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Emerg Med Pract 2022 Apr 15;25(5, Suppl 1):1-28. Epub 2022 Apr 15.

Duke University School of Medicine, Durham, NC.

Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Findings associated with pneumothorax include dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Read More

Diagnostics (Basel) 2022 Apr 18;12(4). Epub 2022 Apr 18.

Section of Pulmonary, Critical Care and Sleep Medicine, The University of Oklahoma Health Sciences Center and The Oklahoma City VA Health Care System, Oklahoma City, OK 73104, USA.

Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Read More

J Vet Emerg Crit Care (San Antonio) 2022 Apr 20. Epub 2022 Apr 20.

Canada West Veterinary Specialists and Critical Care Hospital, Vancouver, British Columbia, Canada.

Objective: To describe the successful management of a cat with an intrathoracic sewing needle foreign body and septic pericardial effusion.

Case Summary: A 10-year-old neutered female domestic longhair cat was referred for an intrathoracic metallic foreign body identified via thoracic radiography. Two weeks prior, the cat may have ingested a sewing needle. Read More

Front Vet Sci 2022 31;9:818055. Epub 2022 Mar 31.

Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.

Background: Small-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in small animals for management of pleural space disease. We aimed to evaluate the indications, placement locations, types of complications, and complication rate of small-bore wire-guided thoracostomy tube placements in dogs and cats in a university setting.

Methods: Electronic medical records of patients that underwent SBWGTT placement were reviewed. Read More

J Surg Case Rep 2022 Apr 11;2022(4):rjac076. Epub 2022 Apr 11.

Department of Surgery, Veterans Affairs Medical Center, West Roxbury, MA 02132, USA.

Severe coronavirus disease of 2019 (COVID-19) disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes substantial parenchymal damage in some patients. There is a paucity of literature describing the surgical management COVID-19 associated bronchopleural fistula after failure of medical therapy. We present the case of a 59-year-old woman with SARS-CoV-2 pneumonia, secondary bacterial pneumonia with bronchopleural fistula and radiographic and clinical evidence of disease refractory to medical therapy. Read More

Respir Med Case Rep 2022 24;36:101604. Epub 2022 Feb 24.

NMC Royal Hospital, Department of Critical Care, Dubai, United Arab Emirates.

The most critical intervention for large hemothorax is draining the blood out of the pleural cavity by placing a thoracostomy tube but it can be disastrous if done without due consideration. We report a rare case of spontaneous hemothorax due to posterior intercostal artery aneurysm and implication of diagnostic evaluation on its management. Read More

Children (Basel) 2022 Feb 18;9(2). Epub 2022 Feb 18.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany.

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Read More

JAMA Surg 2022 Mar;157(3):269-274

Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento.

Importance: Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician a comprehensive understanding of the types of chest tubes, indications for their effective use, and key management details for ideal patient outcomes. Read More

Cureus 2022 Jan 7;14(1):e21017. Epub 2022 Jan 7.

Thoracic Surgery, Maimonides Medical Center, Brooklyn, USA.

Pleural space infections have been described since the time of Hippocrates and to this day remains a significant pathology. Every year in the USA approximately there are one million hospital admissions for pneumonia with 20%-40% associated with some form of pleural space infections leading to pleural effusions with increased morbidity and mortality. Often, management of these effusions mandate combination of medical treatment and surgical drainage with debridement and decortication. Read More

J Trauma Nurs 2022 Jan-Feb 01;29(1):29-33

Department of General Surgery, Division of Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas (Drs Park, Grant, Dultz, Abdelfattah, Luk, and Dumas and Ms Lin); Department of Trauma, Parkland Memorial Hospital, Dallas, Texas (Mss Johnson and Jeter); Department of Surgery, Trauma and Acute Care Surgery, University of Colorado, Boulder (Dr Cripps).

Background: Training for trauma procedures has been limited to infrequent courses with little data on longitudinal performance, and few address procedural and leadership skills with granular assessment. We implemented a novel training program that emphasized an assessment of trauma resuscitation and procedural skills.

Objective: This study aimed to determine whether this program could demonstrate improvement in both skill sets in surgical trainees over time. Read More

ACG Case Rep J 2022 Jan 28;9(1):e00714. Epub 2021 Dec 28.

Division of Abdominal Imaging, Department of Radiology, Penn State Health Milton S. Hershey Medical Center, PA.

An esophagopleural fistula (EPF) is a rare condition. EPFs are typically of spontaneous, iatrogenic, or neoplastic origin. A 50-year-old man with hepatitis C and alcoholic cirrhosis presented with a history of recurrent variceal hemorrhage requiring esophageal banding, Minnesota tube placement, and a transjugular intrahepatic portosystemic shunt. Read More

J Trauma Acute Care Surg 2022 01;92(1):44-48

From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California.

Background: Ultrasonography for trauma is a widely used tool in the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST) demonstrating equivalence to computed tomography (CT) for detecting clinically significant abdominal hemorrhage. Initial reports demonstrated high sensitivity of CUST for the bedside diagnosis of pneumothorax. We hypothesized that the sensitivity of CUST would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax. Read More

BMJ Mil Health 2021 Dec 20. Epub 2021 Dec 20.

Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel.

Introduction: This study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation of the 2012 IDF-Military Corps plan which included the publication of clinical practice guidelines (CPGs) for thoracic injuries, emphasis on adequate torso protection, introduction of modern life-saving procedures and encouragement of rapid evacuation.

Methods: The IDF prehospital trauma registry was reviewed to identify all patients who sustained thoracic injuries from January 2006 to December 2017. IDF soldiers who were injured, died of wounds or killed in action (KIA) were included. Read More

Ann Med Surg (Lond) 2021 Dec 23;72:103101. Epub 2021 Nov 23.

Department of Thoracic Surgery, Getúlio Vargas University Hospital (HUGV), Manaus, Brazil.

Introduction: Accidents involving chainsaws are not uncommon in trauma care and may present as penetrating injuries with retention of a foreign object in the patient's chest. The current literature, however, does not present a consensus on the best way to approach these cases.

Presentation Of Case: Male patient, 46-year-old man, born in Amazonas countryside, brought to the city of Manaus with a penetrating injury resulting from an accident with a chainsaw and retaining a 2cm sawtooth in his chest, six days after the event. Read More

Anaesthesiol Intensive Ther 2021 ;53(5):456-465

University of Paris, France.

Thoracostomy requires interdisciplinary teamwork. Even though thoracic drainage is a technical surgical procedure, nurses play an important role with major responsibilities during the procedure. This literature review aimed to identify articles related to the interdisciplinary management of thoracostomy. Read More

Front Pediatr 2021 16;9:761896. Epub 2021 Nov 16.

Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.

Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy. Read More

Clin Chest Med 2021 12;42(4):729-738

Interventional Pulmonology, University of Pittsburgh Medical Center, Montefiore Hospital, NW628, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address:

Pneumothorax is a common medical condition encountered in a wide variety of clinical presentations, ranging from asymptomatic to life threatening. When symptomatic, it is important to remove air from the pleural space and provide re-expansion of the lung. Additionally, patients who experience a spontaneous pneumothorax are at high risk for recurrence, so treatment goals also include recurrence prevention. Read More

Indian J Tuberc 2021 Oct 11;68(4):491-496. Epub 2021 Mar 11.

Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.

Background: Empyema thoracis is defined as the presence of pus in the pleural cavity and carries significant morbidity and mortality. This study aimed to explore the demographic and clinico-radiological characteristics of patients with empyema thoracis.

Material And Methods: The present study was conducted in a tertiary care teaching hospital in North India. Read More

Wideochir Inne Tech Maloinwazyjne 2021 Sep 24;16(3):580-586. Epub 2021 Feb 24.

Department of Chest Diseases, Medical Park Elazığ Hospital, Istinye University, Istanbul, Turkey.

Introduction: Chest tube drainage is the first step in the management of complicated pleural effusions that have turned into empyema. In cases where adequate drainage cannot be provided or deloculation is required, intrapleural fibrinolytic therapy or surgical deloculation can be performed. Alteplase is a suitable agent for intrapleural fibrinolytic therapy. Read More

Interact Cardiovasc Thorac Surg 2021 Oct 18. Epub 2021 Oct 18.

Department of Pulmonology, Faculty of Medicine, University of Inonu, Malatya, Turkey.

Objectives: The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. Read More

Am Surg 2021 Oct 7:31348211048849. Epub 2021 Oct 7.

Department of General Surgery/Trauma, 10848WakeMed Health & Hospitals, Raleigh, NC, USA.

Introduction: Cigarette smoking is associated with primary spontaneous pneumothorax (PSP). Electronic cigarettes (E-cigarettes) are touted as a healthier alternative to cigarettes; however, the impact E-cigarette use has on PSP management is not known. The goal of this study was to determine if E-cigarette use is associated with inferior outcomes after PSP, compared to never smokers and cigarette smokers. Read More

J Trauma Acute Care Surg 2022 01;92(1):177-184

From the Department of Surgery (G.B., C.M.C., A.T., G.P.V.), University of California, San Francisco, East Bay, Oakland; Chemical Sciences Division (J.Y.C.), Lawrence Berkeley National Laboratory, Berkeley, California.

Background: Guidelines for penetrating occult pneumothoraces (OPTXs) are based on blunt injury. Further understanding of penetrating OPTX pathophysiology is needed. In observational management of penetrating OPTX, we hypothesized that specific clinical and radiographic features may be associated with interval tube thoracostomy (TT) placement. Read More

J Trauma Acute Care Surg 2021 12;91(6):981-987

From the Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, Utah.

Background: Little is known about patient characteristics predicting postdischarge pleural space complications (PDPSCs) after thoracic trauma. We sought to analyze the patient population who required unplanned hospital readmission for PDPSC.

Methods: Retrospective review of adult patients admitted to a Level I Trauma Center with a chest Abbreviated Injury Scale (AIS) score of 2 or greater between January 2015 and August 2020. Read More

J Surg Res 2022 01 14;269:83-93. Epub 2021 Sep 14.

Department of Surgery, UMass Medical School - Baystate, Springfield, MA; Baystate Children's Hospital, Springfield, MA.

Background: Few studies have identified factors associated with successful VATS or thoracotomy as the initial operative strategy among patients with traumatic hemothorax.

Material And Methods: We performed an exploratory analysis using the 2008 to 2017 TQP database. We identified all patients aged 18 to 89 years with traumatic hemothorax who were treated with tube thoracostomy alone in the first 24-hours of admission, followed by VATS or thoracotomy. Read More

J Thorac Dis 2021 Aug;13(8):5195-5204

Interventional Pulmonary Program, Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, The University of Alabama at Birmingham, Birmingham, AL, USA.

Pneumothorax is not an uncommon occurrence in ICU patients. Barotrauma and iatrogenesis remain the most common causes for pneumothorax in critically ill patients. Patients with underlying lung disease are more prone to develop pneumothorax, especially if they require positive pressure ventilation. Read More

Ann Thorac Surg 2021 Sep 3. Epub 2021 Sep 3.

Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.

Background: Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19).

Methods: A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Read More

J Emerg Med 2021 11 29;61(5):517-528. Epub 2021 Aug 29.

Weill Cornell Medicine, Emergency Medicine, New-York Presbyterian Hospital, New York, New York.

Background: Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. Read More

Ann Med Surg (Lond) 2021 Sep 31;69:102610. Epub 2021 Jul 31.

Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.

Introduction: Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy.

Case Presentation: A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. Read More

Proc (Bayl Univ Med Cent) 2021 Sep 1;34(5):586-587. Epub 2021 Jun 1.

Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.

Management of recurrent pleural effusions can be challenging and may require multiple modalities for treatment. Advanced image guidance with ultrasound or computed tomography is often useful for increased accuracy. We demonstrate a novel application of a percutaneous image-guided technique using electromagnetic navigation to successfully place thoracostomy tubes. Read More

Niger J Clin Pract 2021 Aug;24(8):1247-1251

Department of Surgery, Division of Trauma Surgery/Accident and Emergency Unit, Jos, Nigeria.

Background: Chest injury remains a major source of morbidity and mortality in trauma as approximately two-thirds of all severe traumas involve the chest.

Objective: To determine the changes in the profile management and outcome of severe chest injury in Jos University Teaching Hospital, Jos, Nigeria.

Materials And Methods: This is an analysis of the Trauma Registry of Jos University Teaching Hospital-a prospectively gathered database. Read More