Tratamento operatório de bolhas no enfisema bolhoso: uma simples drenagem

Saad, Roberto; Mansano, Marcelo Domingues; Botter, Marcio; Giannini, Jacqueline Arantes; Neto, Vicente Dorgan

doi:10.1590/s0102-35862000000300003

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…(7) One alternative that is less invasive and avoids complications related to general anesthesia is simple chest tube drainage under local anesthesia. (8) Regardless of the technique employed, surgical resection remains the treatment of choice for congenital cystic malformations of the lung and pulmonary lesions in which the radiological findings are inconclusive; the procedure allows us to conduct a histological study and prevent infections or neoplastic transformation. (9) In the case reported here, the patient presented with sudden-onset chest pain and dyspnea due to expansion of a lung bulla located in the upper lobe of the left lung, as confirmed by chest X-rays.…”

Section: To the Editormentioning

confidence: 99%

Distensão de bolha pulmonar por malformação adenomatoide cística durante viagem aérea

et al. 2012

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Emphysematous bullae are defined as functionally inert, air-filled blebs that are larger than 1 cm and are covered by a thin outer layer that is either translucent or opalescent and is less than 1 mm thick, as well as consisting primarily of visceral pleura. (1) Under low pressure, lung bullae can either expand and lead to mediastinal compression or burst and cause hypertensive pneumothorax, massive hemorrhage, or gas embolism, characterizing an uncommon type of barotrauma. (2) Cases of gas embolism in divers who ascend too rapidly from great depths constitute the most common example of barotrauma, cases of barotrauma during air travel being rare. Therefore, we report the case of a 62-year-old male patient who experienced acute respiratory failure due to expansion of a lung bulla during air travel.The patient was admitted to an emergency room with intense chest pain and sudden-onset dyspnea during air travel. Immediately after admission, electrocardiography was performed and cardiac enzyme levels were determined. The electrocardiogram and cardiac enzyme levels were found to be normal. A chest X-ray revealed a round hypertransparent area located in the middle third of the left lung and compressing the lung parenchyma ( Figure 1). An axial CT scan of the chest confirmed the presence of a hypertransparent area occupying the entire anterior segment of the left upper lobe and measuring 12.2 × 9.0 cm, as well as containing a fine liquid layer. No other changes were found. The patient underwent left thoracotomy with selective lung intubation. We found a lung bulla located in the upper lobe and occupying the entire mediastinal surface of the lung. The affected area was resected and stapled with a mechanical stapler, and abrasion pleurodesis was performed. No other macroscopic changes were observed during the surgical procedure. After the surgical procedure, the patient was transferred to the ICU, where he was woken and extubated. The postoperative evolution was favorable, the chest tube having been removed on postoperative day 5. A follow-up chest X-ray revealed re-expansion of the left lung and hypotransparent areas in the middle third, which were attributed to the edema and the hematoma at the suture site. The histopathological features of the surgical specimen were found to be consistent with cystic adenomatoid malformation.Cystic adenomatoid malformation of the lung is generally asymptomatic in adults, the diagnosis being incidental. (3) Changes in the atmospheric pressure can lead to rupture of previously asymptomatic lung bullae. This can be explained by Boyle's Law, according to which the volume of a gas is inversely proportional to its pressure. (4,5) During commercial flights, the pressure in the passenger cabin varies according to the altitude. At an altitude of approximately 9,000 m, the airplane is pressurized in order to maintain an internal pressure of 2,400 m. During ascent, that change causes the pressure to drop from 760 mmHg (sea level) to 564 mmHg, a pressure that is reached within approximately 20 mi...

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Section: To the Editormentioning

confidence: 99%

Distensão de bolha pulmonar por malformação adenomatoide cística durante viagem aérea

et al. 2012

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Pneumostomia: uma proposta operatória para o tratamento do enfisema pulmonar difuso grave.

Júnior

Lopez

Neto

et al. 2019

Rev. Col. Bras. Cir.

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Objective: to evaluate a new operative technique for the treatment of advanced pulmonary emphysema. Methods: we conducted a prospective analysis of nine patients with severe pulmonary emphysema submitted to pneumostomy. The procedure was performed under local anesthesia, in the anterior thoracic wall, hemiclavicular line, in the second intercostal space, through an anterior thoracotomy of 5cm for access to the upper lobe, whose anterior segment was pinched and fixed to the parietal pleura. We carried out the pneumostomy with electrocautery and blunt insertion of an intrapulmonary drain. To assess the procedure, we performed pulmonary function tests, imaging tests, six-minute walk test, and applied quality of life questionnaires, all measured preoperatively and 30 days after the procedure. Results: no deaths occurred related to the procedure. Imaging studies showed a decrease in lung volume. The pulmonary function showed a significant reduction in the residual volume. The six-minute walk test showed an increase in the distance covered in the postoperative period. There was significant improvement of the quality of life as demonstrated through questionnaires Medical Outcomes Study 36 Item Short-Form Health Survey (SF-36), Saint-George Respiratory Questionnaire (SGRQ), Medical Research Council scale (MRC), and Eastern Cooperative Oncology Group Performance status (ECOG). Conclusion: the proposed technique is feasible, safe, easy to perform and to maintain. Pneumostomy: an operative proposal for the treatment of severe diffuse pulmonary emphysema Saad Júnior Pneumostomy: an operative proposal for the treatment of severe diffuse pulmonary emphysema R E S U M OObjetivo: avaliar uma nova técnica operatória para o tratamento do enfisema pulmonar avançado. Métodos: análise prospectiva de nove pacientes portadores de enfisema pulmonar grave, submetidos à pneumostomia. O procedimento foi realizado sob anestesia local, na parede torácica anterior, linha hemiclavicular, no segundo espaço intercostal, através de toracotomia anterior de 5cm para acesso ao lobo superior, cujo segmento anterior foi pinçado e fixado à pleura parietal. Realizada pneumotomia com eletrocautério e inserção romba de dispositivo (dreno) intrapulmonar. Para avaliação do procedimento, foram realizados os seguintes exames: testes de função pulmonar, exames de imagens, teste da caminhada de seis minutos e questionários de qualidade de vida, medidos todos no pré-operatório e 30 dias após o procedimento. Resultados: não houve mortes relacionadas ao procedimento. Exames de imagens mostraram diminuição do volume pulmonar. A função pulmonar mostrou significante redução do volume residual. O teste de caminhada de seis minutos mostrou um aumento na distância percorrida no pós-operatório. Houve melhora significante da qualidade de vida, demonstrada por meio dos seguintes questionários: Medical Outcomes

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Aplicação terapêutica da ventilação colateral no enfisema pulmonar difuso: apresentação de um protocolo

et al. 2008

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We present a protocol to test a new surgical procedure for the treatment of patients with diffuse lung emphysema who, after having received the golden standard treatment (pulmonary rehabilitation), continue to present respiratory failure with disabling dyspnea. Ten patients with severe lung hyperinflation will be evaluated. The method proposed is designed to create alternative expiratory passages for air trapped in the emphysematous lung by draining the lung parenchyma, thereby establishing communication between the alveoli and the external environment. The ten patients selected will be required to meet the inclusion criteria and to give written informed consent. Those ten patients will be included in the study pending the approval of the Ethics in Research Committee of the São Paulo Santa Casa School of Medicine, São Paulo, Brazil. The protocol we will employ in order to evaluate the proposed procedure is feasible and will show whether debilitated patients suffering from diffuse pulmonary emphysema can benefit from this procedure, which could represent an alternative to lung transplant or lung volume reduction surgery, the only options currently available.Keywords: Pulmonary Emphysema; Pulmonary Disease, Chronic Obstructive; Lung, Hyperlucent. ResumoApresentação de um protocolo, para testar uma nova opção de tratamento operatório nos doentes portadores de enfisema pulmonar difuso, nos quais a terapêutica clínica máxima, incluindo a reabilitação pulmonar, foi realizada e ainda assim, existe falência respiratória com dispnéia incapacitante. Serão avaliados dez doentes portadores de hiperinsuflação pulmonar grave. O método propõe promover passagens expiratórias alternativas à via aérea principal para o ar aprisionado no pulmão enfisematoso, por meio de uma drenagem do parênquima pulmonar, comunicando os alvéolos ao meio exterior. Serão selecionados dez doentes, com os consentimentos informados assinados, e com a aprovação do Comitê de Ética em Pesquisa da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Os doentes selecionados deverão obedecer os critérios de inclusão para participar deste estudo. O protocolo de avaliação do procedimento proposto é viável e ao final será capaz de mostrar, se de fato há ou não benefício para um doente debilitado e sofrido, quando hoje as únicas soluções são o transplante de pulmão ou a cirurgia redutora de volume pulmonar.Descritores: Enfisema pulmonar; Doença pulmonar obstrutiva crônica; Pulmão hipertransparente. * Study carried out at

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Tratamento operatório de bolhas no enfisema bolhoso: uma simples drenagem

Cited by 4 publications

References 17 publications

Distensão de bolha pulmonar por malformação adenomatoide cística durante viagem aérea

Distensão de bolha pulmonar por malformação adenomatoide cística durante viagem aérea

Pneumostomia: uma proposta operatória para o tratamento do enfisema pulmonar difuso grave.

Aplicação terapêutica da ventilação colateral no enfisema pulmonar difuso: apresentação de um protocolo

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