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1.
Medicine (Baltimore) ; 101(11)2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-1769457

ABSTRACT

BACKGROUND: During coronavirus pandemic, despite the increase in the number of studies on spontaneous pneumothorax (SP), there is not enough bibliometric study in the literature. In this study, it was aimed to analyze scientific articles published on SP. METHODS: Studies published on SP between 1980 and 2021 were obtained from the Web of Science database and analyzed using statistical and bibliometric methods. Spearman correlation coefficient was used for correlation studies. The exponential smoothing estimator was used to forecast publication trend for coming years. Network visualization maps were used to analyze citations and identify trending topics. RESULTS: A total of 2422 publications were found. 1403 (57.9%) of these publications were articles. The articles on SP have increased with a non-linear trend in recent years. The top 5 contributors to the literature were USA (231, 16.4%), Japan (161, 11.4%), United Kingdom (98, 6.9%), France (81, 5.7%), and Taiwan (78, 5.5%). The top 3 most active institutions were National Taiwan University Hospital (22, 1.5%), Catholic University Korea (19, 1.3%), and National Taiwan University (19, 1.3%). The top 3 journals that published the most articles were Chest (51), Annals of Thoracic Surgery (46), and Journal of Thoracic Disease (45). The most studied subjects were primary SP, recurrence, thoracoscopy, pleurodesis, video-assisted thoracoscopic surgery, COVID-19, video-assisted thoracic surgery, chest tube(s), and secondary spontaneous pneumothorax. According to trend topics analysis, the keywords studied in recent years are COVID-19, chest tubes, pneumonia, subcutaneous emphysema, risk factors, dyspnea, primary SP, FLCN gene, tension pneumothorax, uniportal, postoperative recurrence, secondary spontaneous pneumothorax, chronic obstructive pulmonary disease, and uniportal. CONCLUSION: In this comprehensive bibliometric study, we summarized 1403 articles about SP, which has an increasing trend in the number of articles during the COVID-19 pandemic process. This article can be a useful resource for clinicians and scientists through presenting a summary of worldwide studies related to SP, including the ones during COVID-19 pandemic.


Subject(s)
COVID-19 , Pneumothorax , Bibliometrics , COVID-19/epidemiology , Humans , Pandemics , Pneumothorax/epidemiology , Pneumothorax/surgery , Thoracic Surgery, Video-Assisted
2.
Sensors (Basel) ; 22(6)2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1765833

ABSTRACT

Pneumothorax is a thoracic disease leading to failure of the respiratory system, cardiac arrest, or in extreme cases, death. Chest X-ray (CXR) imaging is the primary diagnostic imaging technique for the diagnosis of pneumothorax. A computerized diagnosis system can detect pneumothorax in chest radiographic images, which provide substantial benefits in disease diagnosis. In the present work, a deep learning neural network model is proposed to detect the regions of pneumothoraces in the chest X-ray images. The model incorporates a Mask Regional Convolutional Neural Network (Mask RCNN) framework and transfer learning with ResNet101 as a backbone feature pyramid network (FPN). The proposed model was trained on a pneumothorax dataset prepared by the Society for Imaging Informatics in Medicine in association with American college of Radiology (SIIM-ACR). The present work compares the operation of the proposed MRCNN model based on ResNet101 as an FPN with the conventional model based on ResNet50 as an FPN. The proposed model had lower class loss, bounding box loss, and mask loss as compared to the conventional model based on ResNet50 as an FPN. Both models were simulated with a learning rate of 0.0004 and 0.0006 with 10 and 12 epochs, respectively.


Subject(s)
Deep Learning , Pneumothorax , Computers , Humans , Pneumothorax/diagnostic imaging , Thorax , X-Rays
4.
Eur Rev Med Pharmacol Sci ; 26(5): 1765-1769, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1754186

ABSTRACT

OBJECTIVE: Few data are available on the ICU management and on the possible respiratory complications of invasively ventilated pregnant patients affected by COVID-19 pneumonia, especially in the early phase of pregnancy. Tension pneumothorax has been previously described as a rare cause of respiratory failure after delivery, but its occurrence in the postpartum of COVID-19 patient has not been reported yet. We hereby describe the ICU management of a 23rd gestational week pregnant woman who underwent invasive mechanical ventilation, prone positioning, and cesarean delivery during her ICU stay for COVID-19 related pneumonia. Moreover, we focused on the occurrence and management of recurrent tension pneumothorax after the cesarean delivery. CASE REPORT: A 23rd gestational week pregnant woman was admitted to the ICU for a COVID-19 bilateral pneumonia and underwent invasive mechanical ventilation and prone positioning. Cesarean delivery was planned during the ICU stay, while the patient was receiving invasive mechanical ventilation. After delivery, the patient experienced a recurrent pneumothorax that required the positioning of multiple chest drains. CONCLUSIONS: In pregnant critically ill COVID-19 patients, mechanical ventilation management is particularly challenging, especially in the postpartum period. Prone positioning is feasible and can improve oxygenation and respiratory system compliance, while tension pneumothorax must be suspected if the respiratory function suddenly deteriorates after delivery.


Subject(s)
COVID-19/complications , Cesarean Section , Critical Illness , Pneumothorax/etiology , Postoperative Complications/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Adult , COVID-19/diagnostic imaging , Female , Humans , Infant, Newborn , Postoperative Complications/diagnostic imaging , Pregnancy , Prone Position , Recurrence , Respiration, Artificial , Respiratory Distress Syndrome/diagnostic imaging , Treatment Outcome
5.
Clin Med (Lond) ; 22(2): 188-189, 2022 03.
Article in English | MEDLINE | ID: covidwho-1753950
6.
BMJ Open ; 12(2): e053398, 2022 02 21.
Article in English | MEDLINE | ID: covidwho-1709529

ABSTRACT

OBJECTIVES: To study the incidence, characteristics, treatment, associated risk factors and outcome of COVID-19-associated pneumothorax in intensive care unit (ICU). DESIGN: Retrospective observational data review. SETTING: A multicentre study from ICUs of three tertiary care hospitals in Qatar. PARTICIPANTS: 1788 patients with COVID-19 pneumonia requiring ICU admission from 1 March 2020 to 1 November 2020 were enrolled in this study. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was to identify the incidence of COVID-19-associated pneumothorax in patients requiring ICU admission. Secondary endpoints were to determine the associated risk factors, treatment, mortality and morbidity. RESULTS: 1788 patients from 3 centres were reviewed in the study. The total episodes of pneumothorax were 75. Pneumothorax occurred in 4.2% of the patients with COVID-19 pneumonia requiring ICU admission. The majority of the subjects were male (n=72, 96%). The mean age was 55.1 (±12.7 years). The majority of the subjects were nationals of South Asian countries and the Middle East and North Africa regions. 52% (n=39) of the patients were previously healthy without comorbidities before ICU admission. The recurrence rate was 9.3%. The median length of ICU stay was 28 days (20.5-45.8 days). After developing pneumothorax, the length of mechanical ventilation ranged from 6 to 32 days, with a median of 13 days. 44% of patients eventually ended up with tracheostomy. In-hospital mortality in the patients with COVID-19-related pneumothorax was 53.3% (n=40). The odds of mortality in patients with COVID-19 pneumonia with pneumothorax is 7.15 (95% CI 4.45 to 11.48, p<0.0001) compared with those who did not develop pneumothorax. This indicates pneumothorax is a potential independent risk factor associated with mortality in patients with COVID-19 pneumonia requiring ICU admission. CONCLUSIONS: Pneumothorax is a common complication in patients with COVID-19 requiring ICU admission, associated with poor prognosis and outcome. TRIAL REGISTRATION NUMBER: The study was approved by the Medical Research Centre (MRC) Qatar. (MRC-01-20-1116).


Subject(s)
COVID-19 , Pneumothorax , Critical Care , Female , Humans , Intensive Care Units , Male , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Qatar/epidemiology , Retrospective Studies , SARS-CoV-2
7.
J Med Case Rep ; 16(1): 88, 2022 Feb 22.
Article in English | MEDLINE | ID: covidwho-1700364

ABSTRACT

BACKGROUND: Coronavirus disease 2019 has been associated with a plethora of different manifestations of systems affected (including pulmonary, gastrointestinal, and thrombotic disease) and time to presentation of complications. Pneumothorax has been established as a complication in the literature. However, tension pneumothorax remains a rare presentation with higher mortality. We report a case of secondary tension pneumothorax in a patient following apparent recovery from coronavirus disease 2019 pneumonitis. CASE PRESENTATION: Eight days after resolution of coronavirus disease 2019 pneumonitis symptoms, a 51-year-old Caucasian man with no pre-existing pulmonary disease was brought into the emergency department following 48 hours of progressive shortness of breath. Further clinical assessment revealed reduced breath sounds in the right lung, blood pressure was 116/95 mmHg, and jugular venous pressure was not elevated. Chest x-ray showed right-sided tension pneumothorax with mediastinal shift. Insertion of a chest drain led to rapid resolution of symptoms, and the patient was discharged following full re-expansion of the lung. CONCLUSIONS: The period of recovery from coronavirus disease 2019 is variable. Clinicians should consider tension pneumothorax as a possible complication of coronavirus disease 2019 pneumonitis in patients presenting with type 1 respiratory failure, even after resolution of pneumonitis symptoms and a considerable time period following initial contraction of coronavirus disease 2019.


Subject(s)
COVID-19 , Pneumothorax , Chest Tubes/adverse effects , Humans , Male , Middle Aged , Pneumothorax/complications , Pneumothorax/etiology , SARS-CoV-2 , Tomography, X-Ray Computed
8.
J Coll Physicians Surg Pak ; 32(2): 230-232, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1675597

ABSTRACT

Spontaneous pneumomediastinum with COVID pneumonia is a rare occurrence with or without accompanying subcutaneous emphysema or pneumothorax. The aim of this study was to establish relation of this complication to severity of lung disease and its clinical outcome. The study was conducted for a period of seven months from April to October 2020 in the CT Department of Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan. All COVID positive patients having spontaneous pneumomediastinum on high resolution CT (HRCT) chest were included (n=14). These patients were assessed for severity of lung disease as per CT severity score (CTSS), and were followed up for their clinical outcome. All patients with spontaneous pneumomediastinum had moderate to severe degree of COVID pneumonia; mortality in patients with pneumomediastinum was 50%; and was seen in those patients who had greater severity of lung disease as per the CTSS. Key Words: Spontaneous, Pneumomediastinum, COVID, Pneumothorax, Subcutaneous, Emphysema.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology
9.
Drug Discov Ther ; 15(6): 310-316, 2021.
Article in English | MEDLINE | ID: covidwho-1622789

ABSTRACT

COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Tertiary Healthcare
10.
Turk J Med Sci ; 51(6): 2822-2826, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1580296

ABSTRACT

Background/aim: As the number of case reports related to the new type of coronavirus (COVID-19) increases, knowledge of and experience with the virus and its complications also increase. Pleural complications are one relevant issue. We aimed in this study to analyze pleural complications, such as pneumothorax, pneumomediastinum, and empyema, in patients hospitalized with the diagnosis of COVID-19 pneumonia. Materials and methods: The files of patients who have pleural complications of COVID-19 pneumonia and were consulted about thoracic surgery between March 2020 and December 2020 were retrospectively reviewed. The data of the patients were analyzed according to age, sex, length of stay, treatment method for pleural complications, mortality, severity of COVID-19 pneumonia, tube thoracostomy duration, and presence of a mechanical ventilator. Results: A total of 31 patients fulfilling the inclusion criteria were included in the study. There were 11 female (35.5%) and 20 male (65.5%) patients. The most common complication was pneumothorax in 20 patients (65%). The median duration of hospitalization was 22 days and the mortality rate was 71%. Mortality was significantly higher in patients on mechanical ventilation (p = 0.04). Conclusion: The mortality rate is very high in patients with pleural complications of COVID-19 pneumonia. Pneumothorax is a fatal complication in critically ill patients with COVID-19 pneumonia.


Subject(s)
COVID-19/complications , Length of Stay/statistics & numerical data , Pneumothorax/etiology , Adult , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Mediastinal Emphysema , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/mortality , Retrospective Studies , SARS-CoV-2
11.
J Emerg Med ; 61(5): 581-586, 2021 11.
Article in English | MEDLINE | ID: covidwho-1587294

ABSTRACT

BACKGROUND: Coronavirus-19 disease (COVID-19) primarily affects the respiratory tract, causing viral pneumonia with fever, hypoxemia, and cough. Commonly observed complications include acute respiratory failure, liver or kidney injury, and cardiovascular or neurologic symptoms. In some patients, inflammatory damage results in long-term complications, such as pulmonary fibrosis, chronic pulmonary thrombotic microangiopathy, or neurologic symptoms. The development of spontaneous pneumothorax is reported as a rare complication mainly in consequence to mechanic ventilation in the criticall ill. CASE REPORT: We report 2 cases of patients with COVID-19 pneumonia complicated by spontaneous pneumothorax and bullous lesions of the lung. Bilateral giant bullae were observed in 1 of the cases. This complication occurred after an initial resolvement of respiratory symptoms (day 16 and day 29 after COVID-19 treatment was started). Initially, both patients had shown a rather mild course of COVID-19 pneumonia and no mechanical ventilatory support had been necessary. Why Should an Emergency Physician Be Aware of This?: In both cases, COVID-19 caused alveolar damage and the formation of thoracic bullae with consequent spontaneous pneumothorax as a serious complication. Emergency physicans must be aware of this complication even if the initial COVID-19 symptoms have resolved. © 2021 Elsevier Inc.


Subject(s)
COVID-19 , Pneumothorax , Blister/virology , COVID-19/complications , COVID-19/drug therapy , Humans , Pneumothorax/virology
12.
Ann Thorac Surg ; 113(1): e1-e3, 2022 01.
Article in English | MEDLINE | ID: covidwho-1568515

ABSTRACT

Pneumothorax and persistent air leak are documented complications of severe acute respiratory syndrome coronavirus 2 infection. Patients who fall into this category are often poor candidates for invasive thoracic surgical intervention. Endobronchial valves offer an effective and less invasive treatment option and can successfully treat persistent air leak and support the weaning of patients with severe acute respiratory syndrome coronavirus 2 pneumonia off ventilation.


Subject(s)
COVID-19/complications , Pneumothorax/etiology , Pneumothorax/surgery , Prostheses and Implants , Humans , Male , Middle Aged
13.
BMJ Case Rep ; 14(12)2021 Dec 08.
Article in English | MEDLINE | ID: covidwho-1560891

ABSTRACT

We report a case of an adult patient with COVID-19 pneumonia presenting as pneumatoceles as a late complication. These pneumatoceles are steroid-resistant and can predispose to cavitary lesions. These cystic lesions need close follow-up with repeat imaging as these can increase the risk of pneumothorax. It can take up to around 12 weeks for the spontaneous resolution of pneumatoceles.


Subject(s)
COVID-19 , Cysts , Pneumothorax , Adult , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2
14.
Sultan Qaboos Univ Med J ; 21(4): 660-663, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1551955

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, represents an unprecedented global threat. We report a 78-year-old male patient who presented to the Emergency Department at a tertiary care hospital in Muscat, Oman, in June 2020 with a one-day history of right chest pain and severe breathlessness. The patient was an ex-smoker and known to have idiopathic pulmonary fibrosis (IPF) with two previous pneumothoraces in the left lung. On presentation, the patient was breathless with an oxygen saturation of 90% on room air. Chest X-ray demonstrated bilateral lung infiltrates and right-sided pneumothorax. The patient tested positive for SARS CoV 2. A chest drain was placed which resulted in good resolution of the pneumothorax. The patient's condition improved remarkably and he was discharged after 17 days of hospitalisation. To the best of the authors' knowledge, this was the first case of pneumothorax reported in a patient infected with COVID-19 who was known to have underlying IPF.


Subject(s)
COVID-19 , Pneumothorax , Aged , Humans , Male , Pneumothorax/diagnosis , Pneumothorax/etiology , RNA, Viral , SARS-CoV-2
15.
Clin Med (Lond) ; 21(6): e615-e619, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1551858

ABSTRACT

BACKGROUND: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. METHODS: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. RESULTS: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001). CONCLUSIONS: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Humans , Intensive Care Units , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2
16.
Curr Opin Pulm Med ; 28(1): 62-67, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1550615

ABSTRACT

PURPOSE OF REVIEW: Pneumothorax is a global health problem. To date, there is still significant variation in the management of pneumothorax. For the past few years, there have been significant developments in the outpatient management of both primary and secondary spontaneous pneumothorax (SSP). We will review the latest evidence for the management of nontraumatic pneumothorax (spontaneous and iatrogenic) to include pneumothorax associated with COVID-19 infection. RECENT FINDINGS: Outpatient management of both primary and SSP may be safe and feasible. SUMMARY: Outpatient management of both primary and SSP should be included in treatment options discussion with patients.


Subject(s)
COVID-19 , Pneumothorax , Humans , Pneumothorax/therapy , SARS-CoV-2
17.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(9): 552, 2021 11.
Article in English | MEDLINE | ID: covidwho-1540930
19.
BMJ Case Rep ; 14(11)2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1526473

ABSTRACT

Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5-7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.


Subject(s)
COVID-19 , Emphysema , Pneumothorax , Adult , Bronchoscopy , Humans , Male , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2
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