Non-expandable lung: an underappreciated cause of post-thoracentesis basilar pneumothorax

Saha, Biplab K.; Hu, Kurt; Shkolnik, Boris

doi:10.1136/bcr-2020-238292

Cited by 2 publications

(10 citation statements)

References 11 publications

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“…NEL is the inability of the lung to fully expand against the chest wall after pleural drainage. Active inflammation such as pneumonia, pleurisy, or malignant pleural tumors can be cited as causes for this condition [7].…”

Section: Discussionmentioning

confidence: 99%

A Case of Pneumothorax Ex Vacuo Associated with COVID-19

et al. 2023

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Pneumothorax is a known complication of coronavirus disease 2019 (COVID-19). The concept of pneumothorax ex vacuo has also been proposed to describe pneumothorax that occurs after malignant pleural effusion drainage. Herein, we present the case of a 67-year-old woman who had abdominal distension for 2 months. A detailed examination led to the suspicion of an ovarian tumor and revealed an accumulation of pleural effusion and ascitic fluid. Thoracentesis was performed, raising the suspicion of metastasis of high-grade serous carcinoma arising from the ovary. An ovarian biopsy was scheduled to select subsequent pharmacotherapy, and a drain was inserted preoperatively into the left thoracic cavity. Thereafter, a polymerase chain reaction analysis revealed that the patient was positive for COVID-19. Thus, the surgery was postponed. After the thoracic cavity drain was removed, pneumothorax occurred, and mediastinal and subcutaneous emphysema was observed. Thoracic cavity drains were then placed again. The patient’s condition was conservatively relieved without surgery. This patient may have developed pneumothorax ex vacuo during the course of a COVID-19 infection. Since chronic inflammation in the thoracic cavity is involved in the onset of pneumothorax ex vacuo, careful consideration is required for the thoracic cavity drainage of malignant pleural effusion and other fluid retention.

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Section: Discussionmentioning

confidence: 99%

A Case of Pneumothorax Ex Vacuo Associated with COVID-19

et al. 2023

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“…As mentioned earlier, we can see a similar situation in non-expandable lungs after pleural intervention. It can happen due to the presence of a bronchopleural or alveolar-pleural fistula, which creates a unidirectional airflow into the pleural cavity; this is referred to as a pressure-independent mechanism [ 3 , 4 ]. Another possible mechanism is called pressure-dependent, where once the fluid is removed, the lungs do not re-expand to fill this space, and a vacuum is created [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…It can happen due to the presence of a bronchopleural or alveolar-pleural fistula, which creates a unidirectional airflow into the pleural cavity; this is referred to as a pressure-independent mechanism [ 3 , 4 ]. Another possible mechanism is called pressure-dependent, where once the fluid is removed, the lungs do not re-expand to fill this space, and a vacuum is created [ 4 , 5 ]. The negative pressure created causes air to leak in to fill the vacuum [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another possible mechanism is called pressure-dependent, where once the fluid is removed, the lungs do not re-expand to fill this space, and a vacuum is created [ 4 , 5 ]. The negative pressure created causes air to leak in to fill the vacuum [ 4 , 5 ]. The source of the air is uncertain, but a possible theory is that small defects form on the visceral pleura due to the excessive negative pressure created.…”

Section: Discussionmentioning

confidence: 99%

“…Non-expandable lungs (NEL) can be caused by a problem in the airways, lung tissue, or pleura [ 4 , 7 ]. A bronchial obstruction might lead to a lung collapse, which will fail to re-expand.…”

Section: Discussionmentioning

confidence: 99%

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Pneumothorax Ex-vacuo or Trapped Lungs Appearing as Iatrogenic Hydropneumothorax: A Case Report and Review of Non-expandable Lungs (NEL)

Siddiqui¹,

Falak²

2023

Cureus

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Non-expandable lungs are usually diagnosed after a pleural intervention. It can be challenging to differentiate between an iatrogenic pneumothorax and a new diagnosis of non-expandable lungs following a pleural intervention. The correct assessment can save the patient from undergoing the insertion of an unnecessary intercostal chest drain, which often leads to catastrophe. Suspicion and early evaluation remain the keys, particularly in patients with chronic effusion. Often the diagnosis is reached through a combination of history, pleural fluid analysis, and radiological features such as the absence of a straight line in the chest X-ray, which is commonly found in a true hydropneumothorax, along with computed tomographic evidence of chronic effusion with thick pleural rind. Although not routinely performed, pleural manometry can confirm the diagnosis of trapped lungs.We present our case, where a 64-year-old woman with metastatic oesophageal cancer developed a rightsided effusion. The post-procedure chest X-ray following therapeutic aspiration of the pleural fluid gave an impression of iatrogenic hydropneumothorax, which on further careful assessment revealed a rather pneumothorax ex-vacuo along with effusion due to underlying trapped lungs. We present a review of nonexpandable lungs.

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Non-expandable lung: an underappreciated cause of post-thoracentesis basilar pneumothorax

Cited by 2 publications

References 11 publications

A Case of Pneumothorax Ex Vacuo Associated with COVID-19

A Case of Pneumothorax Ex Vacuo Associated with COVID-19

Pneumothorax Ex-vacuo or Trapped Lungs Appearing as Iatrogenic Hydropneumothorax: A Case Report and Review of Non-expandable Lungs (NEL)

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