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Clinical Research of Spontaneous Pneumothorax
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Clinical Research of Spontaneous Pneumothorax

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 23644

Special Issue Editors

Dr. Paola Ciriaco

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Guest Editor
Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
Interests: general thoracic surgery; pediatric thoracic surgery; thoracic endoscopy
Dr. Robert Hallifax

E-Mail Website
Guest Editor
Oxford Centre of Respiratory Medicine, University of Oxford, Oxford, UK
Interests: optimising management of pneumothorax; predicting outcomes (short term air leak and long term recurrence); underlying causes of pneumothorax (particularly aetiology of primary spontaneous pneumothorax)

Special Issue Information

Dear Colleagues,

Spontaneous pneumothorax is a clinical reality that still requires standardization for some diagnostic-therapeutic aspects.

Primary spontaneous pneumothorax typically occurs in young, healthy, tall, thin, male smokers, and is usually caused by rupture of apical subpleural blebs in otherwise normal lungs. It is a relatively rare condition in children.

When a spontaneous pneumothorax occurs in patients with known underlying lung disease, it is referred to as secondary spontaneous pneumothorax. Causes include bullous diseases (chronic obstructive pulmonary disease (COPD) and emphysema), cystic diseases (cystic fibrosis, lymphangioleiomyomatosis), infectious causes (pneumonia, severe acute respiratory syndrome), catamenial effects, connective tissue disorders (Marfan syndrome), and malignancy (primary lung cancer, metastatic disease).

Treatment is closely related to the pneumothorax cause, and ranges from non-operative management (observation, chest tube) to surgery. In the last decade, minimally invasive surgery has become the first choice for the treatment of pneumothorax. The surgical access and technique is not standardized, and many contributions are present in the literature regarding uni- or multi-portal video-assisted thoracic surgery, robotic surgery, and minithoracotomy. The type and role of pleurodesis are heterogeneously discussed by the various centers. The treatment of secondary spontaneous pneumothorax such as catamenial- or COPD-related pneumothorax needs to fall within a multidisciplinary context, and specific pathways are randomly designed. Spontaneous pneumothorax is also approached by pulmonologists via videothoracoscopy, the pros and cons of which are not yet well-defined.

The pathological specimens collected during surgery for pneumothorax can offer important information about the underlying disease such as endometriosis, emphysema, and drugs inhalation, thus emphasizing the importance of close cooperation with the pathologist.

Dr. Paola Ciriaco
Dr. Robert Hallifax
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pneumothorax
  • pleurodesis
  • videothoracoscopy
  • robotic
  • catamenial pneumothorax
  • bullae

Published Papers (6 papers)

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Editorial

Jump to: Research, Review

4 pages, 207 KiB  
Editorial
Special Issue on “Clinical Research of Spontaneous Pneumothorax”
by Paola Ciriaco
J. Clin. Med. 2022, 11(11), 2988; https://doi.org/10.3390/jcm11112988 - 25 May 2022
Cited by 2 | Viewed by 1399
Abstract
Spontaneous pneumothorax (SP) may occur in the apparent absence of disease (primary spontaneous pneumothorax PSP) or as a consequence of an underlying condition (secondary spontaneous pneumothorax SSP) [...] Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)

Research

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10 pages, 1476 KiB  
Article
Catamenial Pneumothorax as the First Expression of Thoracic Endometriosis Syndrome and Pelvic Endometriosis
by Paola Ciriaco, Piergiorgio Muriana, Angelo Carretta, Jessica Ottolina, Massimo Candiani and Giampiero Negri
J. Clin. Med. 2022, 11(5), 1200; https://doi.org/10.3390/jcm11051200 - 23 Feb 2022
Cited by 5 | Viewed by 2113
Abstract
Objective: The menstrual-related catamenial pneumothorax (CP) can be the first expression of thoracic endometriosis syndrome (TES), which is the presence of endometriotic lesions in the lungs and pleura, and pelvic endometriosis (PE). This study aims to analyze our experience with this specific correlation [...] Read more.
Objective: The menstrual-related catamenial pneumothorax (CP) can be the first expression of thoracic endometriosis syndrome (TES), which is the presence of endometriotic lesions in the lungs and pleura, and pelvic endometriosis (PE). This study aims to analyze our experience with this specific correlation describing our multidisciplinary approach to CP. Methods: Hospital records of 32 women, operated for CP at our Department from January 2001 to December 2021 were reviewed. Surgical treatment consisted of videothoracoscopy and laparoscopy when indicated. Results: TES and PE were diagnosed in 13 (40.6%) and 12 (37.5%) women, respectively. The association of TES and PE was present in 11 cases (34%). Fifteen patients (46.9%) underwent laparoscopy, of which 11 concurrently with videothoracoscopy. Most of the patients affected had stage III–IV endometriosis (40.6%). All patients received hormonal therapy after surgery. Five patients with PE conceived spontaneously resulting in six live births. The mean follow-up was 117 ± 71 months (range 8–244). Pneumothorax recurrence occurred in six patients (18.8%). At present, all women are asymptomatic, with no sign of pneumothorax recurrence. Conclusions: CP might be the first expression of TES and/or PE. A multidisciplinary approach is advocated for optimal management of the disease. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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8 pages, 777 KiB  
Article
Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence
by Wongi Woo, Chong Hoon Kim, Bong Jun Kim, Seung Hwan Song, Duk Hwan Moon, Du-Young Kang and Sungsoo Lee
J. Clin. Med. 2021, 10(23), 5687; https://doi.org/10.3390/jcm10235687 - 02 Dec 2021
Cited by 3 | Viewed by 1511
Abstract
Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to [...] Read more.
Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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Review

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10 pages, 841 KiB  
Review
Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances
by George William Nava and Steven Philip Walker
J. Clin. Med. 2022, 11(5), 1173; https://doi.org/10.3390/jcm11051173 - 22 Feb 2022
Cited by 12 | Viewed by 6934
Abstract
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients [...] Read more.
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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7 pages, 961 KiB  
Review
Aetiology of Primary Spontaneous Pneumothorax
by Rob Hallifax
J. Clin. Med. 2022, 11(3), 490; https://doi.org/10.3390/jcm11030490 - 19 Jan 2022
Cited by 7 | Viewed by 5183
Abstract
Air in the pleural cavity is termed pneumothorax. When this occurs in the absence of trauma or medical intervention, it is called spontaneous pneumothorax. Primary spontaneous pneumothorax typically occurs in young patients without known lung disease. However, the idea that these patients have [...] Read more.
Air in the pleural cavity is termed pneumothorax. When this occurs in the absence of trauma or medical intervention, it is called spontaneous pneumothorax. Primary spontaneous pneumothorax typically occurs in young patients without known lung disease. However, the idea that these patients have “normal” lungs is outdated. This article will review evidence of inflammation and respiratory bronchiolitis on surgical specimens, discuss the identification of emphysema-like change (i.e., blebs and bullae), the concept of pleural porosity and review recent data on the overexpression of matrix metalloproteinases in the lungs of patients who have had pneumothorax. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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10 pages, 927 KiB  
Review
Thoracoscopy for Spontaneous Pneumothorax
by José M. Porcel and Pyng Lee
J. Clin. Med. 2021, 10(17), 3835; https://doi.org/10.3390/jcm10173835 - 26 Aug 2021
Cited by 15 | Viewed by 5311
Abstract
Video-assisted thoracic surgery (VATS) is the treatment of choice for recurrence prevention in patients with spontaneous pneumothorax (SP). Although the optimal surgical technique is uncertain, bullous resection using staplers in combination with mechanical pleurodesis, chemical pleurodesis and/or staple line coverage is usually undertaken. [...] Read more.
Video-assisted thoracic surgery (VATS) is the treatment of choice for recurrence prevention in patients with spontaneous pneumothorax (SP). Although the optimal surgical technique is uncertain, bullous resection using staplers in combination with mechanical pleurodesis, chemical pleurodesis and/or staple line coverage is usually undertaken. Currently, patient satisfaction, postoperative pain and other perioperative parameters have significantly improved with advancements in thoracoscopic technology, which include uniportal, needlescopic and nonintubated VATS variants. Ipsilateral recurrences after VATS occur in less than 5% of patients, in which case a redo-VATS is a feasible therapeutical option. Randomized controlled trials are urgently needed to shed light on the best definitive management of SP. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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