• Journal of Chest Surgery
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• 제44권3호
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• pp.253-256
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• 2011

Spontaneous pneumothorax is a common clinical problem in emergency care. However, the overall incidences of primary spontaneous pneumothorax has been reported from as low as 1.4% to 7.6%. The clinical findings of simultaneous bilateral spontaneous pneumothorax can be variable. Clinical presentation is variable, ranging from mild dyspnea to tension pneumothorax. Bilateral tension pneumothorax can defined as cases where no tracheal deviation is detected in chest X-ray, and symptoms may be equal bilaterally. Herein, we present a case with simultaneous bilateral tension pneumothorax, severely deteriorated (i.e. with loss of consciousness, cyanosis, and hemodynamically unstable), that was successfully treated with immediate large-size needle decompression.

• Journal of Chest Surgery
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• 제26권1호
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• pp.54-58
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• 1993

Simultaneous bilateral bleb resection was done through bilateral transaxillary thoracotomy in 10 patients with spontaneous pneumothorax during the period from May 1991 to Novemver 1992 in whom bilateral bulla or bleb was detected with using simple chest X-ray and chest CT scanning. To compare the effectiveness of bilateral transaxillary thoracotomy, we investigated 10 unilateral transaxillary thoracotomy patients with spontaneous pneumothorax and two clinical reports from other institutes which dealt the results of bilateral bleb or bulla resection through median sternotomy also. In bilateral transaxillary thoracotomy group,mean operation time was 115 minute,mean intraoperative bleeding was 329 cc, mean postoperative hospital stay was 7.5 days. Postoperative ABGA[Arterial Blood Gas Analysis] was in normal range and postoperative recovery rates of FVC[Forced Vital Capacity], FEV1[Forced Expiratory Volume at 1 second], TV[Tidal Volume] were 84.3%, 93.4%, 88.7%,respectively. In median sternotomy group,mean operation time was 129 minute,mean intraoperative bleeding was 490 cc, mean postoperative hospital stay was 12.4 days. Postoperative ABGA was in normal range and postoperative recovery rates of FVC, FEV1 were 97.3%, 97.4%, respectively. In unilateral transaxillary thoracotomy group, postoperative ABGA was in normal range also and postoperative recovery rates of FVC, FEV1, TV were 91.6%, 99.0%, 96.0%,respectively. In conclusion, simultaneous bilateral bleb resection through bilateral transaxillary thoracotomy should be considered in pneumothorax patients with bilateral bleb or bulla because of cost-effectiveness[reducing hospital days] and better cosmetic result without any impairment in recovery of respiratory function.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1044-1048
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• 1989

In this study, 26 cases of bilateral spontaneous pneumothorax experienced at the department of thoracic and cardiovascular surgery, Chungnam National University Hospital during from 1985 to August 1989 were analyzed retrospectively. The results were as follows; 1. The incidence of bilateral spontaneous pneumothorax was 13.5 % and sex ratio was 7.7:1 with male preponderance. 2. Among the nonsimultaneously occurring cases of bilateral pneumothorax, 12 patients [75 %] were developed at contralateral side within a year. 3. The most patients [65.4%] belonged to the age group between 15 and 25 year-old, and among 57 male patients suffered spontaneous pneumothorax in the same age group, 16 cases[28%] developed bilaterally. 4. The etiologic factors were as follows; blebs or bullae; 65.4 %, tuberculosis; 15.4 %, unknown; 19.2 %. 5. In the method of treatment, 15 patients were treated by closed tube thoracotomy and underwater-seal drainage only, 10 patients were treated by open thoracotomy. One patient died of respiratory failure due to severe destructed lung.

• Journal of Chest Surgery
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• 제23권4호
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• pp.731-735
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• 1990

Simultaneous and non simultaneous bilateral spontaneous pneumothorax patients[273] were reviewed retrospectively from April 1986 to March 1990 in the Dept. of Thoracic and Cardiovascular Surgery, Kyung Hee University Medical College. The incidence of bilateral spontaneous pneumothorax was 13.6%[37] and sexual distribution was male dominant [Male:33, Female:4]. The patients were classified into three major groups according to therapeutic methods: Group I [7]; who were treated with simultaneous bilateral operation for unilateral recurred spontaneous pneumothorax through median sternotomy. Mean age was 20.7 years[17 \ulcorner28] and follow up duration was 7.7 months [3 weeks \ulcorner2 years]. Group II [23];who were treated with staged lateral thoractomy, unilateral thoracotomy and non simultaneous contralateral closed thoracostomy, or simultaneous or non simultaneous bilateral closed thoracostomy. Mean age was 28.6 years [17 \ulcorner56] and follow up duration was 9.8 months[one week \ulcorner3.5 years]. Group III[10] ;who were treated with simultaneous bilateral operation for simultaneous or non simultaneous bilateral spontaneous pneumothorax through median sternotomy. Mean age was 21.4 years[17 \ulcorner28] and follow up duration was 12.8 months[2 weeks \ulcorner2.7 years]. Among the patients managed through median sternotomy simultaneously [Group I and III], there were visible blebs or bullous changed lesions mainly in the apicoposterior segment bilaterally in 15 patients[88.2%] Postoperative complications were 3 cases in Group II [wound infection:2 cases, temporary left wrist drop: one case] but none in Group I and III. Spontaneous pneumothorax recurred in 2 cases, one in Group II and another in Group III but none in Group I. 12 cases of 94 patients[12.8%o] who were treated with unilateral thoracotomy needed contralateral thoracotomy mean 14.9 months[7.5 \ulcorner 25 months] later. Mean age was 20.9 years [17 \ulcorner28]. In conclusion, simultaneous bilateral operation through median sternotomy should be considered in managements of spontaneous pneumothorax, especially in late teens and early twenties except young women for cosmetic reasons.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.401-405
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• 2002

저자들은 호흡곤란, 흉통 및 경부종창을 주소로 내원한 6세 남아에서 M. pneumoniae 폐렴에 동반된 양측성 특발성 긴장성 폐기흉 1례를 경험하였기에 문헌 고찰과 함께 국내 첫 증례로 보고하는 바이다.

• Journal of Chest Surgery
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• 제39권6호
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• pp.475-478
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• 2006

배경: 동시에 발생한 양측성 자발성 기흉은 아주 드문 질환으로 일측성 기흉과는 달리 긴장성 기흉을 초래하지 않고도 심한 호흡곤란, 청색증, 흉통으로 사망에 이르게 할 수 있어 즉각적인 조치를 필요로 한다. 대상 및 방법: 한전의료재단 한일병원 흥부외과에서는 1994년 3월부터 2004년 2월까지 10년간 총 802명 자발성 기흉 환자 중 14명(1.7%)의 동시에 발생한 양측성 자발성 기흉을 발견하여 치험하였다. 결과: 총 14명 중 2명을 제외한 환자가 남자로 85.7%를 차지하였으며, 환자의 나이는 0세(1일)부터 79세로 넓은 연령층(평균 32.0세)을 보였다. 11명의 환자가 초발성 자발성 기흉이었으며 1명은 좌측 자발성 혈기흉을 동반하였고, 2명은 농기흉을 동반하였다. 신생아를 제외한 환자에 있어 흡연률은 13명 중 6명으로 42.8%였다. 결핵을 앓거나 앓았던 환자는 모두 5명(35.7%)이었으며 이 중 2명을 제외하고 현증 활동성 결핵이었다. 14명 중 3명이 사망하였는데 신생아는 메코니움 흉인성 폐렴으로 당일 사망하였으며, 2명은 급성 호흡곤란증후군과 폐렴으로 사망하였다. 동시에 발생한 양측성 자발성 기흉 환자를 비강을 통한 산소 흡인요법, 폐쇄성 흉강삽관술, 개흉술, 흉강경수술과 화학적 흉막유착술을 시행하여 해결하였다. 결론: 동시에 발생한 양측성 자발성 기흉은 총 802명의 자발성 기흉 환자 중 14명(1.7%)에게서 발생하였다. 증상을 완화시키기 위해 즉각적인 폐쇄성 흉강삽관술이 필요하며 자발성 기흉의 재발률을 낮추기 위해 폐쇄성 흉강삽관술 단독보다는 조기에 개흉술 또는 흉강경수술이 필요할 것이라 생각한다.

• Journal of Chest Surgery
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• 제25권7호
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• pp.763-768
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• 1992

To prevent recurrence of spontaneous pneumothorax, 23 patients were operated through median sternotomy for simultaneous resection of bilateral bullae, And 27 patients with spontaneous pneumothorax were treated with unilateral thoracotomy, We studied the number, duration and sites of recurrence including findings of CT scan, as well as comparing the both operated group. The incidence of spontaneous pneumothorax was 88% in patients with the ages between 16 to 35 Forty one patients[82%] were operated with the indication of recurrent pne-umpthorax. The number of pneumothorax attack was 2.34 per patient with recurrent pneumothorax. The 87.8% of recurrence was occured within 6 months from last attack. Ips-ilateral recurrnet pneumothorax was 56.1% and contallateral involve was 43.9%. The bilaterality of visible bullae was 90.9% in the findings of chest CT scan and 91.3% in the operative finding. The sensitivity and accuracy for bulla detection with chest CT were 92.6%, respectively. Exclude one case of complicated median sternotomy infection, the postoperative hospital stay was shorter in median sternotomy approached group[P<0.05]. In conclusion, the bullous lesions of the lung have tendency of bilaterality so that median sternotomy for simultaneous resection of bilateral bullae should be considered in patients with contralateral visible bullae with chest CT.

• Journal of Chest Surgery
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• 제21권2호
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• pp.299-306
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• 1988

We have reviewed 330 cases of spontaneous pneumothorax from Jan. 1980 to Jul. 1987 at the department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University. The ratio of male to female was 8.4:1, predominant in male. The incidence according to the age group was highest as 32% in the adolescence between 21 and 30 years old. The site of pneumothorax was right in 48%, left in 45% and bilateral in 7%. The initial symptoms were frequently dyspnea in 85%, chest pain in 63%. The etiologic factors were as follows; bleb origin in 31%, tuberculous origin in 30%, COPD in 3.3%, lung cancer in 1.5%, unknown in 29%. There was no significant difference in seasonal incidence irrespective of tuberculous or sex. The employed managements were as follows; bed rest with oxygen inhalation in 4 cases, closed thoracostomy in 326 cases, open thoracotomy in 122 cases, median sternotomy in 23 cases. The operative procedures at thoracotomy were as follows; simple pleurodesis in 5 cases, bleb excision or wedge resection in 113 cases, segmentectomy or lobectomy in 17 cases, decortication in 42 cases. Recurrence rate of each treatment was as follow; 50% in conservative treatment, 19% in closed thoracostomy, 2% in open thoracotomy, 4% in median sternotomy. Therefore overall recurrence rate was 12%. Open thoracotomy was the most effective procedure in recurrent pneumothorax, previous contralateral pneumothorax, bilateral simultaneous pneumothorax, visible bleb or bullae on the chest x-ray and persistent air leakage. 23 cases of unilateral spontaneous pneumothorax was examined whether or not underlying pathology of pneumothorax at opposite lung. 18 cases[78%] were positive findings. Therefore, bilateral thoracotomy by median sternotomy was a good operative method preventing contralateral pneumothorax.

• Medical Lasers
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• 제9권1호
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• pp.65-70
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• 2020

Bronchial foreign body aspiration (BFA) is a common but emergent condition in infants and children. Furthermore, it can result in various complications such as atelectasis, pneumonia, bronchiectasis, and pneumothorax. Among these, pneumothorax is a very rare complication. However, it can be fatal without the swift implementation of appropriate treatment. We experienced a case of 16-month-old girl with an aspirated peanut. The foreign body was fixed in her left main bronchus. A CO₂ laser was used to safely cut and break the foreign body. Removal was successful after breaking it. But after the process, inflammatory tissue of the tracheal mucosa was ruptured. Bilateral tension pneumothorax followed after the rupture. The patient was treated with bilateral chest tube insertion. Here we present this BFA case with a rare and unexpected complication. We also review the appropriate literature.

• Journal of Chest Surgery
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• 제24권8호
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• pp.757-764
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• 1991

We have observed 360 cases of spontaneous pneumothorax from January 1980 to May 1991 at the department of Thoracic and Cardiovascular Surgery, Chosun University Hospital. Males occupied 266 cases[73.9%] and females 94 cases[26.1%], and its ratio was 2.8: l. The age of patients ranged from neonate[5 days] to 84 years old. The site of pneumothorax was right in 50.3%, left in 43.3% and bilateral in 6.4%a. The clinical symptoms were frequently dyspnea, chest pain and coughing. The associated pulmonary lesions were shown pulmonary tuberculosis in 199 cases[55.3%], bullae in 54, pulmonary emphysema in 31, COPD in 17, pneumonia in 6, lung cancer in 5, paragonimiasis in 5, catamenial pneumothorax in 3 and unknown underlying pathology in 39 cases. The results of surgical management of spontaneous pneumothorax are followings: 288 out of 360 cases[80.0%] were cured by closed thoracotomy, 53 cases[14.8%] were cured by open thoracotomy. Open thoracotomy was the most effective procedure in persistent air leakage, recurrent pneumothorax, visible bleb or bullae on the chest X-ray, associated lesion, bilateral simultaneous pneumothorax, parenchymal incomplete lung expansion and bleeding after closed thoracotomy. The incidence of complication was developed in 10. ado and recurrent rate was seen in 10.6%. There was no operative death.