Spontaneous pneumothorax in cocaine users

Abstract

Background Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment. Aim We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax. Design Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution. Results Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120–239). All subjects are now well, with no evidence of pneumothorax. Conclusions Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.

Pneumothorax associated with accidental 4‐nitrophenyl chlonoformate inhalation in an academic chemistry lab

“…Currently, the material data safety sheet states “Inhalation of dusts, generated by the material, during the course of normal handling, may produce toxic effects.” Although these toxic effects are not defined and do not include pneumothorax. Other irritant gasses 2–5 inhaled illicit substances 6–10 and inhaled medications 11 have all been previously implicated as causes of pneumothorax in the literature. For example, at high concentrations, partially water‐soluble chlorine gas has shown to cause respiratory distress when inhaled, because of the development of bronchospasm and pulmonary edema 12 .…”

Recurrent pneumothorax in a patient with liposarcoma as either a complication of lung micrometastasis or a potential adverse event from antibiotic therapy: A case report

“…In our case, the patient was an ex-smoker (20 pack/year up to 5 years before the PNX) and did not have a clinical history of obstructive bronchopneumopathy. As far as we know, he was not a user of cocaine, which can also cause PNX ( 12 ). We thus hypothesized a correlation between the onset of spontaneous PNX and the antibiotic therapy administered.…”

«A maggior gloria di Dio»

“…Simidei 1737, p. 463. 177 «Un monastero de i primi della città diviso in fattioni, perché alcune moniche desideravano frati, ed altre preti, e s'erano affaticati, per ridurle in concordia, et alla ubbidienza del prelato, et il prelato e molt'altri, ma indarno, e però restavano senza confessione, e messe da otto mesi, per opera, et esortatione de' nostri, e si confessarono con li nostri, ed accettarono prontamente il confessore datoli dal Prelato, e si quietarono con edificatione della città» (De Societate Iesu in Corsica [1552-1638, in ARSI, Med 98, f. 24v). 178 Nel 1612 ella ricevette da Vitelleschi un riconoscimento della sua devozione: «Alla s.ra Elisabetta Casella V.R.…”