Spontaneous pneumothorax: are we missing something?

Kouerinis, Ilias A.; Hountis, Panagiotis; Loutsidis, A.; Bellenis, Ion

doi:10.1016/j.icvts.2003.11.015

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…Th ese fi ndings of a strong association between PSP and MVP suggest that, in many patients, PSP may be the manifestation of a systemic abnormality of the connective tissue. Microscopically abnormal collagen fi bers and connective tissue of decreased tensile strength have been found in the lung tissue of PSP subjects, and pneumothorax has been suggested to the result of a forme fruste of Marfan syndrome in some cases, whereas MVP might be a further manifestation of a generalized connective tissue abnormality [16,17]. Bitar et al reported a prevalence of 38% for MVP in patients with PSP, compared to only 8% in age-matched controls [11].…”

Section: Resultsmentioning

confidence: 99%

Primary spontaneous pneumothorax and mitral valve prolapse are not associated

Flego

Lender

Barković

et al. 2011

Wien Klin Wochenschr

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Section: Resultsmentioning

confidence: 99%

Primary spontaneous pneumothorax and mitral valve prolapse are not associated

Flego

Lender

Barković

et al. 2011

Wien Klin Wochenschr

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“…The lung connective tissue and the visceral and parietal pleura (including the blood and lymphatic vessels) are derived from the surrounding splanchnic mesenchyme ( i.e ., from the mesoderm). Thus, it is not surprising that the pathophysiology of PSP is coupled with inflammatory changes of the lungs and pleural cavity [24]. This structural/functional communication between the tissues of the pleura and lungs (based on the common embryonic origin of their connective tissue) is also expected to be reciprocal.…”

Section: Discussionmentioning

confidence: 99%

A combination of predispositions and exposures as responsible for acute eosinophilic pneumonia

Amiconi

Hirl

2014

Multidiscip Respir Med

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BackgroundAcute eosinophilic pneumonia (AEP) is a rare febrile illness which is characterized by respiratory failure and often requires mechanical ventilation. The causes and sequence of events of this disease at a biochemical and histological level remain largely unknown. In this article we report the exceptional case, possibly unique, of a patient who developed AEP and three pneumothoraces within less than one month during her hospitalization.Case presentationA 39-year-old German woman was admitted to our hospital for a laparoscopy-assisted vaginal hysterectomy under general anaesthesia. The surgical intervention was followed by peritonitis in the early postoperative course. Following anaesthesia induction with propofol/midazolam and during the prolonged therapy with several broad-spectrum antibiotics, she developed AEP and three spontaneous (one left-sided and two right-sided) pneumothoraces, the latter ones observed in quick succession. Symptoms, laboratory markers, and chest radiology significantly improved after a one-day treatment with methylprednisolone.ConclusionsOn the whole, these pathological occurrences, together with similar cases reported in literature, can support the conclusion of possible predisposing genetic factors at the lung tissue level of AEP patients, a view that might shed new light on the pathogenesis of this disease. To provide a coherent pattern that explains the reported evidence for AEP and pneumothoraces, independently from the causative stimulus, the supposed molecular mutations could be localized in the connective tissue rather than in the epithelial cells. In order to interpret clinical and laboratory evidence, as well as to support the main conclusions, the important part of scientific research here presented can also assist physicians in making more informed decisions for the treatment of patients with pulmonary infiltrates.

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“…The treatment of pneumothorax includes observation, needle aspiration, insertion of an intercostal tube drainage or invasive thoracoscopy or thoracotomy with pleuodesis or pleurectomy. 6 Video-assisted thoracoscopic surgery is an effective and safe treatment for children with spontaneous pneumothorax. [7][8][9] Although there are no specific pediatric guidelines for spontaneous pneumothorax, as proposed by O'Lone and colleagues in the larger pediatric case-series to date, indication for invasive surgical procedure should be advanced promptly (within 48 hours) for recurrence of pneumothorax and within 5 days for persistent pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Recurrent Spontaneous Pneumothorax

Savasta

Leoni

Strocchio

et al. 2011

Clin Pediatr (Phila)

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A 16-year-old girl was admitted for the first time to our department for acute, increasing left-sided chest pain and shortness of breath. Both physical and radiographic findings were compatible with pneumothorax (Figure 1), and thoracostomy tube drainage was performed as soon as the diagnosis was arrived at. Physical examination revealed hyperelastic and fragile skin, hypermobility of multiple joints, subluxation of the right temporomandibular joint, and ability to hyperextend and hyperabduct the fingers ( Figure 2). The heart was tachycardic with a regular rhythm. Echocardiography was performed, and mitral valve prolapse was revealed. The period progressed uneventfully, and the thoracostomy tube drainage was removed after 3 days.The patient was discharged, but she was readmitted to our department 1 month later for progressively increasing chest pain. She denied any direct thoracic trauma. On physical examination, the vital signs were as follows: temperature 36°C, blood pressure 108/69 mm Hg, heart rate 84 beats/min, and room air oxygen saturation 94%. Laboratory values were as follows: white blood cell count = 8310/mm 3 ; hemoglobin = 11.8 g/dL; platelet count = 186 000/mm 3 ; C-reactive protein = 0.20 mg/dL. The chest X ray showed a left pneumothorax. After 20 days of discharge, the patient again showed the typical symptoms of pneumothorax. Video-assisted thoracoscopic surgery was performed, and the postoperative period progressed uneventfully.Her past medical history was remarkable for recurrent dislocations of the right coxo-femoral joint during sporting activities, and at 8 years of age, hip surgery was performed. At the age of 15 years, she was referred to a local hospital with chest pain, and spontaneous pneumothorax was identified.The clinical findings and the medical history were significant for Ehlers-Danlos syndrome (EDS). Indeed, a dermal biopsy was taken from the upper arm of the patient; a fibroblasts culture was done, and reduced synthesis of collagen type V was found, thus, confirming the diagnosis.At 2 years following surgery, the patient was free of respiratory symptoms. DiscussionSpontaneous pneumothorax is a relatively rare condition in childhood, 1 so especially in the case of recurrent pneumothorax, an underlying condition must be suspected.EDS comprises a heterogeneous group of hereditary connective tissue disorders with different genetic backgrounds (mainly related to defects in the synthesis of collagen) and heterogeneous clinical features. This group of disorders is primarily and collectively characterized by joint hypermobility, fragile or hyperelastic skin, and tissue fragility. 2 Disorders of the respiratory system have been described in some patients with diseases of the connective tissue: Marfan syndrome, cutis laxa, and Marfanoid hypermobility syndrome, which has features of both Marfan syndrome and EDS. Although respiratory manifestations in EDS are uncommon, some cases have been described and include recurrent hemoptysis, bulla formation, spontaneous pneumothorax, acute diaphragm...

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Spontaneous pneumothorax: are we missing something?

Cited by 9 publications

References 6 publications

Primary spontaneous pneumothorax and mitral valve prolapse are not associated

Primary spontaneous pneumothorax and mitral valve prolapse are not associated

A combination of predispositions and exposures as responsible for acute eosinophilic pneumonia

A Rare Cause of Recurrent Spontaneous Pneumothorax

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