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J Pak Med Assoc 2021 Feb;71(2(B)):602-607

College of Physicians and Surgeons of Pakistan, Karachi.

Objective: To compare upper versus lower calyceal approaches in percutaneous nephrolithotomy for managing renal calculi.

Methods: The retrospective study was conducted in the Department of Urology, The Kidney Centre Post-Graduate Training Institute, Karachi, and comprised data of patients who underwent percutaneous nephrolithotomy from January 2014 to January 2015. Patients were divided into upper pole puncture group A and lower pole puncture group B. Read More

J Trauma Acute Care Surg 2021 Apr 29. Epub 2021 Apr 29.

Harborview Injury Prevention and Research Center University of Washington Department of Surgery University of Washington University of Washington University of Washington Medical College of Wisconsin Gundersen Health System Mercy Health, Muskegon, MI St. Vincent Indianapolis Hospital University of Utah University of Utah Oregon Health and Science University Oregon Health and Science University Mission Trauma Services, Asheville, NC Loma Linda University Loma Linda University Harborview Injury Prevention and Research Center University of Washington University of Washington University of Washington.

Background: Single center data demonstrates that regional analgesia (RA) techniques are associated with reduced risk of delirium in older patients with multiple rib fractures. We hypothesized that a similar effect between RA and delirium would be identified in a larger cohort of patients from multiple Level I trauma centers.

Methods: Retrospective data from seven Level-I trauma centers were collected for ICU patients ≥65 years old with ≥3 rib fractures from 1/2012-12/2016. Read More

Bull Emerg Trauma 2021 Jan;9(1):42-45

Thoracic and Vascular Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Tube thoracostomy has been known to be a common and invasive, however not innocuous, procedure which is often life-saving. Though, numerous complications have been reported during executing this procedure. In this report, we describe a 27-year-old woman, case of multiple trauma due to car collision that was transferred to our service due to severe right side chest tube air leak and subcutaneous emphysema in which after proper evaluation, it was revealed that the chest tube crossed through the right pleural cavity and penetrated the bronchus intermedius. Read More

J Trauma Acute Care Surg 2021 May;90(5):769-775

From the Department of Trauma and Acute Care Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado Health Memorial Hospital, Colorado Springs; Department of Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado, Aurora; and Department of Pharmacy (L.P.C., A.A.D., E.W.B.), University of Colorado Health Memorial Hospital, Colorado Springs, Colorado.

Background: Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. Read More

Surgery 2021 Apr 19. Epub 2021 Apr 19.

Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA; Surgeons Writing About Trauma, Stanford University, Stanford, CA.

Background: Traumatic hemothorax is a common injury that invites diagnostic and management strategy debates. Evidence-based management has been associated with improved care efficiency. However, the literature abounds with long-debated, re-emerging, and new questions. Read More

Int J Crit Illn Inj Sci 2020 Oct-Dec;10(4):189-194. Epub 2020 Dec 29.

Department of Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: The need to evacuate the chest after a penetrating wound was first recognized in the 18 century. Most thoracic injuries are treated with tube thoracostomy (TT) which refers to the insertion of a TT into the pleural cavity to drain air, blood, pus, or other fluids. However, TT has been challenged in the trauma care due to insertional, positional, or infective complications. Read More

Ann Transl Med 2021 Mar;9(5):427

Division of Endocrinology and Metabolism, Department of Medicine, Zhejiang University Medical School Second Affiliated Hospital, Hangzhou, China.

Bronchopleural fistula (BPF) with empyema is a severe complication in patients undergoing lobectomy or pneumonectomy and is associated with high morbidity and mortality rates. Although a wide variety of treatment options exist, refractory cases with larger fistulas are still difficult to cure, especially in elderly patients. Here, we report a case of an 83-year-old man with stage I squamous cell lung carcinoma who underwent minimally invasive right lower lobectomy. Read More

BMJ Case Rep 2021 Apr 8;14(4). Epub 2021 Apr 8.

Accident & Emergency, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK.

A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Read More

Crit Care Res Pract 2021 27;2021:6626150. Epub 2021 Mar 27.

Department of Critical Care, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Introduction: Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons' consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons.

Methods And Materials: A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. Read More

Eur J Trauma Emerg Surg 2021 Apr 1. Epub 2021 Apr 1.

Trauma Unit, Shamir Medical Center, Zeriffin, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel.

Introduction: Occult pneumothorax (OPTX) is defined as air in the pleural space that was not suspected on plain chest X-ray but detected on CT. Controversy exists in the management of OPTX, especially in patients who require positive pressure ventilation (PPV). In this study, we investigated the need for tube thoracostomy (TT) in blunt trauma patients with OPTX. Read More

BMJ Case Rep 2021 Apr 1;14(4). Epub 2021 Apr 1.

Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA

Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Read More

Heart Lung Circ 2021 Mar 13. Epub 2021 Mar 13.

Division of Cardiothoracic Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Oceanside, NY, USA. Electronic address:

Background: Decreasing the length of stay after thoracic surgery provides both clinical and financial benefits to both the patient and the clinical system. Since 2017, our institution has seen advancements in the care of patients undergoing thoracic surgery after utilising our protocol Enhanced Recovery After Thoracic Surgery (ERATS).

Methods: The protocol we implemented is comprehensive, including the patient's pain management, thoracostomy tube drainage, physical therapy and rehabilitation, ventilator support and pulmonary care, as well as other features of preoperative, intraoperative, and postoperative care. Read More

Cureus 2021 Jan 30;13(1):e13003. Epub 2021 Jan 30.

Surgery Department #3, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO.

Colonoscopy is routinely used for the diagnosis and treatment of colorectal diseases. Bowel perforation is a rare but severe complication that significantly increases the morbidity and mortality. Tension pneumothorax is an uncommon complication of colonic perforation. Read More

Saudi Med J 2021 Mar;42(3):280-283

From the Department of Pediatric Surgery (Alaqeel, Al Namshan, Al Maary), King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City and from the Department of Family Medicine (Howsawi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Objectives: To review the patterns and outcomes of pediatric thoracic penetrating injuries in a level one trauma center.

Methods: Retrospective chart review of pediatric patients who presented to the King Abdulaziz Medical City Emergency Department (KAMC-ED), Riyadh, Saudi Arabia with thoracic penetrating injury from 2001 to 2016.

Results: Eighty-nine patients had a penetrating injury to the thorax were identified. Read More

North Clin Istanb 2021 31;8(1):82-87. Epub 2020 Aug 31.

Department of Thoracic Surgery, University of Health Sciences, Kayseri Health Practice and Research Center, Kayseri, Turkey.

Objective: In this study, we aimed to draw attention to traumatic pulmonary pseudocysts, which are rare cavitary lesions resulting from thoracic trauma, and review the diagnostic and therapeutic approaches and results.

Methods: Between January 2014 and January 2017, 30 patients included in this study who were diagnosed with traumatic pulmonary pseudocysts, from 582 patients who were admitted to our hospital with blunt thoracic trauma. To obtain data from the hospital information management system of patients included in this study, permission was obtained from the medical specialization board and the data were analyzed retrospectively. Read More

Singapore Med J 2021 01 2;62(1):16-19. Epub 2019 Dec 2.

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.

Introduction: Many institutions still perform routine chest radiography (CXR) after tube thoracostomies despite current guidelines suggesting that this is not necessary for simple cases. We aimed to evaluate the usefulness of routine CXR following ultrasonography-guided catheter thoracostomies for the detection of complications of symptomatic pleural effusions in hospitalised patients.

Methods: This was a retrospective review of 2,032 ultrasonography-guided thoracostomies on hospitalised patients with symptomatic effusions at a single institution from April 2012 to May 2015. Read More

Open Vet J 2021 Jan 12;10(4):443-451. Epub 2020 Dec 12.

Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Ozzano dell'Emilia, Italy.

Background: Pyothorax in cats is routinely managed, at least initially, with thoracic tube placement associated with systemic antimicrobial administration. Traditionally, large-bore trocar-type thoracostomy tubes have preferentially been used for the drainage of thick material from the pleural space. In recent years, the use of small-bore wire-guided thoracic drains has increased in both small animals and in humans. Read More

Respirol Case Rep 2021 Mar 15;9(3):e00718. Epub 2021 Feb 15.

Department of Respiratory Hospital Queen Elizabeth Kota Kinabalu Malaysia.

Ortner syndrome or cardiovocal syndrome is hoarseness of voice due to left recurrent laryngeal nerve palsy as a result of cardiovascular abnormality. It is not known that pneumothorax has any association with Ortner syndrome. A 56-year-old gentleman, with previous history of 20 pack-year smoking and 1-year history of hypertension, presented to us with cough for two weeks with intermittent haemoptysis, as well as hoarseness of voice for the past one year. Read More

Interact Cardiovasc Thorac Surg 2021 Feb 11. Epub 2021 Feb 11.

Department of Thoracic Surgery, Royal Brompton & Harefield, London, UK.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed: Is open window thoracostomy (OWT) the only method to control infection in patients with an empyema following pulmonary resection for primary lung cancer? Altogether 442 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Read More

J Cardiothorac Vasc Anesth 2021 Jan 12. Epub 2021 Jan 12.

Department of Anesthesiology and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA.

Acute aortic dissection is a rare but catastrophic condition. When the dissection extends through the adventitia, blood can extravasate into the extrapleural or intrapleural spaces, causing an extrapleural hematoma or hemothorax. The early recognition of extrapleural hematoma and distinguishing it from hemothorax is critical because the management of those two entities is different. Read More

Support Care Cancer 2021 Jan 30. Epub 2021 Jan 30.

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.

Background: Chemical pleurodesis is an important option for palliation in malignant pleural effusion (MPE).

Objectives: To evaluate the status of iodopovidone for pleurodesis in MPE.

Methods: We performed a systematic review of PubMed and EMBASE databases to identify studies evaluating the role of iodopovidone for pleurodesis in MPE. Read More

Mil Med 2021 01;186(Suppl 1):324-330

Sim*Vivo, LLC, Naples, FL 34110, USA.

Introduction: With blunt and penetrating trauma to the chest, warfighters and civilians frequently suffer from punctured lung (pneumothorax) and/or bleeding into the pleural space (hemothorax). Optimal management of this condition requires the rapid placement of a chest tube to evacuate as much of the blood and air as possible. Incomplete drainage of blood leading to retained hemothorax may be the result of the final tube tip position not being in contact with the blood collections. Read More

Am J Surg 2021 May 17;221(5):873-884. Epub 2020 Nov 17.

Duke University School of Medicine, USA. Electronic address:

Background: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax.

Methods: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. Read More

Case Rep Surg 2020 5;2020:6694990. Epub 2020 Dec 5.

Department of General Surgery, Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240 Moshi, Tanzania.

Breach in diaphragmatic musculature permits abdominal viscera to herniate into the thoracic cavity. Time of presentation and associated injuries determines the surgical approach in management. This case report sets to highlight the challenges in clinical diagnosis, radiological interpretation, and surgical management approaches of posttraumatic diaphragmatic hernia. Read More

Turk J Med Sci 2021 Jan 12. Epub 2021 Jan 12.

Background And Aim: Current neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences.

Material And Methods: The records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. Read More

Cureus 2020 Nov 30;12(11):e11811. Epub 2020 Nov 30.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Objective Silicosis is one of the common occupational lung diseases caused by crystalline silica respiration. Pneumothorax is one of the most common and morbid complications of silicosis involving lung pleura. It is commonly seen unilaterally in chronic silicosis and can often be lethal. Read More

Pediatr Surg Int 2021 May 1;37(5):631-637. Epub 2021 Jan 1.

Department of Clinical Education and Professional Development, CHOC Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.

Purpose: The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone.

Methods: A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. Read More

Pulm Ther 2020 Dec 9. Epub 2020 Dec 9.

Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Pleural infection is a millennia-spanning condition that has proved challenging to treat over many years. Fourteen percent of cases of pneumonia are reported to present with a pleural effusion on chest X-ray (CXR), which rises to 44% on ultrasound but many will resolve with prompt antibiotic therapy. To guide treatment, parapneumonic effusions have been separated into distinct categories according to their biochemical, microbiological and radiological characteristics. Read More

Wideochir Inne Tech Maloinwazyjne 2020 Dec 24;15(4):588-595. Epub 2020 Feb 24.

Department of Thoracic Surgery, Brest Regional Hospital, Brest, Belarus.

Introduction: Intrathoracic negative pressure therapy is an adjunct to standard methods of complex empyema management in debilitated patients. Nevertheless, the use of endoscopic one-way endobronchial valves to successfully close large bronchopleural fistulas in patients with advanced pleural empyema has been described in only a few case reports.

Aim: To present our experience in managing complex pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation. Read More

Korean J Thorac Cardiovasc Surg 2020 Dec 9. Epub 2020 Dec 9.

Department of Thoracic and Cardiovascular Surgery, Dankook University Hospital, Cheonan, Korea.

We present a case study of necrotizing fasciitis (NF), a very rare but dangerous complication of chest tube management. A 69-year-old man with shortness of breath underwent thoracostomy for chest tube placement and drainage with antibiotic treatment, followed by a computed tomography scan. He was diagnosed with thoracic empyema. Read More