drenagem torácica anterior à toracoscopia, 9 (32 por cento) apresentaram pneumotórax, e 5 (18 por cento) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo médio de drenagem e de hospitalização foram, respectivamente, 6 e 10 dias. CONCLUSÕES: A PN deve ser suspeitada na presença de pneumotórax. A toracoscopia precoce pode ser uma opção terapêutica de grande valor na PN da infância, pois acelera a recuperação quando comparada ao tratamento médico isolado e evita ressecções pulmonares extensas da toracotomia tardia.

OBJECTIVE: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. METHODS: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). RESULTS: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79 percent) had undergone thoracic drainage prior to thoracoscopy, 11 (46 percent) presented with pneumothorax, and 16 (67 percent) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36 percent) had undergone thoracic drainage prior to thoracoscopy, 9 (32 percent) presented pneumothorax, and 5 (18 percent) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. CONCLUSIONS: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.

Air filled, inflammatory, lung pseudo-cyst: etio-pathogenesis and management.

Lung cysts in children are usually of congenital origin. Necrotising pneumonias, trauma, cystic fibrosis and kerosene poisoning may be the cause of acquired cysts in the lungs during childhood. We describe a child who presented with pneumothorax and was later discovered to have a cyst in his right lung. The cyst was resected and on histology found to be of inflammatory origin with no epithelial cell lining i.e. a pseudo-cyst. The immuno-histochemical staining of the inflammatory cells from the pseudo-cyst wall showed them to be predominantly histiocytes i.e:, CD68 antigen positive. The cells showed negative staining for S-100 (marker for Langerhans cells), cytokeratins (epithelial markers) and smooth muscle actins excluding the possibility of histiocytosisX, epithelial and congenital cysts respectively. This case illustrates the occurrence of acquired pulmonary pseudocysts unrelated to known etiologic agents which should be considered in the work-up for pneumothoraces.

Neumotórax en el recién nacido: experiencia de un servicio de cirugía de tórax / Pneumothorax in the newborn: experience of a thoracic surgery department

Objetivos: Evaluar la experiencia del Servicio de Cirugía de Tórax del Hospital Universitario de Maracaibo en el diagnóstico y tratamiento del neumotórax en el recién nacido. Métodos: 23 recién nacidos con neumotórax fueron evaluados por el Servicio de Cirugía de Tórax en la Emergencia Pediátrica, Unidad de Cuidados Intensivos Pediátricos y en el Servicio de Neonatología entre los años 2000–2004. Se recolectaron los datos relacionados con: la duración de la gestación, complicaciones maternas durante el embarazo, examen físico, estudios diagnósticos, tratamiento yevolución de los pacientes. Resultados: 13(56.52%) delos recién nacidos eran varones y la edad gestacional promedio fue de 35.25 +/- 2.49 semanas. 12(52.17%) nacieron por cesárea y 10(43.47%) tenían antecedentes de maniobras de reanimación al nacer. El neumotórax se localizó en el hemitórax izquierdo en 8 recién nacidos (34.78%), hemitórax derecho en 14 recién nacidos (60.86%) y en ambos hemitórax en 1 recién nacido (4.47%). 22 (95.65%) presentaron dificultad respiratoria El tratamiento incluyó una conducta expectante en 2 recién nacidos con neumotórax menor de 25%, y la colocación de tubo de toracostomía en 21 recién nacidos (91.30%) con neumotórax mayor de 25% Conclusión: el neumotórax es una complicación que se observa principalmente en el recién nacido con Apgar bajo al nacer o querequieren maniobras de reanimación y se presenta con dificultad respiratoria. Los neumotorax menores de 25% pueden manejarse con observación y radiología seriada, pero aquellos mayores de 25% requerirán colocación de tubo de toracostomía.

Objectives: To evaluate the experience of Thoracic Surgery Service in the diagnosis and treatment of pneumothorax in newborn at theHospital Universitario de Maracaibo.Methods: 23 newborn with pneumothorax were evaluated by the Thoracic Surgery Service in the Pediatric Emergency Unit, PediatricIntensive Care Unit and Neonatology Service between the years 2000-2004. Data was collected regarding gestational age, complications during the pregnancy, physical exam, diagnostic studies, treatment and evolution of the patients. Results: 13 (56.52%) were males, with mean gestational age of 35 +/- 2.5 weeks. 12 (52.17%) were born by caesarean section and 11(47.82%) by vaginal delivery. 10 newborns had history of resuscitation manoeuvres (43.47%). Pneumothorax was located in lefthemithorax in 8 newborn (34.78%), right hemithorax in 14 newborn (60.86%) and both hemithorax in 1 newborn (4.47%). 22 (95.65%)presented respiratory distress. Treatment included observation in 2 newborns with pneumothorax < 25%, and tube thoracostomy in 21 (91.30%) with pneumothorax > 25%. Conclusion: Pneumothorax is a complication seen mainly in newborns with low Apgar score and those who required resuscitation manoeuvres and almost always presents with respiratory distress. Pneumothorax < 25% can be treated with observation and serialradiology but those > 25%.will require tube thoracostomy.

Neumotórax iatrogénico: Nuestra experiencia / Iatrogenic Pneumothorax: authors' experience

Similar a lo observado por otros autores, notamos un incremento del neumotórax iatrogénico en nuestro hospital. El objetivo de este trabajo es conocer la incidencia y factores asociados a la morbimortalidad del NTXI y analizar la experiencia del operador como factor determinante.

Newborn emphysema attributed to medical actions (3 case report) / 法医学杂志

Three cases of newborn emphysema were reported. Parenchymatous emphysema, interstitial emphysema and bullous emphysema were all found in the three cases. One of the three cases showed accumulation of air in interstitial tissue. The air penetrated into septa of the lung at the beginning, then it probably split the hilus pulmonis to reach mediastinum as well as subcutaneous tissues of the chest, neck, abdomen, inguinal region and scrotum. The oxygen inhalation under pressure during first-aid may be the cause of the newborn emphysema.

Neumotorax (D) en RN / Neumotorax (D) in RN

Presenta Proceso de enfermería basado en un estudio realizado a un bebé ingresado en la sala de Neonatología en la Unidad de Cuidados Intensivos, del Hospital San Juan de Dios, durante el período de mayo a junio del 2001, con frecuencia cardíaca, sianótico. El objetivo del proceso es aplicar las etapas del proceso de enfermería en la elaboración de acciones que ayuden a mejorar las condiciones del paciente con Neumotorax

Quistes pulmonares traumáticos presentación de un caso / Cysts pulmonary traumatics presentation of on case

Presentamos el caso de un paciente sano quien posterior a un trauma cerrado de tórax en un accidente vial , desarolló un neumotórax izquierdo y lesiones quísticas con nivel en el hemitórax derecho, presenta insuficiencia respiratoria y posterior infección pulmonar que involucró las lesiones quísticas aéreas , ameritó ventilación mecánica y permanencia en terapia intensiva durante 11 días . Presentamos además las radiografías y las tomografías de tórax que muestran las lesiones quísticas y una radiografía tomada dos meses después mostrando la resolución de las mismas en forma espontánea

Osificación pulmonar idiopática con neumotórax espontáneo recidivante / Idiopathic pulmonary ossification with recidivant spontaneous pneumotorax

La osificación pulmonar idiopática puede ocurrir como depósito de hueso en el intersticio y en los espacios alveolares. La mayoría de los casos publicados han sido hallazgos de necropsia en sujetos viejos con enfermedad pulmonar crónica. Este caso se refiere a un joven con escasa sintomatología y peumotórax espontáneo de repetición, la osificación pulmonar fue diagnosticada por biopsia pulmonar. Las imágenes características de tipo dendriforme se demuestran por TACH

Pneumotorax e pneumoperitonio: uma associacao rara / Pneumothorax and pneumoperitonium: a rare association

A associacao de pneumotorax e pneumoperitonio e rara devido a diferenca de pressao entre o torax e o abdomen que e maior que 40cm H2O, tanto na inspiracao como na expiracao. Neste trabalho, apresentaremos dois casos desta associacao ocorridos na UTI do Hospital d Pronto Socorro de Porto Alegre (HPS), revisando sua fisiopatogenia, diagnostico e terapeutica

Videotoracoscopia para tratamento de pneumotorax espontaneo primario complicado / Video-assisted thoracoscopic surgery in the treatment of complicated spontaneous primary pneumothorax

Os autores apresentam sua experiencia inicial com o uso da videotoracoscopia no tratamento de dois casos de pneumotorax espontaneo primario. Os dois casos descritos foram operados no mes de julho de 1993, seguindo a mesma tecnica videotoracoscopica com uso de aparelhos de sutura mecanica e pleurodese abrasiva. Destaca-se o menor trauma cirurgico como vantagem do metodo, expresso no curto periodo de internacao dos pacientes e o rapido retorno as atividades laborativas dos pacientes. Diante dos resultados obtidos, os autores tracam um paralelo com a literatura mundial, ressaltando os criterios de indicacao do metodo

Spontaneous pneumothorax complicating active pulmonary tuberculosis

A retrospective study of spontaneous pneumothorax complicating active pulmonary tuberculosis was conducted at Ojha Institute of Chest Diseases [OICD], Karachi to asses quantum of this common complication after half a century of the advent of effective chemotherapy. Fifty-three% admissions [943] were due to active pulmonary tuberculosis in the year 1993. Among them 1.7% cases had spontaneous pneumothorax. Male to female ratio was 3:1. Most of the patients were adult between 15-44. Nearly half of the cases were smokers and were males. Majority had unilateral involvement. One third had hydrothorax as well. Half of the patients were managed conservatively. Mortality was almost fifty% as compared to pre-chemotherapeutic era