Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmo...Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.展开更多
BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare genetic disorder associated with mutations in the BHD gene,which can manifest symptoms at any age,including dermatological and pulmonary complications,as well as r...BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare genetic disorder associated with mutations in the BHD gene,which can manifest symptoms at any age,including dermatological and pulmonary complications,as well as renal tumors.This study presents a case of a BHD patient who experienced spontaneous pneumothorax,aiming to enhance the understanding of this syndrome.CASE SUMMARY A 42-year-old female patient presented with left-sided chest pain and tightness lasting three days.Chest computed tomography scans revealed left-sided pneumothorax and multiple pulmonary bullae.Physical examination indicated decreased vocal fremitus and tympanic percussion on the left side.A thorough family history revealed a pattern of pulmonary disorders,including emphysema,spontaneous pneumothorax,and lung cancer among relatives.Genetic testing identified a heterozygous frameshift mutation in the FLCN gene at the 17p11.2 locus.Based on the clinical presentation,imaging findings,family history,and genetic results,the patient was suspected to have BHD syndrome.CONCLUSION We present a case of a heterozygous mutation in the FLCN gene in a patient with BHD syndrome,aiming to review the associated clinical characteristics and genetic mechanisms of this condition.This case serves as a reference point to offer insights into the diagnosis of multiple pulmonary cysts and spontaneous pneumo-thorax of unknown etiology in clinical practice.展开更多
BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through ...BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through case reports.The inci-dence rate is now 1 in 10000 among Caucasians and 0.00144 in 10000 among Japanese.Pneumothorax occurs when gas enters the pleural cavity,typically due to lung disease or chest trauma,and is characterized as either spontaneous or traumatic.Spontaneous pneumothorax is commonly linked to congenital lung tissue abnormalities or lung conditions,such as ruptured pulmonary bullae,emphysema,and bronchial asthma.Respiratory involvement in SAPHO syn-drome has historically been noted.CASE SUMMARY We present the case of a 44-year-old male patient who had previously been diagnosed with SAPHO syndrome.Following a two-year cessation of methotrexate therapy,he experienced recurrent anterior chest wall and joint pain accompanied by dyspnea.We conducted a comprehensive examination for the patient,which included physical examination,laboratory tests,and imaging studies.The clinical presentation and treatment outcomes suggest that his pneumothorax was related to an episode of SAPHO syndrome.We performed closed thoracic drainage surgery for the patient and treated his symptoms with etoricoxib(60 mg daily).Upon discharge,methotrexate was prescribed again.In subsequent follow-ups,there was no recurrence of joint and respiratory symptoms observed in the patient.CONCLUSION SAPHO syndrome has been proposed as a transitional stage between ankylosing spondylitis and psoriatic arthritis.One study reported a 0.29%incidence of spontaneous pneumothorax in patients with ankylosing spondylitis,higher than in the general population.Additionally,30%of patients with SAPHO syndrome test positive for HLA-B27,an antigen linked to ankylosing spondylitis.Symptomatically,some patients with SAPHO syndrome meet diagnostic criteria for ankylosing spondylitis,with sternoclavicular joint involvement and paravertebral ossific-ations resembling syndesmophytes in ankylosing spondylitis.These features suggest a possible linked between SAPHO syndrome and ankylosing spondylitis.展开更多
Background:Pneumothorax is a medical emergency caused by the abnormal accumulation of air in the pleural space—the potential space between the lungs and chest wall.On 2D chest radiographs,pneumothorax occurs within t...Background:Pneumothorax is a medical emergency caused by the abnormal accumulation of air in the pleural space—the potential space between the lungs and chest wall.On 2D chest radiographs,pneumothorax occurs within the thoracic cavity and outside of the mediastinum,and we refer to this area as“lung+space.”While deep learning(DL)has increasingly been utilized to segment pneumothorax lesions in chest radiographs,many existing DL models employ an end-to-end approach.These models directly map chest radiographs to clinician-annotated lesion areas,often neglecting the vital domain knowl-edge that pneumothorax is inherently location-sensitive.Methods:We propose a novel approach that incorporates the lung+space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs.To circumvent the need for additional annotations and to prevent potential label leakage on the target task,our method utilizes external datasets and an auxiliary task of lung segmentation.This approach generates a specific constraint of lung+space for each chest radiograph.Furthermore,we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets.Results:Our results demonstrated considerable improvements,with average performance gains of 4.6%,3.6%,and 3.3%regarding intersection over union,dice similarity coefficient,and Hausdorff distance.These results were con-sistent across six baseline models built on three architectures(U-Net,LinkNet,or PSPNet)and two backbones(VGG-11 or MobileOne-S0).We further con-ducted an ablation study to evaluate the contribution of each component in the proposed method and undertook several robustness studies on hyper-parameter selection to validate the stability of our method.Conclusions:The integration of domain knowledge in DL models for medical applications has often been underemphasized.Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation and further bolster clinicians'trust in DL tools.Beyond pneumothorax,our approach is promising for other thoracic conditions that possess location-relevant characteristics.展开更多
BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could ...BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could be encountered in such conditions.CASE SUMMARY A 50-year-old Hispanic male who was a prior smoker presented with shortness of breath.He was diagnosed with SARS-CoV-2.He improved and was discharged with home oxygen.A month later,he presented with sudden onset cough and shortness of breath.Chest X-ray showed development of right-sided tension pneumothorax,right pleural effusion and an air-filled cystic structure.Computed tomography thorax showed findings suggestive of pulmonary coccidioidomycosis.Coccidioides antigen was positive,and fluconazole was initiated.For pneumothorax,a pigtail catheter was placed.The pigtail chest tube was later switched to water seal,unfortunately,the pneumothorax re-expanded.Another attempt to transition chest tube to water seal was unsuccessful.Pigtail chest tube was then swapped to 32-Fr chest tube and chemical pleurodesis was performed.This was later transitioned successfully to water seal and finally removed.He was discharged on a four-week oral course of fluconazole 400 mg and was to follow up closely as an outpatient for continued monitoring.CONCLUSION Pneumothorax is associated with a worse prognosis,especially with comorbidities such as diabetes,immunosuppression and malignancy.Suspicion for concomitant fungal infection in such patients should be high and would necessitate further investigation.展开更多
Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax ...Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.展开更多
Primary spontaneous pneumothorax(PSP) commonly occurs in tall,thin,adolescent men.Though the pathogenesis of PSP has been gradually uncovered,there is still a lack of consensus in the diagnostic approach and treatment...Primary spontaneous pneumothorax(PSP) commonly occurs in tall,thin,adolescent men.Though the pathogenesis of PSP has been gradually uncovered,there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder.Herein,the literature is reviewed concerning mechanisms and personal clinical experience with PSP.The chest computed tomography(CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies.The development of video-assisted thoracoscopic surgery(VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.展开更多
Objective： To review our experience of the treatment of bilateral primary spontaneous pneumothorax （PSP） by video-assisted thoracoscopic surgery （VATS）. Materials and methods： Retrospective chart review was foll...Objective： To review our experience of the treatment of bilateral primary spontaneous pneumothorax （PSP） by video-assisted thoracoscopic surgery （VATS）. Materials and methods： Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results： Twelve males and one female, with age ranging from 15 to 36 years （mean 23.1 years）, were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously （n=4） or sequentially （n=9）. The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients （84.6%） had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was （45.6±18.3） min （range 25-96 min） and （120.6±28.7） min （range 84-166 min） respectively for the non-simultaneous （second VATS for the recurrence of contralateral side after first VATS） and simultaneous （bilateral VATS in one operation） procedures. There was no postoperative mortality. However, prolonged air leakage （〉7 d） occurred in one patient （7.7%） who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions： VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.展开更多
This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patient...This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.展开更多
Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intub...Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients' history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or Pa O2/Fi O2 < 200 mm Hg were found to have higher mortality.展开更多
We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine...We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm;however,the term"Chilaiditi syndrome"is used for symptomatic hepatodiaphragmatic interposition.The patient had no symptoms of abdominal pain,constipation,diarrhea,or emesis.Incidentally,Chilaiditi sign was diagnosed on chest radiography.Pneumothorax is defined as air in the pleural space.Pneumothoraces are classified as spontaneous or traumatic.Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present,or secondary,when it is associated with pre-existing lung disease.Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.展开更多
BACKGROUND Bevacizumab is an antiangiogenic agent,and that synergizes with chemotherapeutic drugs.When used in combination therapies,Bevacizumab is associated with adverse events such as hemorrhage,gastrointestinal pe...BACKGROUND Bevacizumab is an antiangiogenic agent,and that synergizes with chemotherapeutic drugs.When used in combination therapies,Bevacizumab is associated with adverse events such as hemorrhage,gastrointestinal perforation,delayed wound healing,and pneumothorax.However,the molecular mechanisms underlying these adverse events are not fully understood.CASE SUMMARY A 45-year-old female with multiple lung metastases that were derived from primary breast cancer,was placed on Bevacizumab+paclitaxel therapy,since this combination has a potent antitumor effect.She reported dyspnea before cycle 3,day 1 and we therefore ran a chest X-ray,which detected a right pneumothorax.The coronal plane computed tomography revealed that one solid mass rapidly necrosed and was replaced by a cavity that passed through the bronchus in the right lower lobe.The cavity eventually ruptured the pleura and made the bronchopleural fistula that led to this pneumothorax.Thoracic cavity drainage using an intercostal catheter was performed.On the 7th day of drainage,the patient was discharged from our hospital on recovery.Recurrence of pneumothorax was not reported,and continuation of chemotherapy was made possible by changing the regimen.CONCLUSION Patients with lung metastases surrounding the bronchi and on the pleura should be monitored for pneumothorax by Bevacizumab-containing chemotherapies.展开更多
An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocar...An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocardiogram (Figure 1). Transthoracic echocardiography showed reduced left ventricular function (LVEF = 47%) with regional wall motion abnormality of right coronary artery (RCA) and left circumflex coronary artery (LCx) artery. Coronary angiography showed patent previous proximal RCA and distal LCx stents. Temporary pacemaker was inserted initially and the patient was planned for permanent pacemaker insertion after the surgery.展开更多
BACKGROUND Chronic obstructive pulmonary disease(COPD)combined with spontaneous pneumothorax,is characterized by significant decline in lung function,and even cause cardiopulmonary failure and hypoxia.AIM To evaluate ...BACKGROUND Chronic obstructive pulmonary disease(COPD)combined with spontaneous pneumothorax,is characterized by significant decline in lung function,and even cause cardiopulmonary failure and hypoxia.AIM To evaluate the clinical effectiveness of central venous catheters and indwelling pleural catheters(IPC)in managing closed thoracic drainage in patients diagnosed with COPD with concomitant by spontaneous pneumothorax.METHODS Retrospective analysis was conducted on the clinical information of 60 elderly patients with COPD complicated by spontaneous pneumothorax admitted to the Shexian Branch of the second affiliated hospital of Zhejiang university school of medicine between March 2020 and March 2023.The clinical efficacy,complications,hospitalization duration,and costs were compared between patients with an indwelling thoracic catheter and those with a central venous catheter.Univariate logistic regression was used to analyze the causes of catheter displacement.RESULTS According to our findings,there were significant differences in the IPC group’s clinical efficacy,catheter operation time,and lung recruitment time(P<0.05).Comparing the complications after catheter treatment between the two groups revealed statistically significant variations in the incidence of postoperative analgesics,catheter abscission,catheter blockage,and subcutaneous emphysema in the IPC group(P<0.05).Univariate analysis demonstrated significant differences between patients with and without catheter dislodgement regarding duty nurse’s working years(less than three),Acute Physiology and Chronic Health Evaluation II(APACHE II)scores(less than 15),lack of catheter suture fixation,and the proportion of catheters not fixed twice(P<0.05).CONCLUSION Our results demonstrated that when treating elderly COPD patients with spontaneous pneumothorax,indwelling thoracic catheters are more effective than the central venous catheter group.Patients’catheter shedding is influenced by the primary nurse’s working years,APACHE II scores,and catheter fixation technique.展开更多
Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the tre...Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.展开更多
INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infecti...INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.展开更多
Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respi...Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination.These techniques are not fully applicable in field conditions and on the battlefield,where situational and environmental factors may impair clinical capabilities.We aimed to assemble a device able to sample,analyze,and classify the unique acoustic signatures of pneumothorax and hemothorax.Methods:Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model.Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation.The thoracic cavity was injected with increasing volumes of 200,400,600,800,and 1000 ml of air or saline to simulate pneumothorax and hemothorax,respectively.The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution,a cutting-edge approach in the artificial intelligence discipline.Results:The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy,sensitivity and specificity ranging from 64%to 100%,63%to 100%,and 63%to 100%,respectively,in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more,and regardless of background noise.Conclusions:We present a novel,objective device for rapid diagnosis of potentially lethal thoracic injuries.With further optimization,such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.展开更多
Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopu...Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax;this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.展开更多
BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold st...BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.展开更多
Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical cond...Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.展开更多
文摘Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.
文摘BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare genetic disorder associated with mutations in the BHD gene,which can manifest symptoms at any age,including dermatological and pulmonary complications,as well as renal tumors.This study presents a case of a BHD patient who experienced spontaneous pneumothorax,aiming to enhance the understanding of this syndrome.CASE SUMMARY A 42-year-old female patient presented with left-sided chest pain and tightness lasting three days.Chest computed tomography scans revealed left-sided pneumothorax and multiple pulmonary bullae.Physical examination indicated decreased vocal fremitus and tympanic percussion on the left side.A thorough family history revealed a pattern of pulmonary disorders,including emphysema,spontaneous pneumothorax,and lung cancer among relatives.Genetic testing identified a heterozygous frameshift mutation in the FLCN gene at the 17p11.2 locus.Based on the clinical presentation,imaging findings,family history,and genetic results,the patient was suspected to have BHD syndrome.CONCLUSION We present a case of a heterozygous mutation in the FLCN gene in a patient with BHD syndrome,aiming to review the associated clinical characteristics and genetic mechanisms of this condition.This case serves as a reference point to offer insights into the diagnosis of multiple pulmonary cysts and spontaneous pneumo-thorax of unknown etiology in clinical practice.
基金Supported by The National Natural Science Foundation of China,No.82074246.
文摘BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through case reports.The inci-dence rate is now 1 in 10000 among Caucasians and 0.00144 in 10000 among Japanese.Pneumothorax occurs when gas enters the pleural cavity,typically due to lung disease or chest trauma,and is characterized as either spontaneous or traumatic.Spontaneous pneumothorax is commonly linked to congenital lung tissue abnormalities or lung conditions,such as ruptured pulmonary bullae,emphysema,and bronchial asthma.Respiratory involvement in SAPHO syn-drome has historically been noted.CASE SUMMARY We present the case of a 44-year-old male patient who had previously been diagnosed with SAPHO syndrome.Following a two-year cessation of methotrexate therapy,he experienced recurrent anterior chest wall and joint pain accompanied by dyspnea.We conducted a comprehensive examination for the patient,which included physical examination,laboratory tests,and imaging studies.The clinical presentation and treatment outcomes suggest that his pneumothorax was related to an episode of SAPHO syndrome.We performed closed thoracic drainage surgery for the patient and treated his symptoms with etoricoxib(60 mg daily).Upon discharge,methotrexate was prescribed again.In subsequent follow-ups,there was no recurrence of joint and respiratory symptoms observed in the patient.CONCLUSION SAPHO syndrome has been proposed as a transitional stage between ankylosing spondylitis and psoriatic arthritis.One study reported a 0.29%incidence of spontaneous pneumothorax in patients with ankylosing spondylitis,higher than in the general population.Additionally,30%of patients with SAPHO syndrome test positive for HLA-B27,an antigen linked to ankylosing spondylitis.Symptomatically,some patients with SAPHO syndrome meet diagnostic criteria for ankylosing spondylitis,with sternoclavicular joint involvement and paravertebral ossific-ations resembling syndesmophytes in ankylosing spondylitis.These features suggest a possible linked between SAPHO syndrome and ankylosing spondylitis.
文摘Background:Pneumothorax is a medical emergency caused by the abnormal accumulation of air in the pleural space—the potential space between the lungs and chest wall.On 2D chest radiographs,pneumothorax occurs within the thoracic cavity and outside of the mediastinum,and we refer to this area as“lung+space.”While deep learning(DL)has increasingly been utilized to segment pneumothorax lesions in chest radiographs,many existing DL models employ an end-to-end approach.These models directly map chest radiographs to clinician-annotated lesion areas,often neglecting the vital domain knowl-edge that pneumothorax is inherently location-sensitive.Methods:We propose a novel approach that incorporates the lung+space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs.To circumvent the need for additional annotations and to prevent potential label leakage on the target task,our method utilizes external datasets and an auxiliary task of lung segmentation.This approach generates a specific constraint of lung+space for each chest radiograph.Furthermore,we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets.Results:Our results demonstrated considerable improvements,with average performance gains of 4.6%,3.6%,and 3.3%regarding intersection over union,dice similarity coefficient,and Hausdorff distance.These results were con-sistent across six baseline models built on three architectures(U-Net,LinkNet,or PSPNet)and two backbones(VGG-11 or MobileOne-S0).We further con-ducted an ablation study to evaluate the contribution of each component in the proposed method and undertook several robustness studies on hyper-parameter selection to validate the stability of our method.Conclusions:The integration of domain knowledge in DL models for medical applications has often been underemphasized.Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation and further bolster clinicians'trust in DL tools.Beyond pneumothorax,our approach is promising for other thoracic conditions that possess location-relevant characteristics.
文摘BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could be encountered in such conditions.CASE SUMMARY A 50-year-old Hispanic male who was a prior smoker presented with shortness of breath.He was diagnosed with SARS-CoV-2.He improved and was discharged with home oxygen.A month later,he presented with sudden onset cough and shortness of breath.Chest X-ray showed development of right-sided tension pneumothorax,right pleural effusion and an air-filled cystic structure.Computed tomography thorax showed findings suggestive of pulmonary coccidioidomycosis.Coccidioides antigen was positive,and fluconazole was initiated.For pneumothorax,a pigtail catheter was placed.The pigtail chest tube was later switched to water seal,unfortunately,the pneumothorax re-expanded.Another attempt to transition chest tube to water seal was unsuccessful.Pigtail chest tube was then swapped to 32-Fr chest tube and chemical pleurodesis was performed.This was later transitioned successfully to water seal and finally removed.He was discharged on a four-week oral course of fluconazole 400 mg and was to follow up closely as an outpatient for continued monitoring.CONCLUSION Pneumothorax is associated with a worse prognosis,especially with comorbidities such as diabetes,immunosuppression and malignancy.Suspicion for concomitant fungal infection in such patients should be high and would necessitate further investigation.
文摘Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.
文摘Primary spontaneous pneumothorax(PSP) commonly occurs in tall,thin,adolescent men.Though the pathogenesis of PSP has been gradually uncovered,there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder.Herein,the literature is reviewed concerning mechanisms and personal clinical experience with PSP.The chest computed tomography(CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies.The development of video-assisted thoracoscopic surgery(VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.
文摘Objective： To review our experience of the treatment of bilateral primary spontaneous pneumothorax （PSP） by video-assisted thoracoscopic surgery （VATS）. Materials and methods： Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results： Twelve males and one female, with age ranging from 15 to 36 years （mean 23.1 years）, were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously （n=4） or sequentially （n=9）. The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients （84.6%） had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was （45.6±18.3） min （range 25-96 min） and （120.6±28.7） min （range 84-166 min） respectively for the non-simultaneous （second VATS for the recurrence of contralateral side after first VATS） and simultaneous （bilateral VATS in one operation） procedures. There was no postoperative mortality. However, prolonged air leakage （〉7 d） occurred in one patient （7.7%） who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions： VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.
文摘This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.
文摘Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients' history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or Pa O2/Fi O2 < 200 mm Hg were found to have higher mortality.
文摘We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm;however,the term"Chilaiditi syndrome"is used for symptomatic hepatodiaphragmatic interposition.The patient had no symptoms of abdominal pain,constipation,diarrhea,or emesis.Incidentally,Chilaiditi sign was diagnosed on chest radiography.Pneumothorax is defined as air in the pleural space.Pneumothoraces are classified as spontaneous or traumatic.Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present,or secondary,when it is associated with pre-existing lung disease.Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.
文摘BACKGROUND Bevacizumab is an antiangiogenic agent,and that synergizes with chemotherapeutic drugs.When used in combination therapies,Bevacizumab is associated with adverse events such as hemorrhage,gastrointestinal perforation,delayed wound healing,and pneumothorax.However,the molecular mechanisms underlying these adverse events are not fully understood.CASE SUMMARY A 45-year-old female with multiple lung metastases that were derived from primary breast cancer,was placed on Bevacizumab+paclitaxel therapy,since this combination has a potent antitumor effect.She reported dyspnea before cycle 3,day 1 and we therefore ran a chest X-ray,which detected a right pneumothorax.The coronal plane computed tomography revealed that one solid mass rapidly necrosed and was replaced by a cavity that passed through the bronchus in the right lower lobe.The cavity eventually ruptured the pleura and made the bronchopleural fistula that led to this pneumothorax.Thoracic cavity drainage using an intercostal catheter was performed.On the 7th day of drainage,the patient was discharged from our hospital on recovery.Recurrence of pneumothorax was not reported,and continuation of chemotherapy was made possible by changing the regimen.CONCLUSION Patients with lung metastases surrounding the bronchi and on the pleura should be monitored for pneumothorax by Bevacizumab-containing chemotherapies.
文摘An 87-year-old male with old myocardial infarction was referred to the hospital due to left femur neck fracture and intermittent dizziness. Significant 2:1 atrioventricular block was demonstrated on initial electrocardiogram (Figure 1). Transthoracic echocardiography showed reduced left ventricular function (LVEF = 47%) with regional wall motion abnormality of right coronary artery (RCA) and left circumflex coronary artery (LCx) artery. Coronary angiography showed patent previous proximal RCA and distal LCx stents. Temporary pacemaker was inserted initially and the patient was planned for permanent pacemaker insertion after the surgery.
文摘BACKGROUND Chronic obstructive pulmonary disease(COPD)combined with spontaneous pneumothorax,is characterized by significant decline in lung function,and even cause cardiopulmonary failure and hypoxia.AIM To evaluate the clinical effectiveness of central venous catheters and indwelling pleural catheters(IPC)in managing closed thoracic drainage in patients diagnosed with COPD with concomitant by spontaneous pneumothorax.METHODS Retrospective analysis was conducted on the clinical information of 60 elderly patients with COPD complicated by spontaneous pneumothorax admitted to the Shexian Branch of the second affiliated hospital of Zhejiang university school of medicine between March 2020 and March 2023.The clinical efficacy,complications,hospitalization duration,and costs were compared between patients with an indwelling thoracic catheter and those with a central venous catheter.Univariate logistic regression was used to analyze the causes of catheter displacement.RESULTS According to our findings,there were significant differences in the IPC group’s clinical efficacy,catheter operation time,and lung recruitment time(P<0.05).Comparing the complications after catheter treatment between the two groups revealed statistically significant variations in the incidence of postoperative analgesics,catheter abscission,catheter blockage,and subcutaneous emphysema in the IPC group(P<0.05).Univariate analysis demonstrated significant differences between patients with and without catheter dislodgement regarding duty nurse’s working years(less than three),Acute Physiology and Chronic Health Evaluation II(APACHE II)scores(less than 15),lack of catheter suture fixation,and the proportion of catheters not fixed twice(P<0.05).CONCLUSION Our results demonstrated that when treating elderly COPD patients with spontaneous pneumothorax,indwelling thoracic catheters are more effective than the central venous catheter group.Patients’catheter shedding is influenced by the primary nurse’s working years,APACHE II scores,and catheter fixation technique.
文摘Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.
文摘INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.
基金supported by the Israel Defense Forces(IDF)Medical Corps and Directorate of Defense Research&Development,Israeli Ministry of Defense(IMOD DDR&D)。
文摘Background:Tension pneumothorax is one of the leading causes of preventable death on the battlefield.Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination.These techniques are not fully applicable in field conditions and on the battlefield,where situational and environmental factors may impair clinical capabilities.We aimed to assemble a device able to sample,analyze,and classify the unique acoustic signatures of pneumothorax and hemothorax.Methods:Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model.Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation.The thoracic cavity was injected with increasing volumes of 200,400,600,800,and 1000 ml of air or saline to simulate pneumothorax and hemothorax,respectively.The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution,a cutting-edge approach in the artificial intelligence discipline.Results:The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy,sensitivity and specificity ranging from 64%to 100%,63%to 100%,and 63%to 100%,respectively,in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more,and regardless of background noise.Conclusions:We present a novel,objective device for rapid diagnosis of potentially lethal thoracic injuries.With further optimization,such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.
文摘Background: Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax;this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.
文摘BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.
文摘Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.
