MyMedR

Fulltext A survey on the initial management of spontaneous pneumothorax

Ismail T, Anshar MF, How SH, Hashim CW, Mohamad WH, Katiman D

Med J Malaysia, 2010 Sep;65(3):187-91.

PMID: 21939165

Spontaneous pneumothorax (SP) is a common medical condition but continues to be a frequent management problem among doctors. Despite the availability of guidelines on management of SP, studies have shown that the compliance with the guidelines is low. The various treatment options available in treating this condition further confuse doctors on the right approach in managing SP. The objective of this study is to investigate the awareness of the availability of these existing guidelines and to investigate how the doctors involved in the initial management of SP would manage this condition. A self completed questionnaire which included three case scenarios were distributed among doctors in two teaching university hospitals and two large Ministry of Health hospitals. This study showed that there is a lack of awareness of the existing guidelines even among the senior doctors and there is a variation in the initial management of SP. Therefore a locally produced guideline may be beneficial to standardise and improve the management of SP.

Matched MeSH terms: Pneumothorax/therapy*

Fulltext Acute breathlessness and chest pain following a harsh bout of coughing

Khajotia R, Somaweera N

Can Fam Physician, 2012 Mar;58(3):276-9.

PMID: 22518898

Matched MeSH terms: Pneumothorax/diagnosis*; Pneumothorax/etiology; Pneumothorax/radiography

Fulltext Bilateral spontaneous persistent open pneumothorax with chylothorax

Khajotia R, Raman S

Can Fam Physician, 2012 Jul;58(7):757-60.

PMID: 22859639

Matched MeSH terms: Pneumothorax/complications; Pneumothorax/etiology*

Fulltext Respiratory clinics: left-sided hydropneumothorax in a young male: importance of clinical and radiological markers in arriving at an aetiological diagnosis

Khajotia R, Kew S, Cham Y

Malays Fam Physician, 2009;4(1):41-3.

PMID: 25606160

Matched MeSH terms: Pneumothorax

Fulltext Bilateral pneumothorax following an acupuncture

Khor CC, Tan TL

Medicine & Health, 2018;13(1):227-231.

MyJurnal

Acupuncture is a form of complementary medicine that has been practiced in China for thousands of years. Adverse effect of acupuncture is rarely reported in local literature. This is a case of a patient who developed bilateral pneumothorax following an acupuncture session. A 63-year-old lady with no significant medical illness presented with sudden onset of shortness of breath half an hour following acupuncture and massage session by traditional medicine practitioner. On examination, she was tachypnoiec and there was reduced air entry bilaterally on lung auscultation. Urgent portable chest X-ray was done and it showed bilateral pneumothorax. Bilateral chest tubes were inserted. Patient was discharged well following five days of hospitalization. As acupuncture is gaining popularity among Malaysian population, medical practitioners need to increase their awareness and knowledge regarding the adverse effect of such alternative practice.

Matched MeSH terms: Pneumothorax

Empyema thoracis complicated by pneumothorax necessitans manifesting as lobulated, localized subcutaneous emphysematous swellings

Kuan YC, How SH, Yeen WC, Ng TH, Fauzi AR

Ann Thorac Surg, 2011 Jun;91(6):1969-71.

PMID: 21619994 DOI: 10.1016/j.athoracsur.2010.11.075

We describe a patient with empyema thoracis that had eroded through the apical chest wall to the supraclavicular fossa and lung parenchyma, ultimately leading to a bronchopleural fistula manifesting as lobulated, localized subcutaneous emphysematous swellings over the chest wall and supraclavicular fossa. This is a rarely reported phenomenon and the reason why the lobulated subcutaneous emphysematous swellings remained localized is unknown.

Matched MeSH terms: Pneumothorax/complications*

Fulltext The urine bag used in pneumothorax

Kuan YC, How SH, Yudisthra G, Ng TH, Fauzi M, Sapari S

Med J Malaysia, 2008 Mar;63(1):79-80.

PMID: 18935746 MyJurnal

Pneumothorax is the presence of air in the pleural cavity. It can be classified into spontaneous, traumatic or iatrogenic. The majority of pneumothorax cases are spontaneous, which can be further classified into primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP), defined by the absence or presence of obvious underlying lung disease respectively. The treatment of spontaneous pneumothorax includes simple aspiration, intercostal tube drainage or surgical intervention. When intercostal tube drainage is used, it is usually attached to an underwater-seal system. Mobile chest drains, such as the Heimlich valve, replace the underwater-seal and allow outpatient management of spontaneous pneumothoraces. The Heimlich valve however, is costly and not readily available in many local hospitals. Cheaper and easily obtainable alternatives which are also safe are being sought. This is a case report describing the use of the urine bag in the management of a patient with spontaneous pneumothrax.
Study site: Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia.

Matched MeSH terms: Pneumothorax/therapy*

Fulltext Intrapleural central venous catheter malposition

Leang LT

Med J Malaysia, 1989 Jun;44(2):147-50.

PMID: 2626123

Percutaneous insertion of central venous catheter (CVC) is a valuable procedure in managing critically ill patients. However, placement of CVC is not without its complications. The author reports a case in which a CVC was inserted into the right pleural cavity which was not detected by the usual clinical methods of confirming catheter placement and an antero-posterior (A-P) chest x-ray.

Matched MeSH terms: Pneumothorax/etiology

Fulltext Video-assisted thoracoscopic surgery for pneumothorax

Lee YM, Lim YC, Liam CK, Aljafri M

Med J Malaysia, 1995 Dec;50(4):334-8.

PMID: 8668053

Five cases of spontaneous pneumothorax were treated with video-assisted thoracoscopic surgery (VATS). These included four cases of recurrent pneumothorax and one case of persistent pneumothorax. The mean age was 33 years. The identified bullae were eliminated with either endoloop ligation (in one patient) or stapled excision (in four patients). There were no recurrences reported in a mean follow-up of 9.4 months. In conclusion, VATS offers an equally effective and less morbid alternative to open thoracotomy in the management of primary spontaneous pneumothorax.

Matched MeSH terms: Pneumothorax/surgery*

Fulltext Recurrent re-expansion pulmonary oedema complicating rapid decompression of large pneumothoraces

Liam CK, Jaafar S

Med J Malaysia, 1991 Jun;46(2):199-202.

PMID: 1839427

A young male who developed ipsilateral pulmonary oedema on two occasions as a complication of treatment of pneumothoraces involving the left lung is reported. The importance of large pneumothoraces, the rapidity of decompression and the application of suction to the pleural space as factors predisposing to the development of re-expansion pulmonary oedema is well demonstrated by this case. The re-expansion pulmonary oedema was more severe on the second occasion when the lung had collapsed for a longer duration compared to the first pneumothorax which was of more recent onset.

Matched MeSH terms: Pneumothorax/radiography; Pneumothorax/therapy*

An unusual cause of secondary spontaneous pneumothorax in a 27-year-old man

Lim KH, Tan LH, Liam CK, Wong CM

Chest, 2001 Nov;120(5):1728-31.

PMID: 11713160

Matched MeSH terms: Pneumothorax/etiology*

Cefepime-associated thrombocytopenia in a critically ill patient

Lim PP, Chong CP, Aziz NA

Int J Clin Pharm, 2011 Dec;33(6):902-4.

PMID: 21986835 DOI: 10.1007/s11096-011-9571-5

CASE: Cefepime-induced thrombocytopenia is a rare adverse event (incidence <1.0%), based on data from clinical trials. However, there is limited post-marketing surveillance documentation on thrombocytopenia associated with cefepime. We describe a 45-year-old male who was admitted to the intensive care unit after allegedly being hit by a large metal bar in the right upper chest and shoulder. Rhabdomyolysis secondary to the trauma, pneumothorax, acute renal failure, and nosocomial sepsis were subsequently diagnosed. Four days after intravenous cefepime initiation, the patient developed thrombocytopenia with platelet count dropping from 102 × 10(3)/μL to 15 × 10(3)/μL. Cefepime was discontinued and the platelet count normalized to 140 × 10(3)/μL after 6 days. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient's thrombocytopenia and cefepime therapy.

CONCLUSION: Although cefepime-induced thrombocytopenia is rare, clinicians should be alert to this potential adverse effect among critically ill patients.

Matched MeSH terms: Pneumothorax/etiology

Pyopneumothorax--a rare sequelae of retropharyngeal abscess

Lokman S, Sani A, Sidek DS

J Laryngol Otol, 1993 May;107(5):460-2.

PMID: 8326234

A case of massive pyopneumothorax as a rare sequelae of retropharyngeal abscess following fish bone ingestion is reported. An initial attempt at removal of the fish bone in the oesophagus using the fibroptic oesophagoscope was unsuccessful, causing failure of its removal and the development of this rare and potentially fatal complication. The intercommunication of the retropharyngeal space with other spaces of the neck and thorax that allow this and most other complications to occur is described. Rigid endoscopes are the instrument of choice in retrieving sharp foreign bodies in the oesophagus.

Matched MeSH terms: Pneumothorax/etiology*

Endometriosis - A rare cause of primary spontaneous pneumothorax

Low QJ, Cheo SW, Wong WH, Goh KS

Med J Malaysia, 2019 Oct;74(5):445-446.

PMID: 31649227

Catamenial pneumothorax is a rare condition. We report a case of a 36-year-old female who presented with dyspnoea every time before she had her regular menses. Further investigation confirmed that she had catamenial pneumothorax. With this case we wish to highlight this rare diagnostic entity that every clinician should keep in mind.

Matched MeSH terms: Pneumothorax

Fulltext The Flail and Pulseless Upper Limb: an Extreme Case of Traumatic Scapulo-thoracic Dissociation

Maria SW, Sapuan J, Abdullah S

Malays Orthop J, 2015 Jul;9(2):54-56.

PMID: 28435612 MyJurnal DOI: 10.5704/MOJ.1507.002

Scapulo-thoracic dissociation is an infrequent injury resulting from high energy trauma which is often associated with severe neurological and vascular injuries which may be unrecognised at the time of presentation. A 24 year-old female presented with bilateral rib fractures, pneumothorax, liver and kidney injuries following a road traffic accident. She also sustained fractures of her right scapula, odontoid, right transverse processes of the thoracic and lumbar vertebrae and a closed fracture of her right femur. Her right upper limb was later noted to be flail and pulseless, due to complete right brachial plexus injury, scapula-thoracic dissociation and subclavian artery avulsion. We managed the upper limb injuries non-operatively, and focused on resuscitation of the patient. Early exploration of the complete brachial plexus injury was not undertaken in spite of the possible associated poor functional outcome as there was no life-threatening indication.

Matched MeSH terms: Pneumothorax

Fulltext Cardiac A-lines in fast scan as a sign of pneumopericardium

Md Noor J, Eddie EA

Ultrasound J, 2019 Apr 25;11(1):7.

PMID: 31359168 DOI: 10.1186/s13089-019-0123-x

BACKGROUND: Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium.

CASE PRESENTATION: A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.

CONCLUSIONS: Although FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.

Matched MeSH terms: Pneumothorax

Fulltext A diagnostic workup of perioperative anaphylaxis reveals a selective type 1 hypersensitivity to cefazolin

Meera Thalayasingam, Shek, Lynette Pei-Chi

International e-Journal of Science, Medicine & Education, 2015;9(2):37-39.

MyJurnal

Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.

Matched MeSH terms: Pneumothorax

Fulltext Massive subcutaneous emphysema after a blunt neck injury

Mohamad, I., Md Shukri, N., Fauzi, M.H., Abdul Karim, A.H., Nik Hassan, N.F.H.

Malaysian Journal of Emergency Medicine, 2017;2(1):16-20.

MyJurnal

Subcutaneous emphysema can occur after a breach to the air-containing space. The classical condition will be ruptured alveolus in chronic lung disease. A disruption of the upper airway such as trauma to the laryngotracheal framework may lead to similar presentation. The amount of air leak varies depending on site and size of the breach. We report a case of blunt neck trauma after a fall from bicycle, which ended with massive subcutaneous emphysema, pneumothorax and pneumomediastinum requiring intubation.

Matched MeSH terms: Pneumothorax

Fulltext Recurrent spontaneous pneumothorax during pregnancy managed conservatively: a case report

Mohamed Faisal AH, Hazwani A, Soo CI, Andrea Ban YL

Med J Malaysia, 2016 04;71(2):93-5.

PMID: 27326955 MyJurnal

A 36-year-old lady presented with four episodes of right sided pneumothorax during pregnancy requiring multiple chest drain insertion. It was complicated with persistent air leak despite low pressure high volume suction applied to the chest drainage. She delivered safely through spontaneous vaginal delivery with chest drainage. Further imaging by high resolution computed tomography (HRCT) scan of thorax done revealed bilateral scattered pulmonary cysts and sub pleural bullae and was later followed up with respiratory unit. She had no further episodes of pneumothorax postpartum. This case highlights the vital importance of prompt recognition and management of pneumothorax in pregnancy as the patient involved is at higher risk for acute respiratory failure leading to maternal and/or foetal mortality. It is essential for early involvement of obstetric team and to expedite the delivery for a better perinatal and maternal outcome.

Matched MeSH terms: Pneumothorax/therapy*

Fulltext Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report

Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS

Respir Med Case Rep, 2020;31:101276.

PMID: 33209576 DOI: 10.1016/j.rmcr.2020.101276

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

Matched MeSH terms: Pneumothorax

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