Medical management of pleural infection: Why not saline intrapleural lavage?

Mismetti, Valentine; Froudarakis, Marios

doi:10.1111/crj.13548

Cited by 1 publication

(1 citation statement)

References 23 publications

(44 reference statements)

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“…This uncommon phenomenon is characterized by the introduction of air into the pleural space, a consequence of a vacuum-like negative intrapleural pressure stemming from lung collapse [ 2 ]. It is generally observed in patients experiencing bronchial obstructions due to various factors such as mucus plugs, aspiration of foreign bodies, and misplacement of the endotracheal tube [ 5 - 7 ].…”

Section: Discussionmentioning

confidence: 99%

When the Lung Refuses to Expand: A Deep Dive Into a Pneumothorax Ex Vacuo Case

Louis,

Canaan,

Hastings

et al. 2023

Cureus

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Pneumothorax ex vacuo and trapped lung represent challenging clinical entities, especially in the context of pre-existing comorbidities. This case report outlines the diagnostic and management pathway of a 38-year-old patient with cerebral palsy who initially presented with empyema. Following the evacuation of the empyema, the patient developed pneumothorax ex vacuo, a rare phenomenon occurring due to a vacuum-like negative intrapleural pressure initiated by lung collapse. Initially suspected to have an infectious etiology based on laboratory findings, the patient was later found to have a large hydropneumothorax through a combination of imaging, laboratory studies, and clinical evaluations without confirming infection or malignancy. Despite interventions including Tissue Plasminogen Activator (TPA) and Deoxyribonuclease (DNAse) administration to facilitate pleural drainage, the patient's condition persisted, necessitating a surgical intervention that evolved from a minimally invasive video-assisted thoracoscopic surgery (VATS) to a more invasive thoracotomy due to unforeseen pleural thickening. The patient's pre-existing condition of cerebral palsy increased his susceptibility to respiratory complications, including empyema, due to the risk of aspiration. This case highlights the importance of a multidisciplinary approach in managing such complex clinical scenarios. It also serves as a clinical reminder that pneumothorax ex vacuo is generally benign and does not typically require chest tube placement, as the primary issue is an unexpandable lung that is unresponsive to pleural drainage. The report emphasizes the need for flexible surgical planning and robust postoperative management to optimize patient outcomes. It also clarifies the distinct pathophysiology of pneumothorax ex vacuo compared to primary or secondary pneumothorax, advocating for a comprehensive diagnostic approach and the crucial role of a multidisciplinary team in the management of such intricate cases.

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Section: Discussionmentioning

confidence: 99%