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case 1 The upper lobe of the right lung is completely collapsed, but the middle and lower lobes are almost completely expanded, and an air space in the right pleural cavity has appeared around the atelectasis of the upper lobe (A). A calcified mass (red arrowhead), which is suggestive of a foreign body, is observed in the lumen of the right upper bronchus (B). Bronchoscopy reveals obstruction of the bronchial lumen of the upper lobe bronchus by the rice grains (C). After removal of the rice grains, the right upper pulmonary lobe has expanded completely, with some pulmonary edema (D). . (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Source publication
We report two cases of pulmonary collapse that simulated pneumothorax on computed tomographic images and were caused by rapid complete bronchial obstruction. One patient was a 77-year-old woman with sudden dyspnea, and the other was an 83-year-old woman with sudden dyspnea who was infected with influenza A virus. Chest computed tomography revealed...
Context in source publication
Context 1
... of the middle and lower lobes, and a mediastinal shift to the affected side. An air space in the right pleural cavity appeared around the atelectasis of the upper lobe. She was diagnosed with pneumothorax by her primary doctor. A calcified mass, which was suggestive of a foreign body, was observed in the lumen of the right upper bronchus (Fig. 1). Bronchoscopy revealed obstruction of the bronchial lumen of the right upper lobe bronchus by grains of rice. The foreign body was extracted from the bronchial lumen. The day after removal of the rice grains, chest CT showed that the right upper pulmonary lobe had expanded completely, with some pulmonary edema. The air space in the ...
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Objective: Pneumothorax refers to an abnormal accumulation of air in the pleural cavity. This condition is significant in terms of health and can provide a life-threatening risk, particularly when it is extensive or occurs alongside other medical conditions. Nevertheless, the scarcity of work on chest CT segmentation arises from the challenge of ac...
Citations
... The mechanism by which this damage is generated is not fully known but seems to be related to this "trapped lung" [43]. 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 [45]. It is generally observed in patients with bronchial obstructions due to several factors like mucus plugs, aspiration of foreign bodies, and misplacement of the endotracheal tube [46]. ...
Thoracentesis is one of the most important invasive procedures in the clinical setting. Particularly, thoracentesis can be relevant in the evaluation of a new diagnosed pleural effusion, thus allowing for the collection of pleural fluid so that laboratory tests essential to establish a diagnosis can be performed. Furthermore, thoracentesis is a maneuver that can have therapeutic and palliative purposes. Historically, the procedure was performed based on a physical examination. In recent years, the role of ultrasound has been established as a valuable tool for assistance and guidance in the thoracentesis procedure. The use of ultrasound increases success rates and significantly reduces complications. The aim of this educational review is to provide a detailed and sequential examination of the procedure, focusing on the two main modalities, the ultrasound-assisted and ultrasound-guided form.
... Pneumothorax ex vacuo, a phenomenon less frequently encountered in clinical practice, manifests when there is an inability of the lung to re-expand post drainage of a pleural effusion, leading to the presence of air in the pleural space [1]. This occurrence is not due to a breach in the visceral pleura, a characteristic that distinguishes it from primary or secondary pneumothorax, but rather due to the formation of a thick fibrous peel that entraps the lung, preventing its re-expansion [2,3]. ...
... The diagnosis and treatment of the 38-year-old patient with cerebral palsy (CP) in this case report brings to light several critical challenges and considerations in managing pneumothorax ex vacuo and trapped lung. 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][6][7]. ...
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.
