Pneumothorax in patients with AIDS

Coker, R J; Moss, Fiona; Peters, B; McCarty, M.; Nieman, Richard B.; Claydon, E.; Mitchell, D. N.; Harris, J. R. W.

doi:10.1016/s0954-6111(05)80312-9

Cited by 46 publications

(28 citation statements)

References 25 publications

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“…Reports have also described emphysema-like bullous disease in individuals with prolonged HIV infection without previous pulmonary infections [2,3]. Pneumothoraces have been reported in these conditions [4].…”

Section: Discussionmentioning

confidence: 98%

Radiotherapy: a novel treatment for pneumothorax

Ong¹

2006

European Respiratory Journal

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Pneumothorax is a relatively common condition that is usually managed either conservatively, by chest tube drainage or, if a refractory air leak persists, then with cardiothoracic intervention. However, there is a small group of patients with a persistent air leak in whom surgical intervention is felt to be inappropriate. This study looks at a novel management strategy in a patient presenting with this scenario.A male with underlying bullous lung disease presented with a right pneumothorax. Complete reexpansion was not achieved, despite chest tube drainage and suction. Cardiothoracic intervention was felt to be inappropriate and the air leak persisted despite prolonged conservative management. Ventilation scintigraphy was therefore used to localise the air leak prior to targeted radiotherapy in an attempt to seal the leak via radiation-induced fibrosis. Three weeks after the first fraction of radiotherapy, the air leak ceased.In complex cases of pneumothorax with persistent air leak where cardiothoracic intervention is deemed inappropriate, identification of the air leak site and localised radiotherapy could be considered.KEYWORDS: Pneumothorax, radiotherapy, ventilation scintigraphy A 44-yr-old male presented to accident and emergency with acute breathlessness. He had been diagnosed 5 yrs previously with HIV infection complicated by Pneumocystis carinii pneumonia (PCP) and hepatitis B. A highresolution computed tomography scan of the lungs performed immediately on that admission showed the presence of underlying bullous lung disease. He had a 10-pack-yr history of smoking but had never used intravenous drugs. More recently he was noted to have severe pulmonary hypertension (mean pulmonary artery pressure of 54 mmHg at right heart catheterisation).Examination findings were consistent with a right pneumothorax. This was confirmed on a chest radiograph. Oxygen saturations were 80% on air.MANAGEMENT A 24 French gauge chest drain was inserted and, despite suction, the lung never fully re-expanded. A repeat computed tomography scan, which was unchanged compared with that taken previously, except for the pneumothorax, showed the presence of large sub-pleural bullae occupying the entire right upper lobe with compression of the middle lobe ( fig. 1). Early consultation with cardiothoracic surgeons concluded that the patient was not a suitable candidate for surgical intervention. The air leak persisted over the next 4 weeks. Consideration was given as to whether he could be managed conservatively with a Heimlich valve (Becton-Dickinson, Franklin Lakes, NJ, USA), but attempts to stop suction resulted in worsening dyspnoea associated with radiological evidence of increased collapse of the right lung.Consequently, a decision was made to perform localised radiotherapy in an attempt to seal the leak via radiation-induced fibrosis. Ventilation scintigraphy using 81m-Krypton (standard planar plus single-photon emission computed tomography (SPECT) imaging) was performed to localise the leak in order to limit radiation ...

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Section: Discussionmentioning

confidence: 98%

Radiotherapy: a novel treatment for pneumothorax

Ong¹

2006

European Respiratory Journal

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“…Así sólo se han comunicado casos de enfermos aislados (5,(9)(10)(11), o que además presentaban alguna peculiaridad asociada, como la formación de un neumotórax recurrente bilateral (l2), o con un hidroneumotórax similar al que presento uno de nuestros enfermos (13).…”

Section: Discussionunclassified

Neumotórax espontáneo y tuberculosis pulmonar activa

Ortega

Valiente

et al. 2001

An. Med. Interna (Madrid)

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INTRODUCCIÓNLa tuberculosis pulmonar curada, en la fase de fibrosis residual que origina retracciones en el parénquima con enfisema y bullas en la vecindad de la pleura, es una causa relativamente frecuente de neumotórax secundario (l-3). Sin embargo es una complicación muy rara durante la infección pulmonar activa (4,5) motivo por el que creemos de interés presentar tres enfermos con un neumotórax como manifestación clínica más destacada de una infección tuberculosa del pulmón.CASOS APORTADOS Caso 1. Enfermo de 40 años fumador y bebedor importante con mal estado de nutrición. Ingresó por presentar desde un mes antes un cuadro de astenia, anorexia, pérdida de peso, tos, expectoración y sudoración nocturna. Horas antes de su ingreso refería dolor de costado derecho de instauración brusca y disnea progresiva. No presentaba adenopatías, tenia estigmas de hepatopatía crónica y abolición del murmullo vesicular en el pulmón derecho, con hepatomegalia de 2 cm. En los datos analíticos presentaba 12.600 leucocitos/mm, VSG 90, resto de parámetros dentro de límites normales. Serología VIH negativa, Mantoux positivo. La radiología simple de tórax ( Fig. 1) mostró un neumotórax derecho con un infiltrado en el interior del pulmón colapsado y otro infiltrado cavitado en lóbulo superior del pulmón izquierdo. Se colocó tubo de drenaje intercostal, observando al reexpandirse el pulmón infiltrado y caverna en el lóbulo superior derecho. El cultivo de esputo en medio de Lowenstein fue repetidamente positivo para Mycobacterium tuberculosis. Se mantuvo el drenaje hasta la reexpansión completa del pulmón diez días después. Se trató con isoniazida, rifampicina, etambutol y pirazinamida a dosis habituales durante nueve meses sin secuelas pulmonares posteriores.Caso 2. Enfermo de 42 años que vivía solo, con alimentación deficiente, fumador y bebedor importante. Desde 2 semanas antes de su ingreso presentaba fiebre de 39° tos, expectoración purulenta y dolor progresivo en hemitórax derecho con disnea importante en las 45 [0212-7199 (2001) RESUMENPresentamos tres enfermos varones, con anticuerpos VIH negativos, con un neumotórax espontáneo como manifestación clínica más destacada de una tuberculosis pulmonar activa. El cuadro agudo del neumotórax con dolor torácico y disnea motivó su ingreso. Las radiografías de tórax mostraban un colapso del pulmón, con infiltrados cavitados en su interior en dos enfermos y un hidroneumotórax en el otro. La evolución clínica fue favorable, sin recidivas, con tubo de drenaje intercostal y tratamiento antituberculoso con cuatro fármacos. Aunque frecuente en la fibrosis pulmonar tuberculosa, el neumotórax espontáneo es raro como complicación de la tuberculosis pulmonar activa en la actualidad, a pesar del notable incremento de su incidencia.

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“…The mortality rate is 18%to 24% in several reports (7)(8)(9)(10). Therefore, the treatment for pneumothorax includes chemical pleurodesis, and thoracoscopic or surgical treatment in addition to chest tube drainage.…”

Section: Case Reportmentioning

confidence: 99%

AIDS-related Pneumocystis carinii Pneumonia with Disappearance of Cystic Lesions after Treatment.

et al. 2002

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A 21-year-old hemophiliac with human immunodeficiency virus (HIV) infection was admitted to our hospital because of bilateral pneumothoraces associated with Pneumocystis carinii pneumonia (PCP). He underwent chest tube drainages and intravenous pentamidine therapy, resulting in clinical improvement. Twomonths after treatment for PCP, cystic lesions that had existed before treatment disappeared on chest computed tomography. Weconcluded that Pneumocystis carinii infection might be associated with lung destruction and cyst formation, and that inflammatory exudates in the small bronchioles might act as a ball-valve with subsequent spontaneous pneumothoraces. (Internal Medicine 41: 896-898, 2002)

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Pneumothorax in patients with AIDS

Cited by 46 publications

References 25 publications

Radiotherapy: a novel treatment for pneumothorax

Radiotherapy: a novel treatment for pneumothorax

Neumotórax espontáneo y tuberculosis pulmonar activa

AIDS-related Pneumocystis carinii Pneumonia with Disappearance of Cystic Lesions after Treatment.

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