Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients
Author(s)
Ahmed I. Al-Azzawi
ABSTRACT
Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.
Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.
Cite this paper
Al-Azzawi, A. (2015) Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients. World Journal of Cardiovascular Surgery, 5, 18-24. doi: 10.4236/wjcs.2015.52004.
Al-Azzawi, A. (2015) Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients. World Journal of Cardiovascular Surgery, 5, 18-24. doi: 10.4236/wjcs.2015.52004.
References
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http://dx.doi.org/10.1378/chest.105.4.1142 [4] Druepple, L.G. and Cox, W.A. (1974) Simultaneous Bilateral Spontaneous Pneumothorax. Military Medicine, 139, 296-299. [5] Teixidor, S.J., Estrada, S.G., Sole, M.J., et al. (1994) Spontaneous Pneumothorax Apropos 2505 Cases. Archivos de Bronconeumología, 30, 131-135. [6] Gupta, D., Mishra, S., Faruqi, S. and Aggarwal, A.N. (2006) Etiology and Clinical Profile of Spontaneous Pneumothorax in Adults. Indian Journal of Chest Disease and Allied Science, 48, 261-264. [7] Athanassiadi, K., Kalavrouziotis, G., Loutsidis, A., et al. (1998) Treatment of Spontaneous Pneumothorax: Ten Year Experience. World Journal of Surgery, 22, 803-806.
http://dx.doi.org/10.1007/s002689900473 [8] Graf-Deuel, E. and Knoblauch, A. (1994) Simultaneous Bilateral Spontaneous Pneumothorax. Chest, 105, 1142-1146.
http://dx.doi.org/10.1378/chest.105.4.1142 [9] Sayar, A., Turna, A., Metin, M., et al. (2004) Simultaneous Bilateral Spontaneous Pneumothorax Report of 12 Cases and Review of the Literature. Acta Chirurgica Belgica, 104, 572-576. [10] Yamada, S., Yoshino, K. and Inoue, H. (2008) Simultaneous Bilateral Spontaneous Pneumothorax with Pleural Window Communicating with Bilateral Pleural Spaces. Annals of Thoracic Surgery, 85, 1434-1436.
http://dx.doi.org/10.1016/j.athoracsur.2007.10.033 [11] Graf-Deuel, E. and Knoblauch, A. (1994) Simultaneous Bilateral Spontaneous Pneumothorax. Chest Journal, 105, 1142-1146.
http://dx.doi.org/10.1378/chest.105.4.1142 [12] Mohebbi, I., Hassani, E., Salarilak, S. and Bahrami, A.R. (2007) Do Bullae and Emphysema Increase Risk of Pneumothorax in Silicosis? Journal of Occupational Medicine and Toxicology, 1, 8. [13] Takahashi, S., Yokoyama, T., Ninomiya, N., Yokota, H. and Yamamoto, Y. (2006) A Case of Simultaneous Bilateral Spontaneous Pneumothorax Developed into Tension Pneumothorax. Journal of Nippon Medical School, 73, 29-32.
http://dx.doi.org/10.1272/jnms.73.29 [14] Sayar, A., Turna, A., Metin, M., Kucukyagci, N., Solak, O. and Gurses, A. (2004) Simultaneous Bilateral Spontaneous Pneumothorax, Report of 12 Cases and Review of Literature. Acta Chirurgica Belgica, 104, 572-576. [15] Hatta, T., Mastuda, S., Kuris, S., Ohyabu, H., Tachibana, S., Kita, Y., et al. (1993) A Case of Simultaneous Bilateral Pneumothorax. Kyobu Geka, 46, 287-289. [16] Ohara, K., Yamazaki, T., Sakaguchi, K., Nakayama, M. and Kobayashi, A. (1994) A Case of Simultaneous Bilateral Spontaneous Pneumothorax. Kyobu Geka, 47, 1110-1111. [17] Neal, J.F., Vargas, G., Smith, D.E., Akl, B.F. and Edwards, W.S. (1979) Bilateral Bleb Excision through Median Sternotomy. American Journal of Surgery, 138, 794-797.
http://dx.doi.org/10.1016/0002-9610(79)90298-8 [18] Eroglu, A., Turkyilmaz, A., Aydin, Y., Erdem, A.F. and Cinici, O. (2007) Treatment of Secondary Spontaneous Pneu-mothorax: 100-Patient Experience. Eurasian Journal of Medicine, 39, 97-102. [19] Baumann, M.H. and Strange, C. (1997) Treatment of Spontaneous Pneumothorax: A More Aggressive Approach? Chest Journal, 112, 789-804.
http://dx.doi.org/10.1378/chest.112.3.789 [20] Chee, C.B., Abisheganaden, J., Yeo, J.K., Lee, P., Huan, P.Y.M., Poh, S.C. and Wang, Y.T. (1998) Persistent Air-Leak in Spontaneous Pneumothorax: Clinical Course and Outcome. Respiratory Medicine, 92, 757-761.
http://dx.doi.org/10.1016/S0954-6111(98)90008-7 [21] Aydin, Y., Turkyilmaz, A., Intepe, Y.S. and Eroglu, A. (2010) Simultaneous Bilateral Spontaneous Pneumothorax: A Rare Emergency Clinical Condition. Eurasian Journal of Medicine, 42, 5-8.
[1] Light, R.W. (1994) Pneumothorax. In: Murray, J.F., Ed., Textbook of Respiratory Medicine, Vol. 2, WB Saunders, Philadelphia, 2193-2208. [2] Melton III, L.J., Helper, N.G.G. and Offord, K.P. (1979) Incidence of Spontaneous Pneumothorax in Olmsted County, Minnesota: 1950 to 1974. American Review of Respiratory Disease, 120, 1379-1381. [3] Graf-Deuel, E. and Knoblauch, A. (1994) Simultaneous Bilateral Spontaneous Pneumothorax. Chest, 105, 1142-1146.
http://dx.doi.org/10.1378/chest.105.4.1142 [4] Druepple, L.G. and Cox, W.A. (1974) Simultaneous Bilateral Spontaneous Pneumothorax. Military Medicine, 139, 296-299. [5] Teixidor, S.J., Estrada, S.G., Sole, M.J., et al. (1994) Spontaneous Pneumothorax Apropos 2505 Cases. Archivos de Bronconeumología, 30, 131-135. [6] Gupta, D., Mishra, S., Faruqi, S. and Aggarwal, A.N. (2006) Etiology and Clinical Profile of Spontaneous Pneumothorax in Adults. Indian Journal of Chest Disease and Allied Science, 48, 261-264. [7] Athanassiadi, K., Kalavrouziotis, G., Loutsidis, A., et al. (1998) Treatment of Spontaneous Pneumothorax: Ten Year Experience. World Journal of Surgery, 22, 803-806.
http://dx.doi.org/10.1007/s002689900473 [8] Graf-Deuel, E. and Knoblauch, A. (1994) Simultaneous Bilateral Spontaneous Pneumothorax. Chest, 105, 1142-1146.
http://dx.doi.org/10.1378/chest.105.4.1142 [9] Sayar, A., Turna, A., Metin, M., et al. (2004) Simultaneous Bilateral Spontaneous Pneumothorax Report of 12 Cases and Review of the Literature. Acta Chirurgica Belgica, 104, 572-576. [10] Yamada, S., Yoshino, K. and Inoue, H. (2008) Simultaneous Bilateral Spontaneous Pneumothorax with Pleural Window Communicating with Bilateral Pleural Spaces. Annals of Thoracic Surgery, 85, 1434-1436.
http://dx.doi.org/10.1016/j.athoracsur.2007.10.033 [11] Graf-Deuel, E. and Knoblauch, A. (1994) Simultaneous Bilateral Spontaneous Pneumothorax. Chest Journal, 105, 1142-1146.
http://dx.doi.org/10.1378/chest.105.4.1142 [12] Mohebbi, I., Hassani, E., Salarilak, S. and Bahrami, A.R. (2007) Do Bullae and Emphysema Increase Risk of Pneumothorax in Silicosis? Journal of Occupational Medicine and Toxicology, 1, 8. [13] Takahashi, S., Yokoyama, T., Ninomiya, N., Yokota, H. and Yamamoto, Y. (2006) A Case of Simultaneous Bilateral Spontaneous Pneumothorax Developed into Tension Pneumothorax. Journal of Nippon Medical School, 73, 29-32.
http://dx.doi.org/10.1272/jnms.73.29 [14] Sayar, A., Turna, A., Metin, M., Kucukyagci, N., Solak, O. and Gurses, A. (2004) Simultaneous Bilateral Spontaneous Pneumothorax, Report of 12 Cases and Review of Literature. Acta Chirurgica Belgica, 104, 572-576. [15] Hatta, T., Mastuda, S., Kuris, S., Ohyabu, H., Tachibana, S., Kita, Y., et al. (1993) A Case of Simultaneous Bilateral Pneumothorax. Kyobu Geka, 46, 287-289. [16] Ohara, K., Yamazaki, T., Sakaguchi, K., Nakayama, M. and Kobayashi, A. (1994) A Case of Simultaneous Bilateral Spontaneous Pneumothorax. Kyobu Geka, 47, 1110-1111. [17] Neal, J.F., Vargas, G., Smith, D.E., Akl, B.F. and Edwards, W.S. (1979) Bilateral Bleb Excision through Median Sternotomy. American Journal of Surgery, 138, 794-797.
http://dx.doi.org/10.1016/0002-9610(79)90298-8 [18] Eroglu, A., Turkyilmaz, A., Aydin, Y., Erdem, A.F. and Cinici, O. (2007) Treatment of Secondary Spontaneous Pneu-mothorax: 100-Patient Experience. Eurasian Journal of Medicine, 39, 97-102. [19] Baumann, M.H. and Strange, C. (1997) Treatment of Spontaneous Pneumothorax: A More Aggressive Approach? Chest Journal, 112, 789-804.
http://dx.doi.org/10.1378/chest.112.3.789 [20] Chee, C.B., Abisheganaden, J., Yeo, J.K., Lee, P., Huan, P.Y.M., Poh, S.C. and Wang, Y.T. (1998) Persistent Air-Leak in Spontaneous Pneumothorax: Clinical Course and Outcome. Respiratory Medicine, 92, 757-761.
http://dx.doi.org/10.1016/S0954-6111(98)90008-7 [21] Aydin, Y., Turkyilmaz, A., Intepe, Y.S. and Eroglu, A. (2010) Simultaneous Bilateral Spontaneous Pneumothorax: A Rare Emergency Clinical Condition. Eurasian Journal of Medicine, 42, 5-8.