Spontaneous Pneumothorax with Persistent Air Leakage and Invasive Procedures

Abstract

Objective Prolonged air leaks in patients with spontaneous pneumothorax are not infrequent. The aim of this study was to assess the duration of air leaks and define the clinical variables associated with the therapeutic success of chest tube drainage for spontaneous pneumothorax. Methods A total of 441 patients with spontaneous pneumothorax treated with chest tube drainage between 2008 and 2012 were retrospectively evaluated. The clinical differences between the patients successfully treated with drainage and those who required more invasive procedures were analyzed. Results Invasive procedures, such as video-assisted thoracic surgery (n=121), fibrin glue administration through a chest tube (n=8) and pleurodesis with OK-432 (n=21), were performed in 34% (150/441) of the patients. The treatment rate of chest drainage alone was higher in the patients with initial pneumothorax (72%; 124/170) than in those with recurrent pneumothorax (62%; 167/271) (p=0.015). In addition, this rate was higher in the patients with moderate lung collapse (70%; 167/237) than in those with severe lung collapse (61%; 124/204) (p=0.032). Conclusion Patients with recurrent pneumothorax or severe lung collapse associated with prolonged air leakage are more likely to receive invasive procedures.

A reliable fistula closure technique for refractory pneumothorax unresponsive to pleurodesis

“…PTFE pledget is mainly used for prosthesis of ventricular myocardium defects and reinforcement of suture sites during cardiac surgery [ 6 ], and is also useful for reinforcement of fragile tissues such as bulla of chronic emphysema. Pleurodesis with OK-432 causes restrictive damage to the lungs and mediastinal organs, making subsequent intrathoracic procedures extremely difficult and should be carefully selected as a treatment [ 7 ]. Although bronchoscopic treatment has been reported in recent years [ 8 ], filling the dilated upper lobe bronchus with spigot is not easy and may not be universal to the patient.…”

Evaluation of the relationship between primary spontaneous pneumothorax and exercise and patient return to previous activities in patients after treatment

“…The most common clinical symptom (53.2%) was chest pain [9]. Yoon et al examined risk factors for spontaneous pneumothorax in 2013; they showed that 65.7% of patients were male, with the most common complaint being chest pain in 35.2% and shortness of breath in 21.7% [13]. In addition to clinical findings, our study examined CT scans, with the most common finding in both athlete and non-athlete patients being multiple blebs ranging from 42.7% to 52.4%.…”

“…Its incidence in men is 7 to 18 cases per 100,000 population per year and in women 1 to 6 cases per 100,000 population per year . Other risk factors include smoking, tall, young men aged 10 to 30 years [13][14]. Moreover, 10% of PSP cases have a positive family history [7][8].…”

Case report: Endobronchial valve placement for treatment of a persistent air leak

“…To date, various methods of endobronchial management of bronchpleural fistula have been used. Early interventions included tissue glue and lead shot [ 3 ], and later interventions involved use of ethanol silver nitrate, cyanoacrylate compounds, coils, lead plugs, balloons, fibrin or tissue glue, antibiotics, gel foam, and autologous blood patches [ 4 , 5 ]. W atanabe et al .…”