A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure

Matsuoka, Shunichiro; Miyazawa, Mitsuhiro; Kashimoto, Kentaro; Kobayashi, Hiroaki; Mitsui, Fumihiko; Tsunoda, Hajime; Kunitomo, Kazuyoshi; Chisuwa, Hisanao; Haba, Yoshiaki

doi:10.1007/s11748-014-0489-4

Cited by 8 publications

(4 citation statements)

References 8 publications

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“…The surgical outcomes of PE correction have been progressively improving because of advances in minimally invasive surgical techniques (5). However, the chest wall corrected by the Nuss procedure becomes more vulnerable to pneumothorax, and there are several reports of lifethreatening cases of bilateral PSP in a buffalo chest following the Nuss procedure for PE (16)(17)(18). The potential risk involves the development of bilateral pneumothorax in a buffalo chest due to bilateral thoracic cavity communication following the Nuss bar insertion, which can have catastrophic consequences if not promptly and appropriately managed surgically.…”

Section: Discussionmentioning

confidence: 99%

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum

Lee,

Jeong,

Suh

et al. 2023

Front. Surg.

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ObjectivePatients with primary spontaneous pneumothorax (PSP) tend to be young, tall, and thin, as do those with pectus excavatum (PE). Notably, the Haller index, which measures the severity of PE, tends also to be higher in patients with PSP, further suggesting a potential predisposing factor for the development of PSP in individuals with PE. This study aimed to share clinical experiences with case series of concomitant PSP and PE and to emphasize the importance of evaluating these two conditions together.MethodsIn this single-center study, we conducted a retrospective records review to identify patients who were diagnosed and treated (including surgical or conservative treatment and follow-up observation) for the diagnosis of PE between July 2011 and February 2023. From these, we selected patients who were diagnosed with both PE and PSP and analyzed their clinical presentations.ResultsAmong a total of 139 patients with PE, there were 8 (5.76%) who had concurrent diagnoses of PE and PSP and who underwent surgery for PSP, PE, or both. The average age of these 8 patients (male:female = 7:1) was 19.38 years. The 8 patients were grouped into four categories based on their clinical scenarios. Group A had 1 patient with PE diagnosed first, followed by the discovery of PSP during evaluation; Group B included 2 patients initially presenting with PSP and subsequently diagnosed with PE during evaluation; Group C consisted of 1 patient who had PSP before undergoing surgical PE correction; and Group D comprised 4 patients who developed PSP after PE correction.ConclusionsThe incidence of PSP in patients with PE was 5.76% (8 out of 139 patients), indicating the importance of vigilant monitoring for PSP prior to PE surgery, and vice versa. Furthermore, the authors recommend close observation for PSP independent of PE surgery, even in the absence of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum

Lee,

Jeong,

Suh

et al. 2023

Front. Surg.

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“…Abrasion near the Nuss bar is not recommended because excess adhesion may compromise the subsequent Nuss bar removal procedure. There were two reported cases developed bilateral pneumothorax after Nuss correction: Sakamoto reported that a 14-year-old boy developed dyspnea 2 months after correction surgery [17] and Matsuoka reported that one 17-year-old man had bilateral PSP 16 months after the Nuss operation [18]. The possible risk is iatrogenic buffalo chest caused by communication of the bilateral thoracic cavity after Nuss bar insertion.…”

Section: Discussionmentioning

confidence: 99%

Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax

Huang

Lin

et al. 2020

World j. surg.

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Background and Objective This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE). Methods From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively. ResultsThe incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p \ 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p \ 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481-3.330, p \ 0.001). ConclusionWe discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI [3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.

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“…In patients with severe pectus excavatum, this defect cannot be completely healed in the short term. Patients with pectus excavatum comorbid by pulmonary bulla and ruptures during this period are prone to serious bilateral pneumothorax, which is difficult to cure by drainage alone; a bullectomy is needed (19,20) All the patients in this group were given a chest CT examination before an operation. Two cases were found to have comorbid pulmonary bulla; both patients were given pulmonary bulla incisions and pectus excavatum surgeries in the same period after we fully communicated with them and obtained their consent.…”

Section: Discussionmentioning

confidence: 99%

Multiple-bar Nuss operation: an individualized treatment scheme for patients with significantly asymmetric pectus excavatum

et al. 2020

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Background: Research into multiple-bar Nuss operations for the treatment of wide-range or significantly asymmetric pectus excavatum is rarely reported. This paper aims to explore the curative effects of multiplebar Nuss operations on wide-range or significantly asymmetric pectus excavatum. Methods:We reviewed the clinical data of 153 patients with pectus excavatum who were treated in our hospital from September 2006 to August 2014. All the patients had wide-range or significantly asymmetric pectus excavatum and underwent multiple-bar Nuss operations performed by the author.Results: All 153 patients agreed to undergo the operation. The median age was 17 y (10.2-41 y). The median Haller index was 3.98 (3.2-25). One hundred and fifty-one patients accepted treatment with two bars, and 2 cases accepted treatment with three bars. The median operation time was 123 min (65-500 min), the median blood loss was 20 mL (2-200 mL), and the median postoperative hospital stay was 6 days (3-33 days).The incidence rates of pleural effusion, pneumothorax and hydropneumothorax that required drainage treatment were 0.7% (1/153), 1.3% (2/153) and 3.3% (5/153), respectively. Displacement of a bar occurred in one case, and bar exposure occurred in 7 cases. Therefore, 2 cases had the bars removed early, within 2 years postoperation. One patient with severe depression (Haller index: 8.8) had an unhealed auxiliary incision of the xiphoid process, and although the incision was cured after the early removal of the inferior bar, the deformity recurred. There were no cases of death. Currently, 51.6% (79/153) of the cases have had the bars removed. The most recent follow-up revealed that patients' median satisfaction score for the surgical correction effect was 9 points (10 points indicated full satisfaction).Conclusions: For patients with significantly asymmetric and severely deformed pectus excavatum, the multiple-bar Nuss operation not only is safe and effective but can also achieve a better cosmetic appearance.However, we should continue to explore technical improvements.

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A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure

Cited by 8 publications

References 8 publications

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum

Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax

Multiple-bar Nuss operation: an individualized treatment scheme for patients with significantly asymmetric pectus excavatum

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