Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax. M. Noppen, M. Meysman, J. d'Haese, I. Monsieur, W. Verhaeghe, M. Schlesser, W. Vincken. ©ERS Journals Ltd 1997. ABSTRACT: Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved.In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27±8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43±21 yrs) with persistent SSP.TT proved to be equally effective in achieving pleurodesis in both groups: there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p>0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p=0.004) and a longer postoperative chest tube drainage time (35.5±18 vs 24.9±3.2 hrs; p=0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7±2 vs 3.2±0.5 days; p<0.0001). Postoperative pain (90 vs 43%; p<0.0001) and fever (65 vs 17%; p= 0.001) were more frequent in the PSP group than in the SSP group.There were no major peri-or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax. Eur Respir J 1997; 10: 412-416 Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax occurring spontaneously in a person without (known) underlying lung disease; whereas, a secondary spontaneous pneumothorax (SSP) is defined as a spontaneous pneumothorax occurring in a patient with known underlying lung disease [1]. Although it is now widely recognized that the majority of PSP patients do have underlying abnormalities of their lungs (i.e. subpleural blebs or bullae, most often located at the apices of the lung) [2,3], their typical history and the absence of associated pulmonary disease allows the categorization of PSP as a distinct clinical entity [4,5].Numerous therapeutic options are available for the treatment of spontaneous pneumothorax, including: simple observation (with oxygen supplementation); simple manual aspiration; chest tube thoracostomy with or without instillation of various sclerozing agents; thoracoscopy with talc poudrage; pleural scarification; parietal pleurectomy; neodimium yytrium aluminium garnet (NdYAG) laser bleb ablation; bleb or bulla oversewing or stapling; and open thoracotomy with a variety of possible interventions [1]. The procedure of choice in any given patient with a spontaneous pneumothorax will depend upon: the extent and severi...

We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement.In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.

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Teratomas of the mediastinum are rare, accounting for 8% to 13% of the tumours in this region. They primarily occur in the anterior mediastinum of young adults. Surgery should be performed whenever complications, such as atelectasis of lung tissue, adhesion to or compression of adjacent structures, or malignant transformation, are likely to be present. Results after surgical resection are excellent.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease often not recognized until it is far advanced. Medical management does not reverse the effects of the disease, nor does it prevent its progression. Pulmonary thromboendarterectomy is the preferred treatment.We present the case of a patient in whom CTEPH was mistaken for an interstitial lung disease with mediastinal lymph node enlargement. The mediastinal lymph node enlargement was due to vascular transformation of the lymph node sinuses (VTS). This is an unusual case of chronic thromboembolic pulmonary hypertension with vascular transformation of the lymph node sinuses. Eur Respir J 1997; 10: 1191-1193 Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but potentially treatable cause of pulmonary hypertension. Unfortunately, there is often a delay in the diagnosis due to the fact that signs and symptoms are nonspecific in the majority of these patients. For this reason, CTEPH is frequently mistaken for other entities, such as chronic obstructive pulmonary disease, coronary artery disease, interstitial lung disease, congestive heart failure, or psychosomatic dyspnoea [1].We present the case of a patient in whom enlarged mediastinal lymph nodes and a mosaic pattern of lung attenuation on chest computed tomography (CT) scan were mistaken for interstitial lung disease. At autopsy, CTEPH and vascular transformation of the lymph node sinuses (VTS) were found. Case reportA 32 year old male was transferred to our institution because of respiratory distress and haemoptysis after transbronchial biopsy. Since the age of 10 yrs, the patient had been treated with inhaled β 2 -mimetics on demand, for allergic asthma. He had a smoking history of 15 pack-years but had ceased smoking 3 yrs before admission. Varicectomy of the lower limbs had been performed 2 yrs earlier.The patient was examined at another hospital a few months before admission because of worsening exertional dyspnoea and wheezing. Inhaled corticosteroids, budesonide 400 mg·day -1 , were added to his treatment, without any improvement in his symptoms. Spirometry performed at that time showed moderate obstructive pulmonary disease, with significant bronchial hypersensitivity at histamine provocation testing (provocative dose causing a 20% fall in forced expiratory volume in one second (PD20) 0.8 mg·mL -1 ). A chest radiograph was reported to show cardiac enlargement and pulmonary hyperinflation. An electrocardiogram revealed sinus rhythm with inverted T-waves in the precordial leads, and an echocardiogram demonstrated considerable enlargement of the right atrium and ventricle. Mean pulmonary artery pressure by Doppler evaluation of the tricuspid regurgitant envelope was estimated at 42 mmHg. A CT scan of the chest ( fig. 1a and b) revealed mediastinal lymph node enlargement and a mosaic pattern of lung attenuation, suggesting interstitial lung disease.Bronchoscopy and transbronchial biopsy were performed but haemoptysis and respiratory distress developed soon afterwards. The ...