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Yoshino R, Yoshida N, Ujiie N, Ito A, Nakatsubo M, Tanino M, Kitada M. Surgical Treatment of Secondary Pneumothorax-Complicated Interstitial Lung Disease. Cureus 2023; 15:e46816. [PMID: 37954808 PMCID: PMC10636492 DOI: 10.7759/cureus.46816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION To investigate the feasibility of early surgical treatment and perioperative steroid use in patients with interstitial lung disease (ILD) complicated by pneumothorax. METHODS We retrospectively examined data, including patient characteristics, laboratory findings, surgical treatment details, postoperative complications, and deaths, of nine patients with ILD complicated by secondary pneumothorax. The patients had been treated at our hospital during the past 10 years. RESULTS All nine patients were male (median age, 69.0 years). A total of nine patients had a histopathologic diagnosis of ILD after surgery. Of these, five were clinically diagnosed with ILD before surgery. Collagen disease was diagnosed in one case, drug-induced in one case, and idiopathic ILD (IILD) in three cases. All nine patients were diagnosed with postoperative ILD, including one case of collagen disease, one case of drug-induced, three cases of idiopathic pulmonary fibrosis (IPF)/cryptogenic fibrosing alveolitis, one case of nonspecific interstitial pneumonia (NSIP), and three cases of cryptogenic organizing pneumonia (COP). Regarding preoperative clinical characteristics, the performance status (PS) was 0 or 1 in all patients. Overall, three patients received oxygen (0-3 L/min), whereas steroids were administered to five patients. The mean drainage period was 23.5 days, and this was consistent with the time taken from pneumothorax occurrence to surgery. Video-assisted thoracic surgery (VATS) and thoracoscopic-assisted surgery were performed in seven and two patients, respectively. No postoperative recurrence or surgery-related deaths occurred. CONCLUSIONS Early surgery for secondary pneumothorax complicated by ILD may be a viable option for patients in good preoperative condition. For patients who are preoperatively treated with steroids, continued use of steroids should be carefully considered.
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Affiliation(s)
- Ryusei Yoshino
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nana Yoshida
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nanami Ujiie
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Akane Ito
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masaki Nakatsubo
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Mishie Tanino
- Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masahiro Kitada
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
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Kenyon S, Careless D, Navaratnam V, Reddy T. Rapidly progressive interstitial lung disease complicated by pulmonary interstitial emphysema in anti-MDA5 amyotrophic dermatomyositis. Thorax 2023; 78:946-947. [PMID: 37474317 DOI: 10.1136/thorax-2022-219859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/18/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Sarrinder Kenyon
- Department of Medical Imaging, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - David Careless
- Department of General Medicine, St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
- Department of General Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Vidya Navaratnam
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Curtin University Division of Health Sciences, Perth, Western Australia, Australia
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Nakamata A, Tsuchiya N, Miyara T, Shiotani M, Gibo S, Murayama S. Computed tomography findings, temporal course, and clinical relevance of subpleural pulmonary interstitial emphysema in patients with pneumomediastinum. Acta Radiol Open 2021; 10:20584601211034264. [PMID: 34377542 PMCID: PMC8330479 DOI: 10.1177/20584601211034264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Subpleural pulmonary interstitial emphysema is defined as the air in the subpleural portion of the lung, and the clinical relevance is not well understood. Purpose to evaluate the frequency, temporal course, risk factors, and clinical significance of subpleural pulmonary interstitial emphysema (PIE) in patients with pneumomediastinum resulting from ruptured alveoli and other causes. Material and Methods This was a retrospective study of 130 patients with pneumomediastinum on CT between January 2009 and December 2019 at 2 hospitals. Patients were divided into 3 groups as follows: spontaneous pneumomediastinum (n = 101), pneumomediastinum due to blunt trauma (n = 16), and pneumomediastinum due to another known cause (n = 13). The frequencies of radiographic features (subpleural PIE, peribronchovascular PIE, pneumothorax, pulmonary fibrosis, and emphysematous changes) between the 3 groups were compared by the χ2 or Kruskal–Wallis test. Odds ratios were calculated to evaluate candidate risk factors for subpleural and peribronchovascular PIE. Results Subpleural PIE was observed in 0%, 15.8%, and 31.3% of patients with pneumomediastinum due to another cause, spontaneous mediastinum, and blunt trauma, respectively. In most patients, subpleural PIE resolved spontaneously (85.7% within 8 days). Two patients with pulmonary fibrosis showed recurrent subpleural PIE on follow-up. Young age showed increased risk for subpleural PIE (odds ratio [OR] 0.9, 95% confidence interval [CI] 0–0.99). Conclusion Subpleural PIE was only detected in patients with pneumomediastinum due to ruptured alveoli and resolved spontaneously and rapidly. Subpleural PIE may be one route the air from ruptured alveoli to the mediastinum.
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Affiliation(s)
- Akihiro Nakamata
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Uehara, Okinawa, Japan.,Department of Radiology, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Uehara, Okinawa, Japan
| | - Tetsuhiro Miyara
- Department of Radiology, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Murasaki Shiotani
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Uehara, Okinawa, Japan
| | - Shinji Gibo
- Department of Radiology, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Uehara, Okinawa, Japan.,Department of Radiology, Urasoe General Hospital, Urasoe, Okinawa, Japan
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Abstract
Cystic diseases of the lung encompass a fairly broad variety of different diseases with causes including genetic abnormalities, smoking-related problems, developmental disorders, malignant neoplasms, and inflammatory processes. In addition, there are several diagnoses that closely resemble cystic lung disease, including cavitary diseases, cystic bronchiectasis, emphysema, and cystic changes in fibrosing interstitial lung disease. This article provides a review of cystic lung disease and its gross and histologic mimics.
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Takahashi F, Takihara T, Nakamura N, Horio Y, Enokida K, Hayama N, Oguma T, Aoki T, Masayuki I, Asano K. Etiology and prognosis of spontaneous pneumothorax in the elderly. Geriatr Gerontol Int 2020; 20:878-884. [PMID: 32770645 DOI: 10.1111/ggi.13996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
AIM Spontaneous pneumothorax shows a bimodal age distribution, with the secondary peak including patients aged ≥50 years. The purpose of this study was to clarify the etiology and prognosis of spontaneous pneumothorax in the elderly. METHODS Patients aged ≥50 years who were admitted to a tertiary university hospital between 2006 and 2016 due to spontaneous pneumothorax were retrospectively investigated. RESULTS Among 136 consecutive patients aged ≥50 years with spontaneous pneumothorax (mean age, 70 years; 114 men), 124 (91%) had underlying lung diseases, including pulmonary emphysema (42%) and interstitial pneumonia (27%). The median period of thoracic drainage was longer (14 days) in the cases with interstitial pneumonia than in the cases of primary pneumothorax (4 days; P < 0.001) and emphysema (9 days; P < 0.005). Eighteen patients (13%) died within 180 days after the onset of pneumothorax. The mortality rate was highest in the cases with interstitial pneumonia (27%) and was mostly associated with infectious complications. Death or worsened respiratory failure within 180 days from admission was associated with older age, systemic corticosteroid use and interstitial pneumonia in multivariate logistic regression analysis. CONCLUSIONS Pulmonary emphysema is the most common underlying disease associated with spontaneous pneumothorax in the elderly population. Pneumothorax associated with interstitial pneumonia is less frequent, but it requires prolonged tube thoracostomy and demonstrates higher mortality and morbidity, particularly in those receiving systemic corticosteroids. Different treatment strategies are warranted for patients with interstitial pneumonia-related pneumothorax. Geriatr Gerontol Int 2020; 20: 878-884.
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Affiliation(s)
- Fuminari Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahisa Takihara
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Noriko Nakamura
- Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Horio
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Keito Enokida
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Naoki Hayama
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takuya Aoki
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Iwazaki Masayuki
- Division of Thoracic surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Abstract
This review discusses diagnostic pathology in idiopathic interstitial pneumonias (IIPs). Accurate understanding of basic structure of lung lobules is critical because the location of abnormalities inside the lobule is an important effector of pathology diagnosis. Depending on the method of obtaining tissue, recognition of the location may be difficult or impossible. Cryobiopsy is a new technology and its coverage of lung lobules is limited. This article discusses fundamental anatomy and approach to interstitial pneumonia. In addition, most histologic types of IIPs are covered, but the focus is on diagnosis of usual interstitial pneumonia because of its clinical importance.
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Affiliation(s)
- Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Kameda Medical Center, 929 Higashi-machi, Kamogawa, Chiba 296-8602, Japan.
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