Spontaneous pneumothorax in pregnancy – Case report

Pneumothorax and Pregnancy: A Systematic Review of the Current Literature and Proposal of Treatment Recommendations

INTRODUCTION

Spontaneous pneumothorax occurs rarely during pregnancy with less than 100 cases reported in the English literature. There is no strong evidence concerning the treatment of spontaneous pneumothorax during pregnancy and labor. The aim of this study is to systematically review all the reported cases and to suggest recommendations for its diagnosis and treatment.

METHODS

A PubMed research was conducted. The following data were collected: maternal age, gestation age (weeks), presence of underlying lung pathology, initial management, definitive management, obstetric outcome, and the complications for the mother and the fetus.

RESULTS

Eighty-seven cases were identified. The mean maternal age was 27 years (standard deviation [SD] ± 6). The mean gestational age was 25 weeks (SD ± 11.4). In 37.9% of cases, there was no underlying lung disease. In the majority of cases (67.4%), the initial treatment was the placement of a chest tube. In 48% of cases, the pneumothorax was resolved with conservative treatment. Surgical therapy was performed either antepartum or postpartum. In 58.6% of cases, there was a vaginal delivery, spontaneous or instrumental. In three cases (3.4%), there were fetal complications.

CONCLUSION

The analysis of the current literature provides low evidence, since there are only case reports and small case series. It is likely that the frequency of this condition is underestimated. However, this analysis permits to draw some conclusions concerning the timing of pneumothorax treatment, the operative strategy, and the mode of delivery to decrease the risk for the mother and the fetus.

A case of recurrent spontaneous pneumothorax during pregnancy treated with video assisted thoracoscopic surgery

Pneumothorax during pregnancy is uncommon. Recently ambulatory chest drainage has been advised to treat the pneumothorax and to cover the delivery period. This imposes restrictions on the mother with associated co-morbidity. The authors present a case of recurrent chest-tube resistant pneumothorax during pregnancy which had persisted for 4-weeks. To guide management of a patient referred in the third trimester of pregnancy the authors undertook a systematic review. This led to definitive video assisted thoracoscopic surgery (VATS) for bullectomy and pleurodesis which was successful without either peri-operative or peri-partum complications or recurrence of pneumothorax. Our review suggests that a VATS approach during pregnancy is both safe and effective.

Pneumothorax and pregnancy

BACKGROUND

Though more common in male patients, primary spontaneous pneumothorax might be expected to occur reasonably often in female patients of child-bearing age. However, < 50 cases of pneumothorax in pregnancy have been previously reported. Special risks are posed for both the mother and the fetus in this situation. Previous management strategies have varied widely, without describing the more modern and less invasive techniques, and existing pneumothorax guidelines do not incorporate this difficult scenario.

METHODS

A retrospective search of our database of 250 spontaneous pneumothorax patients over a 10-year period, in a stable local population of 500,000 patients, identified five cases of pneumothorax occurring in pregnancy. We report our experience, the largest series yet described, review the medical literature, and make management recommendations.

RESULTS

We found favorable outcomes for both mothers and infants in our series, with modern techniques such as simple aspiration, elective assisted delivery at or near term with regional anesthesia, and video-assisted thoracoscopic surgery.

CONCLUSIONS

Future guidelines on the management of pneumothorax should consider the inclusion of advice on the problems of pregnancy, based on previous published experience, and utilizing the modern and less invasive techniques. Such advice would inform and support those specialists involved in managing a potentially hazardous situation to the benefit of both mother and child.

Pulmonary toxicity associated with erlotinib

Interstitial lung disease (ILD) related to therapy with the drug gefitinib has been well reported. The adverse pulmonary effects of erlotinib are less well known. We report a case of fatal pulmonary toxicity in a patient with advanced non-small cell lung cancer who received erlotinib. He had been found to have pathologic findings of usual interstitial pneumonia (UIP) on the resected lung cancer specimen prior to receiving erlotinib. This case and other published evidence should alert physicians to the possibility of fatal erlotinib-induced ILD. Similar to reports in patients receiving gefitinib, those with pathologic findings of UIP on resected lung specimens or known pulmonary fibrosis may be at particular risk for erlotinib pulmonary toxicity.