pneumothorax

Pneumothorax is characterized by the presence of air in the pleural space and is a pathology that can be life-threatening and usually requires urgent treatment. It can be seen at any age. Its frequency is in men; 18-28/100000/year, in women; It has been reported as 1.2-6/100000/year.
It may develop spontaneously or may occur secondary to an underlying lung disease or due to traumatic (iatrogenic or after blunt/penetrating thoracic trauma) reasons. However, its etiology is still not fully understood today. It can rarely be seen as familial.
Spontaneous pneumothorax is called primary or secondary. While primary spontaneous pneumothorax occurs in healthy patients, secondary spontaneous pneumothorax is pneumothorax that develops in cases where it is known that there is an existing lung disease.

The type of pneumothorax, the age of the patient and the presence of accompanying pathologies are important parameters in the morbidity and mortality of the disease. Mortality may be high, especially in spontaneous pneumothorax that develops in newborns and in patients aged 0-1 years. It may recur despite appropriate diagnosis and treatment.
The majority of patients apply to the physician or emergency clinic with complaints of chest pain or shortness of breath. Chest pain is usually of the stinging – pleuritic type and has a sudden onset in most patients. Findings of pneumothorax include decreased breath sounds on the pneumothorax side, tachycardia, and hyperresonance with percussion. In patients with tension pneumothorax, the clinical picture can be very pronounced and even hypotension and shock may be observed.

Plain chest radiography (posteroanterior) is usually sufficient for diagnosis. In the radiograph, the borders of the lung are not visible, lung tissue is not visible in the lung periphery, and intense consolidation caused by the collapsed lung in the hilar region is observed. Although computed tomography is known as the gold standard diagnostic tool, its routine use is not recommended, especially in children.
Options in pneumothorax treatment are based on the severity of the cases. conservative monitoring, needle aspiration, tube thoracostomy and surgery. Although the timing of surgical treatment is not clear in the literature, it is generally recommended to resort to invasive procedures in cases of air leakage lasting more than 2 weeks. Underwater drainage is performed by placing a drain in the chest cavity under general or local anesthesia to evacuate the air in the pleural cavity.
In recurrent pneumothorax, pleurodesis with autologous blood has been found to be easy to perform, safe and successful.
The aim of the treatment is to ensure the re-expansion of the collapsed lung and to prevent recurrences.

As Istanbul Medeniyet University Göztepe Training and Research Hospital Pediatric Surgery Clinic, we successfully diagnose and treat patients with pneumothorax.
The recurrence rate after the first spontaneous pneumothorax is around 20%. After the second pneumothorax, this rate is between 39% and 47%, and therefore a surgical intervention may be required in recurrent pneumothorax. The probability of recurrence is around 80% in patients who remain conservative and do not undergo surgery for the second pneumothorax and have a third pneumothorax.
Recurrence has been reported between 0.1% and 1% in patients treated with surgery. Although there are publications reporting around 7% recurrence after videothoracoscopic intervention, recurrence rates in patients who underwent pleurectomy during VATS are the same as those who underwent thoracotomy. In patients with extensive bullous lung and/or emphysema, relapse is over 30% even after the first pneumothorax.

PDF dökümanı(PDF)

PDF önizleme

PDF dökümanı(PDF)

PDF önizleme

PDF dökümanı(PDF)

PDF önizleme