Cases reported "Pneumothorax"

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1/16. Pulmonary tuberculosis with unusual cystic change in an immunocompromised host.

    We present a rare case of upper zone cystic change of the lung with disseminated tuberculosis of a non-smoking 30-year-old immunocompromised male. He suffered from repeated pneumothorax. The basic pathological feature of video-assisted thoracoscopic lung biopsy revealed granulomatous involvement in the respiratory bronchioles with poorly developed epithelioid cells and disruption of elastic fibers. Electron microscopy demonstrated a decrease in elastic fibers and disruption of the epithelial basement membrane of the respiratory bronchiole and no langerhans cells in the lesion. autopsy of the lung revealed centroacinar distribution of multiple cystic lesions in the bilateral upper lobe. Almost all cystic walls showed loss of elastic fibers and cysts frequently involved the respiratory and terminal bronchioles, alveolar ducts and, occasionally, alveoli. Some larger cystic lesions revealed communication to the bronchi. The cystic changes in this case of pulmonary tuberculosis may be caused by a check-valve mechanism due to granulomatous involvement of the bronchioles and also by excavation of caseous necrotic material by draining bronchi.
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2/16. Haemodynamic compromise during thoracoscopic/laparoscopic oesophagectomy.

    Minimally invasive oesophagectomy is a relatively new procedure that is performed by means of thoracoscopy and laparoscopy. One stage of the procedure involves creation of a peritoneo-pleural communication in the presence of a pneumoperitoneum. In the case presented, severe hypotension occurred at this point. We believe this was caused by the escape of carbon dioxide from the peritoneal cavity into the right hemithorax, resulting in tension pneumothorax and cardiac tamponade. We believe this to be a predictable complication of this procedure but one that if expected, recognised and correctly managed, should not result in adverse outcomes.
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3/16. Spontaneous resolution of a giant pulmonary bulla.

    Giant bullae occur most often in individuals who chronically inhale tobacco smoke. The natural history of these bullae is unpredictable, although the majority of them increase gradually in size and cause worsening respiratory function. Complete spontaneous resolution of a giant bulla is a rare occurrence, with only eight cases reported in English literature. Most of the cases of spontaneous resolution of giant bullae are thought to have resulted from an infectious process leading to closure of the communication between the airways and the bulla. However, resolution of a bulla has been associated with adenocarcinoma of the lung.
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4/16. pneumopericardium and pneumothorax after permanent pacemaker implantation.

    We present a patient with chronic obstructive pulmonary disease who developed discomfort 2 days after dual-chamber pacemaker implantation via the left cephalic vein approach. The pacer was placed with active-fixation leads without obvious complications. A computed tomography (CT) scan taken in the emergency room showed right pneumothorax and associated pneumopericardium without pneumomediastinum. A three-dimensional reconstruction of CT images confirmed the atrial lead protruding into the pleural space. This lead likely ruptured a bulla causing a pneumothorax followed by pneumopericardium through a pleuro-pericardial communication. Chest tube placement relieved both pneumothorax and pneumopericardium without the need for atrial lead extraction.
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5/16. communication between the two pleural cavities after major cardiothoracic surgery: relevance to percutaneous intervention.

    The authors describe evidence of communication between the two pleural cavities after major cardiothoracic surgery (combined heart and lung transplantation, heart transplantation, and correction of complex congenital heart disease) performed in three patients. In two patients, unilateral lung biopsy caused a symptomatic bilateral pneumothorax. This was successfully treated with insertion of a single chest tube in one patient and two chest tubes in the other patient. In the third patient, simultaneous evacuation of large bilateral pleural effusions was performed by means of unilateral thoracentesis because of the presence of a common pleural cavity.
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6/16. Arterial to end-tidal CO2 laparoscopic gradient reversal during pheochromocytoma resection.

    PURPOSE: We report the development of severe intraoperative hypercarbia and a pronounced arterial to end-tidal gradient reversal during laparoscopic pheochromocytoma resection. Although complex physiologic mechanisms may be responsible for this finding, anatomic alterations such as a direct communication between a capnoperitoneum and/or capnothorax and the airways resulting from prior pathology and the type of procedure should also be considered. CLINICAL FEATURES: During anesthesia for laparoscopic pheochromocytoma removal we noticed an abrupt, extensive increase of the end-tidal CO(2) accompanied by a change of the capnographic CO(2) tracing and reversal of the normal arterial-to-end-tidal gradient. These changes consistently disappeared by intermittent deflation of the abdomen and at the end of surgery. A chest x-ray revealed a right-sided loculated pneumothorax with pleural thickening. Peritoneo-thoracic CO(2) tracking and pleural scaring with pulmonary adhesions resulting in a unidirectional communication between the pleural space and airways may best explain the chest x-ray and clinical findings. CONCLUSION: Severe intraoperative hypercarbia and arterial to end-tidal CO(2) gradient reversal represents an intraoperative challenge. The possibility of a direct communication between the pleural space and the bronchial tree should be considered when other etiologies have been excluded. Simple maneuvers such as abdominal de- and re-inflation and analysis of the end-tidal capnographic tracing might aid in the differential diagnosis and management.
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7/16. Case of the month: Buffalo chest: a case of bilateral pneumothoraces due to pleuropleural communication.

    Simultaneous spontaneous bilateral pneumothoraces, the presentation of separate right and left pneumothoraces together, is a rare event. The pleural cavities in humans are separated completely and the only previous reports of pleuropleural communication have been associated with major invasive thoracic procedures, specifically mediastinal surgery. The term "buffalo chest" has been coined for the condition on the basis that the buffalo or bison has a single pleural cavity, one of the few mammals to do so. We present the case of a woman with a past history of a single right sided spontaneous pneumothorax but no major thoracic surgery, who presented to the emergency department with a second spontaneous right pneumothorax that was under tension. After thoracostomy, she was found to have bilateral pneumothoraces which resolved with a unilateral chest drain demonstrating pleuropleural communication. We believe this to be the first reported case of such a presentation in the literature. The case demonstrates an unusual emergency presentation of a rare anatomical anomaly.
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8/16. pneumocephalus secondary to tension pneumothorax associated with comminuted fracture of the thoracic spine.

    We present an unusual case of pneumocephalus secondary to a tension pneumothorax associated with fracture of the thoracic spine. air from a pneumothorax entered the thoracic intraspinal compartment and the intracranial cavity through a comminuted fracture of the spine. The pneumocephalus and the pneumothorax resolved after aspiration of the intrathoracic air via an intercostal catheter. diagnosis, therapeutic modalities, and potential complications of a pneumocephalus and of a communication between the thoracic cavity and the spinal dural space are discussed.
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9/16. Massive hemoptysis and tension pneumothorax following pulmonary artery catheterization.

    We report a case of massive hemoptysis and bilateral tension pneumothorax immediately following placement of a fiberoptic pulmonary artery catheter. We postulate air entry into a traumatic communication caused by the catheter, traversing a parenchymal artery, the contiguous airspace and the interstitial space. dissection of air through the perivascular sheath and into tissue planes of the thorax and abdomen followed. This sequence was rapidly fatal. Tension pneumothorax should be considered if dynamic respiratory system compliance remains poor despite aggressive evacuation of blood from the trachea of a patient with a recently inserted balloon-type catheter.
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10/16. Extralobar pulmonary sequestration. Unusual presentation and systemic vascular communication in association with a right-sided diaphragmatic hernia.

    A 17-day-old infant with a right-sided extralobar pulmonary sequestration associated with an intact diaphragmatic hernia sac presented as an acute respiratory emergency. The diagnosis was obscured by the initial resuscitative treatment of cardiorespiratory arrest necessitating positive-pressure ventilation complicated by bilateral tension pneumothoraces prior to transfer. At operation, unique systemic arterial and venous communications to the sequestration from the dome of the liver through the intact hernia sac were found. A bronchial communication to the right main bronchus was also present. Histologic examination of the sequestration specimen revealed other features common to both intralobar and extralobar sequestration. This case lends support to the hypothesis of a common embryologic basis for both types of sequestration, as well as other congenital pulmonary cystic abnormalities, and the association with diaphragmatic hernia.
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