LARGE EMPHYSEMATOUS BULLAE MIMICKING AS A PNEUMOTHORAX LEADING TO UNNECESSARY CHEST TUBE INSERTION AND IATROGENIC PNEUMOTHORAX
AbstractPneumothorax (Pnx) is the presence of air or gas in the pleural space which hinders the lungs to function appropriately. Pneumothorax that presents in the absence of any underlying aetiology is called primary spontaneous pneumothorax (PSP) and on the other hand, it may present as a complication of underlying lung disease which is known as secondary spontaneous pneumothorax (SSP). Iatrogenic Pneumothorax (IP) is a type of SSP and is caused by medical interventional procedures which include transthoracic needle biopsy (24%), sub clavicular catheterization (22%), thoracocentesis (20%), transbronchial biopsy (10%), pleural biopsy (8%) and positive pressure ventilation (7%). We had a 51-year-old patient with a history of COPD/emphysema who presented with respiratory distress. Large bullae were mistaken as pneumothorax, unnecessary Chest Tube Insertion (thoracostomy) was performed resulting in IP. An extensive review of the literature shows there are only a few reported cases of unnecessary thoracotomy and IP in settings of giant bulla mimicking pneumothorax. Iatrogenic Pneumothorax resulting from giant bullae mimicking pneumothorax leading to unnecessary chest tube insertion. Physicians should be aware of such aetiology of pneumothorax as it has been rarely reported in the literature.
Noppen M. Spontaneous pneumothorax: epidemiology, pathophysiology and cause. Eur Respir Rev 2010;19(117):217–9.
Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000;342(12):868–74.
Sassoon CS, Light RW, O'Hara VS, Moritz TE. Iatrogenic pneumothorax: etiology and morbidity. Results of a Department of Veterans Affairs Cooperative Study. Respiration 1992;59(4):215–20.
Loiselle A, Parish JM, Wilkens JA, Jaroszewski DE. Managing iatrogenic pneumothorax and chest tubes. J Hosp Med 2013;8(7):402–8.
Celik B, Sahin E, Nadir A, Kaptanoglu M. Iatrogenic pneumothorax: etiology, incidence and risk factors. Thorac Cardiovasc Surg 2009;57(5):286–90.
John J, Seifi A. Incidence of iatrogenic pneumothorax in the United States in teaching vs. non-teaching hospitals from 2000 to 2012. J Crit Care 2016;34:66–8.
Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 2011;140(4):859–66.
Bourgouin P, Cousineau G, Lemire P, Hébert G. Computed tomography used to exclude pneumothorax in bullous lung disease. J Can Assoc Radiol 1985;36(4):341–2.
Garg I, Agarwal K, Purohit G, Agarwal S, Umashankar N. Giant Bulla or Tension Pneumothorax: Diagnostic Dilemma in Emergency. Chest 2016;150(4):929.
Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J 2006;28(3):637–50.
Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58(Suppl 2):ii39–52.
Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH, et al. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults. Am J Emerg Med 2006;24(7):795–800.
Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119(2):590–602.