Management of Spontaneous Pneumothorax During Pregnancy: Case Report and Review of the Literature

Abstract

Spontaneous pneumothorax rarely occurs during pregnancy. Only 22 nonmalignancy-related cases have been previously published. Herein we report a case of recurrent spontaneous pneumothorax during the third trimester of pregnancy that necessitated surgical intervention. At thoracotomy, a large bulla was excised from the lower lobe of the right lung; abrasive pleurodesis was subsequently done. Postoperatively, Spontaneous pneumothorax during pregnancy is rare. Twenty-two nonmalignancy-related cases have been previously reported in the English literature (Table 1).1-20 Most patients had pneumothorax at term, during labor, or immediately postpartum and were treated conservatively with tube thoracostomy. Five cases of spontaneous pneumothorax that occurred during the first or second trimester of pregnancy necessitated either thoracotomy or thoracoscopy to prevent future recurrences.tv'P" Herein we report a case of spontaneous pneumothorax that necessitated surgical intervention early during the third trimester of pregnancy. REPORT OF CASEA 26-year-old woman (gravida 2, para 1) sought medical attention because of the development of a large, symptomatic, right-sided pneumothorax at 23 weeks' gestation. She was a nonsmoker. She had no previous pulmonary history or family history of bullous disease and had not previously undergone chest roentgenography. The pneumothorax was managed on an outpatient basis by her local physician, who used chest tube thoracostomy and a Heimlich valve. Three From the Department of Obstetrics and Gynecology (J.T.V.W., J.A.N., MN 55905.the patient had regular contractions, which were successfully stopped with intravenous administration of magnesium sulfate. Indications, procedures, and precautions for operative intervention during pregnancy are discussed.(Mayo Clin Proc 1996; 71:249-252) ICT = computed tomographic I days after removal of the chest tube, a symptomatic right pneumothorax recurred. A second chest tube was placed, connected to suction, and the patient was transferred to Mayo Clinic Rochester. At the time ofthis admission, no air leak was noted, and the right lung was fully expanded. Chest roentgenography demonstrated a thin-walled, air-filled structure within the lower lobe of the right lung (Fig. 1). Suction was continued, and on the fourth hospital day, the chest tube was clamped. Forty-eight hours later, no recurrent pneumothorax was evident, and the chest tube was successfully removed. The patient's condition remained stable, and she was dismissed on the eighth hospital day. A decision was made to delay obtaining a computed tomographic (CT) scan of the chest until after delivery unless the pneumothorax recurred. Unfortunately, the right-sided pneumothorax recurred 2 weeks after the patient had been dismissed. A chest tube was again placed, and the lung was fully reexpanded without an air leak. A shielded CT scan of the chest without use of contrast medium showed that the previously detected mass was a 5-cm air-containing cystic structure within the lower lobe of the right lung (F...

Спонтанний Пневмоторакс Під Час Вагітності. Основні Аспекти Діагностики, Тактики Лікування Пневмотораксу І Ведення Пологів

“…Встановлено, що при вагітності потреба матері у кисні зростає на 20 %, а під час пологів -на 50 % [10].…”

Pregnancy and the lungs

“…In an asymptomatic patient with a pneumothorax less than 15%–20% of the hemithorax inpatient observation is warranted. In patients with a large pneumothorax (more than 20% of the hemithorax) or symptomatic patients, aspiration is recommended 43. Failure of aspiration or recurrence of pneumothorax should be managed by tube thoracostomy.…”

Anterior, thoracoscopic-assisted reduction and stabilization of a thoracic burst fracture (T8) in a pregnant woman

“…Thoracotomies and thoracoscopic surgery have been performed successfully in pregnant females, mostly to treat spontaneous pneumothorax. No surgical complications have been reported in these cases and operative procedures were well tolerated [9][10][11].…”

“…To reach levels below T12, an incision of the diaphragm is generally necessary [9]. Incision of the diaphragm, however, should be avoided in pregnant women, especially during the last trimester.…”