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Introduction: Spontaneous pneumothorax is a rare pathology that affects both young and old people. It can have a high recurrence rate, resulting in morbidity and sometimes mortality of the patients. In our environment we do not have epidemiological data on the disease, which motivated this study to be carried out. Methods: Retrospective study of a prospective database, which included patients over 14 years of age, with a diagnosis of spontaneous pneumothorax who underwent surgery at the Hospital Pablo Tobón Uribe, Medellin, Colombia, between January 2018 and December 2023. Sociodemographic, clinical variables and postoperative outcomes 30 days after the intervention were analyzed. Results: Males were the most affected (68.2%), secondary spontaneous pneumothorax predominated (56.8%) and the right hemithorax was the most common location (63.6%). A similar incidence was found between smokers and non-smokers (45.4% vs. 52.3%, respectively). Wedge resection was the definitive treatment in 50% of patients and wedge resection associated with mechanical pleurodesis in 31.8%. The most common complication was persistent air leak. A recurrence of pneumothorax was recorded in a patient who had undergone wedge resection. At the end of the study, five patients died: three had been treated only with thoracostomy and two had been taken to surgery. Conclusions: Spontaneous pneumothorax is a rare pathology. The causes and the affected population vary according to the classification. In our environment, tuberculosis has greater relevance because it is an endemic disease. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The pneumothorax is consequence of the most frequent air leak in the neonatal period and its treatment is based mainly on severity of clinical manifestations. Oxygen treatment at high concentrations (Nitrogen washout) to those with mild to moderate clinical manifestations has been a therapy used to achieve its rapid resolution; However, its usefulness is controversial. CLINICAL CASES: 36-week neonates that presented spontaneous pneumothorax of 30-45%, associated with mild to moderate respiratory distress. Therefore, oxygen was indicated at high concentrations with adequate clinical response. CONCLUSIONS: The use of oxygen at high concentrations for the treatment of pneumothorax has not generated advantages by recent studies. On the contrary, there may be side effects from hyperoxia and other unfavorable clinical outcomes. In spite of this, there is likely to exist trends for use, with apparent good results. However, for recently studies, this intervention should be avoided and must follow up on the results of pneumothorax in each unit. [ABSTRACT FROM AUTHOR]

The use of specific antibodies in inflammatory myopathies has improved the characterization of this disease, identifying different clinical phenotypes. Patients with dermatomyositis and anti-MDA5 antibodies display typical skin symptoms, lesser muscular involvement, and a prevalence of interstitial lung disease of up to 91%. Beyond interstitial lung disease, spontaneous pneumomediastinum has been identified as a rare but potentially fatal pulmonary manifestation. Two cases of this complication in patients with anti-MDA5 dermatomyositis are reported. [ABSTRACT FROM AUTHOR]

Introduction. Re-expansion pulmonary edema is a rare complication secondary to rapid pulmonary re-expansion after drainage by thoracentesis and/or closed thoracostomy. As of today, an incidence of less than 1% has been described after closed thoracostomy, with a higher prevalence in the second and third decades of life. Its exact pathophysiological mechanism is unknown; a multifactorial process of lung interstitial damage associated with an imbalance of hydrostatic forces has been proposed. Clinical case. We present the case of a patient who developed pulmonary edema due to re-expansion after closed thoracostomy, conducting a review of the literature on this complication. Results. Although the clinic suggests the diagnosis, the sequence of images plays a fundamental role. In most cases, it tends to be a self-limited disease, so its management is mainly supportive. However, mortality rates of up to 20% have been recorded. Therefore, it is important to identify patients with major risk factors and initiate preventive measures in these patients. Conclusions. Re-expansion pulmonary edema after thoracostomy is a rare complication in cases with pneumothorax; however, it is a complication that can occur in daily practice. Therefore, it must be kept in mind to be able to make the diagnosis and an adequate management. [ABSTRACT FROM AUTHOR]

The article in the Mexican Journal of Pediatrics presents a case of hidden pneumothorax detected with lung ultrasound in a newborn in an Intensive Care Unit. The neonate presented sudden desaturation secondary to right pneumothorax, which was detected by lung ultrasound but was not evident in the anteroposterior chest X-ray. Subsequently, the presence of pneumothorax was confirmed in a lateral chest X-ray. The use of lung ultrasound is highlighted as a useful diagnostic tool at the patient's bedside, allowing for early detection and timely management of this complication. [Extracted from the article]

Spontaneous pneumomediastinum and its association with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection is an unusual clinical condition, which is pretended to be explained by the severe diffuse alveoli damage; which causes dissection of the intraalveolar air through the bronchovascular sheaths and arrives to the mediastinum and even to the neck, thorax and abdomen soft tissue; with a clinical manifestation on subcutaneous emphysema. All of the above is related with a poor clinical outcome, this is why the radiologist needs to know the imaging features of this condition; and to be aware of the clinician of such findings. [ABSTRACT FROM AUTHOR]

El neumotórax espontáneo idiopático constituye una causa poco frecuente de neumotórax, si se le atribuyen causas no pulmonares como el neumotórax catamenial y/o neumotórax catamenial no asociado a endometriosis, esta condición se hace aún más rara. El abordaje terapéutico está en estrecha relación al control de las complicaciones generadas por el neumotórax. Se presenta a continuación el caso de una paciente femenina de 34 años, quien debuta con su primer episodio de neumotórax espontáneo, el cual se presume a características catameniales por la coincidencia con el ciclo menstrual de la misma.

BACKGROUND: In recent years there has been an increase in the incidence of non-tuberculous mycobacterial infections due to new imaging techniques and more advanced cultures, as well as the increase in the immunocompromised population. Within the group of non-tuberculous mycobacteria is Mycobacterium abscessus, which is the most important due to its rapid growth, resistance to treatment with macrolides and for being the main non-tuberculous agent in lung infection. Complications, especially pulmonary ones, are frequent due to its rapid growth and resistance, as well as its chronic evolution. CLINICAL CASE: A patient with a diagnosis of chronic infection by a non-tuberculous mycobacterium, Mycobacterium abscessus, who presented spontaneous pneumothorax as a complication and corresponds to the first report of this type in America. CONCLUSIONS: Pulmonary disease in relation to infectious agents has expanded significantly in recent years, so the initial protocol should be broader and always consider the existence of non-tuberculous mycobacteria, request a culture for Mycobacterium initially, and thus, avoid errors in diagnosis and, above all, delay in treatment. [ABSTRACT FROM AUTHOR]

Introducción: la endometriosis torácica es una afección poco frecuente que se define como la presencia de tejido endometrial ectópico en los componentes de la cavidad torácica. El neumotórax catamenial, relacionado temporalmente con la menstruación, es un evento raro, pero puede ser una manifestación de la endometriosis torácica. Caso Clínico: presentamos el caso de una mujer joven con repetidos neumotórax espontáneos, cuya evaluación llevó al diagnóstico de síndrome de endometriosis torácica. La intervención quirúrgica unilateral se realizó con éxito, sin embargo, la paciente presentó un nuevo episodio de neumotórax del lado contrario después de un tiempo. La identificación y tratamiento de la endometriosis es crucial para prevenir recurrencias del neumotórax espontáneo, lo que subraya la importancia de considerar la endometriosis torácica en el diagnóstico diferencial de neumotórax catamenial. Este caso destaca la necesidad de un abordaje multidisciplinario para un manejo exitoso de la endometriosis torácica. Objetivos: exponer caso clínico de neumotórax catamenial, cuadro clínico, evolución clínica, diagnóstico y tratamiento. Metodología: se presenta estudio descriptivo con obtención de datos de historia clínica de la paciente con diagnóstico de síndrome de endometriosis torácica, bajo consentimiento informado, además de imágenes diagnósticas de base de datos del Hospital Regional de Chiquinquirá de Colombia, el 29 de septiembre de 2022. Conclusión: la correcta evaluación de las manifestaciones clínicas de neumotórax espontáneos en mujeres jóvenes durante su ciclo menstrual, con un enfoque clínico integral, entendiendo la enfermedad como un síndrome y no como un evento aislado, del mismo modo, la correcta utilización de recursos imagenológicos como radiografía de tórax y tomografía axial computarizada de tórax, facilitan el diagnóstico diferencial del neumotórax catamenial y asimismo el inicio temprano de tratamiento, el cual puede requerir de intervención quirúrgica, esto con el fin de educar al paciente sobre su condición y prevenir nuevos episodios de neumotórax y posteriormente mantener seguimiento ambulatorio por servicio de cirugía de tórax y servicio de ginecología. Discusión: teniendo en cuenta la importancia de realizar un diagnóstico y tratamiento asertivo en paciente con presentación clínica de neumotórax catamenial, es importante aportar a la literatura médica sobre las diferentes manifestaciones clínicas, evitando así que continúe siendo una patología subdiagnosticada.

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Introducción. Debido a la ausencia de modelos predictivos estadísticamente significativos enfocados a las complicaciones postoperatorias en el manejo quirúrgico del neumotórax, desarrollamos un modelo, utilizando redes neurales, que identifica las variables independientes y su importancia para reducir la incidencia de complicaciones. Métodos. Se realizó un estudio retrospectivo en un centro asistencial, donde se incluyeron 106 pacientes que requirieron manejo quirúrgico de neumotórax. Todos fueron operados por el mismo cirujano. Se desarrolló una red neural artificial para manejo de datos con muestras limitadas; se optimizaron los datos y cada algoritmo fue evaluado de forma independiente y mediante validación cruzada, para obtener el menor error posible y la mayor precisión con el menor tiempo de respuesta. Resultados. Las variables de mayor importancia según su peso en el sistema de decisión de la red neural (área bajo la curva 0,991) fueron el abordaje por toracoscopia video asistida (OR 1,131), el uso de pleurodesis con talco (OR 0,994) y el uso de autosuturas (OR 0,792; p

Introducción: La fibrosis quística (FQ), afecta el epitelio exocrino, formando una mucosidad espesa que obstruye los conductos de los diferentes órganos, siendo el pulmón y páncreas los más afectados. El objetivo del presente estudio fue determinar la asociación entre los factores clínicos y las complicaciones, así como la supervivencia de pacientes con FQ atendidos en un centro de referencia pediátrica en México. Métodos: El presente estudio observacional, longitudinal, fue realizado en el Instituto Nacional de Pediatría en México, de abril del 2012, a abril del 2022. Con una muestra no probabilística ingresaron al estudio niños con fibrosis quística. Las variables fueron: demográficas, complicaciones pulmonares, extrapulmonares y mortalidad. Se realiza la asociación con chi-cuadrado y la supervivencia con Kaplan-Meir. Resultados: Se analizan 71 pacientes, lactantes menores 41 casos (62%), pre-escolares 12 casos (16.9%). Fueron 40 hombres (56.3%). 57 casos (80.3%) tuvieron exacerbación infecciosa, 11 casos (15.5%) aspergilosis broncopulmonar, 9 casos (12.7%) con hipertensión pulmonar, 5 casos (7%) con neumotórax, 12 casos (16.9%) con ventilación mecánica, 70 casos (98.5) con insuficiencia pancreática, 10 casos (14%) con enfermedad hepatobiliar. Hubo asociación de complicaciones extrapulmonares con el fenotipo F508. La supervivencia global fue de 150 meses. En pacientes con ventilación mecánica invasiva la supervivencia fue de 55 meses (P

Introduction: The thoracic trauma is among the first causes of death, fundamentally in young people. Objectives: To characterize a population operated due to thoracic trauma according to clinical epidemiological variables and describe the postsurgical tomographic findings. Methods: An observational and descriptive study of 48 patients assisted in the Radiology Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018, to whom a multidetector computed tomography was carried out. Results: The thoracic traumas prevailed in young male people, fundamentally associated with violent actions that caused open traumas. The lung contusion was the most frequent initial tomographic finding, as long as, the persistent pneumothorax and the coagulated hemothorax constituted the most influential tomographic findings in the decision of a surgical reintervention. Conclusions: Tomography is a diagnostic means that allows a detailed description of the postoperative state in the affected organs, with a high orientative value to decide later surgical procedures.

El enfisema subcutáneo se produce como complicación frecuente en intervenciones quirúrgicas, técnicas invasivas, ventilación mecánica, lesiones traqueales y neumotórax. La progresión fuera del tórax con afectación facial, abdominal e incluso inguinal puede producir un síndrome compartimental con compresión de estructuras aledañas como la tráquea y vasos del cuello, tal situación se ha denominado enfisema subcutáneo masivo. En este documento se reporta el caso de un paciente que desarrolló un enfisema subcutáneo masivo como signo precoz de lesión traqueal asociada a la intubación y ventilación a presión positiva.

Introducción. Por ser un procedimiento de mínima invasión, la colangiopancreatografía retrógrada endoscópica (CPRE) es el procedimiento más utilizado para el manejo de la patología litiásica biliar. Sin embargo, puede presentar complicaciones que comprometen la vida del paciente. Caso clínico. Paciente masculino de 63 años es llevado a CPRE por una coledocolitiasis recidivante gigante. Durante el procedimiento presentó una disección aérea masiva con neumotórax bilateral a tensión, secundarios a una perforación duodenal, que derivó en una fístula bilio-retroperitoneal. Se trató de forma conservadora con una adecuada evolución. Discusión. Se han descrito pocos casos de neumotórax como complicación de la CPRE. Se considera que este es el primer caso publicado de neumotórax a tensión manejado exitosamente de forma conservadora. Conclusión. El diagnóstico temprano de las disecciones aéreas es el único predictor independiente que podría cambiar el curso clínico de esta patología y su manejo dependerá de la experticia del cirujano y del estado clínico del paciente.

BACKGROUND: Barotrauma is a lesion generated for changes in the pressure and/or volume within a specific anatomic way; pneumo-mediastinum and pneumothorax are clear samples of this effect, frequently related to infectious symptoms. CLINICAL CASES: Two clinical cases are presented, 34 and 44 years old, that had pneumonia due to COVID-19, with subsequent exacerbation of the symptoms caused by barotrauma. Patients were evaluated at emergency unit of the Hospital Angeles Pedregal, Mexico City; their clinical presentation was similar and was unleashed by repeated cough in the context of pneumonia due to SARS-CoV-2. CONCLUSIONS: Now there is more experience on the complications associated during COVID-19, although more cases must be study to know their prognostic meaning and, in case it becomes a progression marker of the illness, to establish specific measures and therapeutic recommendations. The presentation of pneumonia stands out despite the vaccination, having to get the general population make consciousness of continuing with measures of respiratory isolation. [ABSTRACT FROM AUTHOR]

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Introducción: El neumotórax catamenial es aquel neumotórax espontáneo y recurrente que se presenta relacionado con el ciclo menstrual. Más frecuente en mujeres con edad fértil por encima de los 30 años de edad y a predominio del hemitórax derecho. El diagnóstico primario es difícil y el tratamiento que mejores resultados registra es la cirugía por técnicas de mínimo acceso, asociada a tratamiento hormonal. Objetivo: Presentar un caso de neumotórax catamenial, sus características clínicas y el procedimiento videotoracoscópico empleado. Caso clínico: Paciente de 48 años de edad, con antecedentes de dolor torácico y tos al inicio de la menstruación. Además, dos neumotórax espontáneos derechos anteriores. Ingresó de urgencia con el diagnóstico de neumotórax espontáneo derecho. Se realizó biopsia, frenorrafia y pleurodesis por videotoracoscopía. Conclusiones: Los elementos clínicos y radiológicos inducen a pensar en el diagnóstico de neumotórax catamenial, apoyado por la presencia de fenestraciones diafragmáticas y la no reaparición del cuadro de neumotórax después del cierre de los defectos diafragmáticos y el tratamiento satisfactorio con pleurodesis con talco, por cirugía de mínimo acceso.

Several therapies are used for the management of subcutaneous emphysema in adults, but no reference to subcutaneous drainage using Beck's technique has been found in pediatric patients. This is the clinical case of a 14-year-old female patient who presented a blunt force trauma that resulted from a ten-meter-high fall. On admission, she was unconscious and developed respiratory distress syndrome, thus mechanical ventilation was indicated. Seven days later, subcutaneous emphysema occurred, and a fenestrated angiocatheter was inserted using Beck's method. At 24 hours, the emphysema was reduced in the upper chest and face, and, at 72 hours, complete resolution was observed. [ABSTRACT FROM AUTHOR]

Introduction. Patients with congenital pulmonary airway malformation (CPAM) are usually asymptomatic, but some may present with respiratory distress. We report a rare presentation of a CPAM as an image compatible with persistent and localized spontaneous pneumothorax. Case report. A 2-month-old male infant without prenatal diagnosis, postnatal distress or barotrauma, was admitted with acute respiratory symptoms and a right tension pneumothorax on chest X-ray. Despite placement of a chest drain, radiological image persisted. CT confirmed the presence of a CPAM. An open surgical approach was decided and a huge bulla depending from the right upper apex lobe was found and resected. Pathological report disclosed type 4 CPAM. Discussion/conclusion. Despite the negative prenatal screening, the diagnosis of CPAM should be considered in a patient with sudden respiratory distress and suspicion of an spontaneous pneumothorax. Type 4 CPAM may appear like unique lung cyst mimicking a spontaneous bullae or a massive pneumothorax. [ABSTRACT FROM AUTHOR]

Presentado en sesión de 11 de noviembre de 1953

Presentado en sesión de 18 de noviembre de 1953

El empiema pleural es una patología de importancia en nuestro medio. De él existen muchos tipos según la causa etiológica. Durante varios años se ha considerado la fisiopatología inflamatoria, como un fenómeno común en todos los tipo de empiema pleural. No obstante, esta es distinta para el caso del empiema de origen postraumático. También su manejo difiere ostensiblemente. El interés de este artículo es recalcar en el cirujano las diferencias que existen entre el empiema postneumónico y el pos traumático y establecer algunas pautas para un tratamiento específico del mismo.

Copyright of INSPILIP. Revista Ecuatoriana de Ciencia, Tecnología e Innovacion en Salud Pública is the property of Instituto Nacional de Investigacion en Salud Publica (INSPI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The thoracic trauma is among the first causes of death, fundamentally in young people. Objectives: To characterize a population operated due to thoracic trauma according to clinical epidemiological variables and describe the postsurgical tomographic findings. Methods: An observational and descriptive study of 48 patients assisted in the Radiology Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018, to whom a multidetector computed tomography was carried out. Results: The thoracic traumas prevailed in young male people, fundamentally associated with violent actions that caused open traumas. The lung contusion was the most frequent initial tomographic finding, as long as, the persistent pneumothorax and the coagulated hemothorax constituted the most influential tomographic findings in the decision of a surgical reintervention. Conclusions: Tomography is a diagnostic means that allows a detailed description of the postoperative state in the affected organs, with a high orientative value to decide later surgical procedures. [ABSTRACT FROM AUTHOR]

Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients. [ABSTRACT FROM AUTHOR]

The migration phenomenon is increasingly common worldwide. It is essential for radiologists to be aware of the endemic diseases of the migrant's country as well as the characteristics of the journey to be able to understand and interpret radiological findings when admitted to our centre. This article aims to use imaging from our centre to describe the most common pathologies that migrant patients present with after long journeys by boat., (Copyright © 2024 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

El SARS-CoV-2 es una pandemia que actualmente se encuentra en curso y sigue en estudio todas las repercusiones sistémicas que tiene. Actualmente cursa con 150 millones de casos positivos y 3 millones de muerte. Su presentación radiológica es bastante conocida, sin embargo, el neumotórax y neumomediastino son manifestaciones raras y aun más en pacientes no ventilados. Presentamos un caso de un paciente masculino con neumotórax y neumomediastino espontaneo no ventilado.

Introducción: La criobiopsia pulmonar transbronquial (TBCB) se ha convertido en una alternativa diagnóstica a la biopsia pulmonar quirúrgica, principalmente en la enfermedad pulmonar intersticial. A pesar de su naturaleza menos invasiva y de un mayor rendimiento diagnóstico, se han descrito algunas complicaciones asociadas, como el neumotórax. En pocas oportunidades se ha comparado la TBCB y la biopsia transbronquial con fórceps (TBFB). El objetivo del presente estudio es evaluar la incidencia de neumotórax después de TBFB y TBCB y la necesidad de drenaje pleural. Métodos: Estudio retrospectivo de pacientes que se sometieron a TBCB y TBFB, específicamente aquellos que desarrollaron neumotórax postoperatorio. Resultados: Se realizaron un total de 181 biopsias pulmonares transbronquiales. Sesenta y tres (35%) fueron TBFB y 118 (65%) fueron TBCB. Tres pacientes en el grupo TBFB (5%) presentaron neumotórax postoperatorio, mientras que 16 pacientes (14%) presentaron neumotórax en el grupo TBCB (p 0,051). El análisis univariado reveló una asociación estadísticamente significativa entre el diagnóstico preoperatorio de fibrosis y un mayor riesgo de neumotórax postoperatorio después de TBCB (p 0.027), mientras que otras variables no arrojaron un resultado significativo. Conclusión: Aunque se necesitan más estudios comparativos de alto volumen, este documento destaca la relevancia del neumotórax después de la TBCB. Esto deriva en una fuerte necesidad de protocolos de procedimientos claramente estandarizados para TBCB y una evaluación cuidadosa de sus complicaciones versus su rendimiento diagnóstico

Introduction: pneumothorax is defined as a disease caused by the entry of air into the virtual space that separates the visceral and parietal pleura; this air causes loss of contact between them and a lung collapse. Objective: to characterize the behavior of spontaneous pneumothorax in patients at the “Dr. Leon Cuervo Rubio” Teaching Surgical Clinical Hospital. Methods: an observational, descriptive and cross-sectional study was carried out in 43 patients with clinical radiological diagnosis of spontaneous pneumothorax, treated at the “Dr. León Cuervo Rubio ” Hospital during 2019. Descriptive statistics were used, and bioethical principles were met. Results: a predominance of male patients (72,09 %) and aged between 60 and 69 years (37,20 %) was found. 90,69 % presented dyspnea and 83,72 % presented chest pain. A predominance of patients with a history of chronic obstructive pulmonary disease was found (86,04 %). 48,83 % of the patients were treated with a minimal high pleurostomy and 48,83 % presented tube obstruction. Conclusions: older adults, mainly males and with a history of chronic obstructive pulmonary disease, were prone to developing pneumothorax. The main symptomatology was dyspnea, minimal high pleurostomy the main treatment, and tube obstruction was the main complication. The identification of vulnerable populations, as well as the follow-up of patients with previous pneumothorax, is a necessity.

La cánula nasal de alto flujo (CNAF) es una alternativa en la oxigenoterapia de pacientes en insuficiencia respiratoria aguda hipoxémica, especialmente en contexto de pandemia por SARS-CoV-2. Existen muchos beneficios, con distintos niveles de evidencia y muy pocos efectos adversos reportados a su uso descritos en adultos. Se presenta el caso de un paciente con enfermedad pulmonar obstructiva crónica, que cursando con una neumonía grave por SARS-CoV-2, mientras recibía terapia con CNAF, desarrolló un neumotórax. Esta complicación asociada a la terapia con CNAF es poco reportada en la literatura, lo que motiva este reporte.

Introducción. El objetivo de este artículo fue reportar el caso de un paciente con antecedente de enfisema bulloso bilateral que le ocasionó un neumotórax persistente de difícil tratamiento. Caso clínico. Se trata de un paciente de 50 años de edad con diagnóstico de neumotórax asociado con un enfisema bulloso bilateral, en quien estaba contraindicado el tratamiento quirúrgico. El cuadro clínico comenzó con dolor en el hemitórax derecho y disnea, que se fue intensificando hasta el punto de no tolerar el decúbito. En la radiografía de tórax se observó colapso del pulmón derecho con múltiples bulas en ambos pulmones, por lo que se practicó una pleurotomía mínima alta derecha. La evolución del paciente no fue favorable por persistir el neumotórax, lo cual llevó al uso de un tratamiento alternativo. Discusión. En los pacientes con neumotórax persistente por enfisema bulloso bilateral sin indicación quirúrgica, el talco es una alternativa menos invasiva para lograr una sínfisis pleural con buenos resultados, método cuya utilidad se demuestra.

RESUMEN Introducción: La linfangioleiomiomatosis pulmonar constituye un desafío, tanto en su manejo diagnóstico como en la atención de sus complicaciones. Es una enfermedad rara que se caracteriza por la proliferación del músculo liso alrededor de las estructuras bronco-vasculares, linfáticos y en el intersticio pulmonar, unido a la dilatación quística de los espacios aéreos terminales. Objetivo: Describir la evolución clínica y el tratamiento de un paciente con linfangioleiomiomatosis pulmonar. Presentación de caso: Se presenta un caso de linfangioleiomiomatosis pulmonar que desde el punto de vista clínico se manifestó por neumotórax a repetición. Se llegó a diagnóstico definitivo mediante la realización de una biopsia de pulmón. Desarrollo: La linfangioleiomiomatosis es una entidad rara que afecta fundamentalmente a mujeres en edad fértil y que se caracteriza por la presencia de un patrón quístico difuso. Su prevalencia e incidencia es desconocida. Conclusiones: Se puede concluir que la presencia de neumotórax espontáneo o recidivante en una mujer en edad fértil, o embarazada, debe sospecharse linfangioleiomiomatosis.

Introducción: La transmisión del SARS-CoV-2 principalmente se da por gotas y contacto cercano con las personas infectadas, pero los aerosoles parecen ser también una fuente de infección. El neumotórax espontáneo o secundario puede presentarse en pacientes con COVID-19, ayudado por patologías de base como la enfermedad pulmonar obstructiva crónica. Es necesario garantizar procedimientos seguros para los pacientes y buscar todas las medidas posibles para la protección del personal de la salud, por eso el drenaje de neumotórax con catéter pleural en lugar de sonda de toracostomía puede ser una de ellas. El objetivo de este estudio es presentar a los cirujanos una alternativa a la toracostomía tradicional, mediante la utilización de catéteres de menor diámetro, para la resolución de la ocupación pleural. Aspectos Técnicos: Se presenta el protocolo para inserción segura de un catéter pleural para el drenaje de neumotórax, mediante un sistema completamente cerrado, y se dan recomendaciones sobre el uso de filtros virales y solución viricida en el sistema de drenaje pleural conectado al catéter. Conclusión: El estado de pandemia por COVID-19 y el riesgo que representa para los profesionales de la salud la exposición a fuentes de transmisión durante procedimientos generadores de aerosoles, hace que se deban extremar las medidas para evitar el contagio.

El traumatismo en general, corresponde a la tercera causa muerte en pacientes jóvenes y adultos menores de 40 años. El trauma torácico (TT), es considerado responsable de 20-35% de estos fallecimientos. La mayoría de las lesiones traumáticas a nivel del tórax son provocadas por colisiones automovilísticas, seguida por las heridas penetrantes. Clínicamente el TT, se clasifica en lesiones contusas o cerradas y penetrantes o abiertas. Dentro de las múltiples lesiones, se encuentran las fracturas de costales, fracturas de clavícula, esternón, escápula, tórax inestable, contusiones cardiopulmonares, neumotórax, hemotórax, lesiones vasculares, daño a órganos digestivos superiores, entre otras. El abordaje inicial, debe basarse estrictamente en los lineamientos de atención de pacientes poli traumatizados. Su tratamiento definitivo se dirige a restaurar el funcionamiento fisiológico de la cavidad torácica; menos del 10% de los traumatismos cerrados y sólo 15-30% de los penetrantes, requerirán procedimientos quirúrgicos avanzados.

Aim: To report the case of a 77-year-old patient treated for angiosarcoma of the scalp, who evolves with bilateral pneumothorax, whose histopathological study reports metastatic disease. Materials and Method: Review of electronic clinical record, computerized imaging record and biopsy reports. Outpatient followup at the polyclinic of surgery. Results: Management was performed by bilateral videothoracoscopy, with bulectomy plus pleurodesis. Discussion: Secondary pneumothorax due to metastatic disease is rare, approximately 1 to 2% of cases. Sarcomas are among the tumors that most frequently metastasize to the lung. Conclusion: Metastatic pneumothorax is infrequent and requires a high index of suspicion. Its management will depend on the prognosis and the general conditions of the patient. [ABSTRACT FROM AUTHOR]

BACKGROUND: In patients infected with SARS-CoV-2, the presence of acute respiratory failure is generally secondary to acute respiratory distress syndrome. However, in these patients, other acute complications have been detected in the differential diagnosis, such as pulmonary embolism and pneumothorax, among others, which require a different therapeutic approach. CLINICAL CASES: We present two patients with COVID-19 complicated by spontaneous pneumothorax and one of them also with spontaneous pneumomediastinum, two conditions very rarely associated with this infection. CONCLUSIONS: The best treatment is still to be established; its true incidence and whether the presence of these complications in this patient population is associated with greater severity remain to be established, although based on the limited evidence available in case reports, mortality appears to be higher. It is necessary to carry out more studies on this topic to clarify these unknowns and to be able to offer better medical care. [ABSTRACT FROM AUTHOR]

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Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nocardiosis is a rare opportunistic infection caused by the bacteria Nocardia spp. It may present as a localized infection or as an invasive infection (pulmonary, central nervous system or disseminated). The authors describe a 76-year-old woman under corticotherapy for the last month because of a recent diagnosis of cryptogenic organising pneumonia. She presented to the emergency department with one week evolution of pleuritic chest pain and shortness of breath. Chest radiograph showed a left hydropneumothorax. A chest tube was inserted and the drained pleural effusion was purulent, compatible with a pyopneumothorax. The pleural fluid culture came positive for Nocardia Cyriacigeorgica. Nocardiosis is a serious infection with non-specific presentation making its diagnosis a challenge.

Introducción. El trauma de tórax tiene alta incidencia y el neumotórax es el hallazgo más frecuente. La literatura es escasa sobre qué hacer con los pacientes asintomáticos y con neumotórax por trauma de tórax penetrante. El objetivo de este estudio fue evaluar cuáles son los hallazgos de la radiografía de control de los pacientes con trauma de tórax penetrante que no son llevados inicialmente a cirugía, y su utilidad para determinar la necesidad de un tratamiento adicional. Métodos. Se realizó un estudio retrospectivo de cohorte, incluyendo pacientes mayores de 15 años que ingresaron por trauma de tórax penetrante entre enero de 2015 y diciembre de 2017 y que no requirieron manejo quirúrgico inicial. Se analizaron los resultados de la radiografía de tórax, el tiempo de su toma y la conducta decidida según los hallazgos en los pacientes dejados inicialmente bajo observación. Resultados. Se incluyeron 1.554 pacientes, cuya edad promedio fue de 30 años, 92,5 % del sexo masculino y 97% con herida por arma cortopunzante. Se dejaron 361 pacientes bajo observación con radiografía de control, de los cuales 186 (51,5 %) no presentaban alteraciones en su radiografía inicial, 142 tenían neumotórax menor del 30 % y 33 tenían neumotórax mayor del 30 %, hemoneumotórax o hemotórax. Se requirió toracostomía cerrada como conducta final en 78 casos, esternotomía o toracotomía en 2 casos y 281 se dieron de alta. Conclusión. En pacientes asintomáticos con neumotórax pequeño o moderado y sin otras lesiones significativas, podrían ser innecesarios los largos tiempos de observación, las radiografías y la toracostomía cerrada.

The use of specific antibodies in inflammatory myopathies has improved the characterization of this disease, identifying different clinical phenotypes. Patients with dermatomyositis (DM) and anti-MDA5 antibodies display typical skin symptoms, lesser muscular involvement, and a prevalence of interstitial lung disease (ILD) of up to 91%. Beyond ILD, spontaneous pneumomediastinum (SN) has been identified as a rare but potentially fatal pulmonary manifestation. Two cases of this complication in patients with anti-MDA5 DM are reported., (Copyright © 2023 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objetive: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy., Material and Methods: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard., Results: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software., Conclusions: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Lung ultrasound has become increasingly important in the evaluation of the thorax and its pathologies. It has proved to be very useful in the evaluation of hospitalized patients, allowing doctors to evaluate and make quick decisions, as well as providing guidance for diagnostic and therapeutic procedures. Ultrasound has many advantages over other studies since it can avoid transferring patients, and it is harmless, accessible and fast. In this article we will review basic concepts of lung ultrasound and its use in the diagnosis of pathologies. [ABSTRACT FROM AUTHOR]