MyMedR

Fulltext Spontaneous oesophageal perforation: a case report

Shu Ann Hon, Jan Jan Chai, Lian Thai Lee, Qin Jian Low

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):326-328.

MyJurnal

A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesoph- agogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.

Matched MeSH terms: Pneumothorax

The technique of bilateral artificial pneumothorax

Paneth O

Journal of the Malaya Branch of British Medical Association, 1939;3:139-42.

Matched MeSH terms: Pneumothorax

Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence

Ng GYH, Nah SA, Teoh OH, Ong LY

Pediatr Surg Int, 2020 Mar;36(3):383-389.

PMID: 31993738 DOI: 10.1007/s00383-020-04619-x

BACKGROUND: The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes.

METHODS: We reviewed children aged pneumothorax laterality, CT results, treatment protocols and recurrences.

RESULTS: 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1).

CONCLUSION: This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.

Matched MeSH terms: Pneumothorax/diagnosis; Pneumothorax/surgery*

Pancreatic pseudocyst: the controversial value of total parenteral nutrition

Shahrudin MD, Noori SM

Hepatogastroenterology, 1997 Mar-Apr;44(14):559-63.

PMID: 9164537

Total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst has been of hypothetical benefit.

Matched MeSH terms: Hydropneumothorax/etiology; Pneumothorax/etiology

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 Post motor vehicle accident with multiple jagged laceration wound

Irfan Mohamad, Arumugam, Puvan Arul, Nik Fariza Husna Nik Hassan

Archives of Orofacial Sciences, 2011;6(2):86-88.

MyJurnal

An 11-year-old Malay boy was allegedly involved in motor vehicle accident. He sustained left lung contusion and pneumothorax which necessitate chest tube insertion at a district hospital. On arrival at Accident & Emergency Unit, general physical examination was performed. Neck examination revealed multiple jagged lacerations wound on the left side of the neck (Panel 1). (Copied from article).

Matched MeSH terms: Pneumothorax

Fulltext A case of missed giant bullae emphysema diagnosed as pneumothorax

Ong, S.F., Nik Azlan, N.M.

Medicine & Health, 2017;12(1):90-93.

MyJurnal

We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Keywords: emphysema, haemopneumothorax, thoracostomy, thorax

Matched MeSH terms: Pneumothorax

Fulltext Empyema thoracis presented as giant back abscess

Abd Karim SH, Wan Zain WZ, Mohd Hashim MN, Zakaria AD, Hayati F, Ng CY

Radiol Case Rep, 2021 May;16(5):1061-1064.

PMID: 33680277 DOI: 10.1016/j.radcr.2021.02.030

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment.

Matched MeSH terms: Pneumothorax

Fulltext Spontaneous pneumothorax: a review of 29 admissions into Hospital Universiti Sains Malaysia 1984-90

Harun MH, Yaacob I, Mohd Kassim Z

Singapore Med J, 1993 Apr;34(2):150-2.

PMID: 8266158

Twenty-nine patients (16 males, 13 females) with spontaneous pneumothorax admitted into Hospital Universiti Sains Malaysia, Kubang Kerian, from September 1984 to September 1990 were reviewed. Their ages ranged from newborn to 75 years. The commonest chief presenting symptom was dyspnoea (69%), followed by chest pain (35%). Four patients had chronic obstructive airway disease, 7 had pneumonia, 2 had pulmonary tuberculosis, one patient had emphysema while 4 patients had multiple underlying lung disorders. The left and right lungs were involved with equal frequency. Bilateral pneumothorax occurred in one patient. Most patients had a single episode of pneumothorax but recurrent pneumothoraces occurred in 3 patients (10%). Six patients were observed conservatively, 20 patients required chest tube insertion alone and 3 patients also required pleurodesis. Death occurred in 8 patients (28%) mainly due to coexisting infection and respiratory failure.

Matched MeSH terms: Pneumothorax/complications; Pneumothorax/epidemiology*; Pneumothorax/physiopathology; Pneumothorax/therapy

Fulltext Extra pelvic endometriosis and catamenial pneumothorax

Rachagan SP, Zawiah S, Menon A

Med J Malaysia, 1996 Dec;51(4):480-1.

PMID: 10968038

Extra pelvic endometriosis is rare and its presentation is varied. A case of pulmonary and umbilical endometriosis which presented as catamenial pneumothorax is presented. Due to poor response to medical treatment, a total abdominal hysterectomy and bilateral salpingo-oophorectomy was done to relieve the patient of her recurrent symptoms.

Matched MeSH terms: Pneumothorax/etiology*

Risk factors associated with pneumothorax in Malaysian neonatal intensive care units

Boo NY, Cheah IG, Malaysian National Neonatal Registry

J Paediatr Child Health, 2011 Apr;47(4):183-90.

PMID: 21244549 DOI: 10.1111/j.1440-1754.2010.01944.x

This study aimed to determine the risk factors associated with the development of pneumothorax among infants admitted to the Malaysian neonatal intensive care units (NICUs).

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

Fulltext A case of lymphangioleiomyomatosis with multiple angiomyolipomas in the kidneys: a case report

How, S.H., Azlin, S., Pang, Y.K., Liam, C.K.

JUMMEC, 2006;9(2):35-38.

MyJurnal

Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.

Matched MeSH terms: Pneumothorax

Fulltext Mycobacterium abscessus - to treat or not to treat

Pang YK, Ngeow YF, Wong YL, Liam CK

Respirol Case Rep, 2013 Dec;1(2):31-3.

PMID: 25473536 DOI: 10.1002/rcr2.17

A patient with Mycobacterium abscessus lung disease was mistaken to have pulmonary tuberculosis with airway colonization by the non-tuberculous mycobacterium. Appropriate antibiotics were only given when the patient's signs and symptoms worsened while on anti-tuberculosis therapy. Despite treatment with a combination of antibiotics showing in vitro susceptibility, the pathogen persisted in the respiratory secretions for longer than 6 months and the patient suffered a spontaneous pneumothorax 14 months into treatment. This case illustrates the chronic course of M. abscessus lung infection, the tendency for flare-ups, the inadequacy of current treatment regimens, and the necessity for prolonged patient follow-up.

Matched MeSH terms: Pneumothorax

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 Hamman’s syndrome: a rare benign syndrome

Aida Abdul Rahim, Mohd Taufiq Yahaya1, Siti Nor Farhana Mohd Shafie, Laila Mastura Ahmad Apandi

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):357-359.

MyJurnal

Hamman’s syndrome by definition is spontaneous pneumomediastinum with the exclusion of thoracic trauma or iatrogenic cause. It is rare and is more common in adolescence male. Amongst the risk factors are underlying lung condition such as asthma and interstitial lung disease, drug inhalation and parturient woman. Patient usually pres- ents with sudden onset of shortness of breath and chest pain with subcutaneous emphysema on examination. The diagnosis is confirmed with chest radiograph. The prognosis of Hamman’s syndrome is excellent. Most cases are self-limiting and resolve spontaneously. However, Hamman’s syndrome is a poorly recognised disease due to its rarity. Therefore, the patient may be subjected to misdiagnosis and treatment. This is a case report of Hamman’s syn- drome misdiagnosed and treated as pneumothorax. The objective of this case report is to highlight the importance of differentiating this benign syndrome with life threatening differentials which may have similar clinical presentation. Thus, avoiding unnecessary costly investigation, treatment and invasive procedures.

Matched MeSH terms: Pneumothorax

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 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*

A case of cough induced rib fracture with subcutaneous emphysema and pneumothorax

Shukri WNA, Ng VH, Ismail AK

Med J Malaysia, 2019 12;74(6):551-552.

PMID: 31929488

Coughing is an important reflex mechanism which enhances the clearance of secretions and particulates from the airways, however repetitive muscle strain due to prolonged coughing may cause the uncommon complication of stress fracture of the ribs. The following is an unusual case of cough induced multiple rib fractures associated with subcutaneous emphysema and pneumothorax which was missed in the emergency setting. Delayed diagnosis and treatment would have been avoided if this uncommon condition was considered as a possibility.

Matched MeSH terms: Pneumothorax/diagnosis; 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

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*

Displaying publications 21 - 40 of 59 in total