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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spontaneous contralateral pneumothorax after pneumonectomy is a rare condition&#46; A high index of suspicion is required for a correct diagnosis&#46; Management can be challenging&#44; as surgical intervention&#44; if necessary&#44; is a very high risk procedure&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Chemical pleurodesis can be a simple and effective measure in cases with no major air leak&#46; We describe the case of a 21-year-old female with spontaneous pneumothorax in a single lung&#44; which posed several diagnostic and therapeutic problems&#46; The presence of a &#8220;buffalo chest&#8221; made the initial chest x-ray interpretation difficult&#46; The patient had an important air leak without complete pulmonary expansion and thoracic surgery was considered of risk&#46; Accordingly&#44; instillation of talc slurry through one of the thoracic drains was undertaken with eventual resolution&#46; We are convinced that bronco-pleural fistula resolution was facilitated by <span class="elsevierStyleItalic">slurry talc</span>&#44; despite complete lung expansion never having been achieved&#46;</p>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O pneumot&#243;rax contralateral ap&#243;s pneumonectomia &#233; uma situa&#231;&#227;o rara&#46; &#201; necess&#225;rio um alto &#237;ndice de suspei&#231;&#227;o para um correcto diagn&#243;stico&#44; na aus&#234;ncia de exames complementares de diagn&#243;stico&#46; O tratamento &#233; um desafio&#44; uma vez que a interven&#231;&#227;o cir&#250;rgica&#44; se necess&#225;ria&#44; &#233; um procedimento de risco&#46; A pleurodese qu&#237;mica pode ser uma medida simples e eficaz&#44; em casos sem f&#237;stula broncopleural importante&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrevemos o caso cl&#237;nico de uma doente de 21 anos com pneumot&#243;rax espont&#226;neo em pulm&#227;o &#250;nico&#44; que colocou v&#225;rias dificuldades&#44; diagn&#243;sticas e terap&#234;uticas&#46; A presen&#231;a de pulm&#227;o vicariante dificultou a interpreta&#231;&#227;o inicial do RX tor&#225;cico&#46; A doente apresentava f&#237;stula broncopleural de alto d&#233;bito&#44; sem expans&#227;o pulmonar completa&#44; mesmo ap&#243;s coloca&#231;&#227;o de um segundo dreno tor&#225;cico&#44; e a cirurgia tor&#225;cica foi considerada de risco&#46; Foi efectuada instila&#231;&#227;o de talco atrav&#233;s de um dos drenos tor&#225;cicos&#44; com posterior resolu&#231;&#227;o&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estamos convencidos de que a resolu&#231;&#227;o da f&#237;stula broncopleural foi facilitada pela talcagem&#44; mesmo sem expans&#227;o pulmonar total&#44; que nunca se tinha conseguido&#46;</p>"
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Vol. 13. Issue 4.
Pages 613-617 (July - August 2007)
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Vol. 13. Issue 4.
Pages 613-617 (July - August 2007)
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A spontaneous pneumothorax in a “buffalo chest”
Pneumotórax espontâneo num pulmão vicariante
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Anabela Marinho1,
Corresponding author
a.n.marinho@tvtel.pt

Correspondência: Serviço de Pneumologia do Hospital de S. João Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal. Telefone: 225512100 ou 963311481, Fax: +00351225512215.
, Beatriz Lima2, Idalina Araújo3, Pedro Bastos4, J. Agostinho Marques5, Isabel Gomes6
1 Interna Complementar de Pneumologia do Hospital de S. João
2 Assistente Hospitalar de Pneumologia do Hospital de S. João
3 Assistente Hospitalar Graduada de Pneumologia do Hospital de S. João
4 Chefe de Serviço de Cirurgia Torácica do Hospital de S. João; Professor Associado Convidado da Faculdade de Medicina da Universidade do Porto
5 Chefe de Serviço de Pneumologia do Hospital de S. João; Professor Catedrático da Faculdade de Medicina da Universidade do Porto
6 Assistente Hospitalar Graduada de Pneumologia do Hospital de S. João
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Article information
Abstract

Spontaneous contralateral pneumothorax after pneumonectomy is a rare condition. A high index of suspicion is required for a correct diagnosis. Management can be challenging, as surgical intervention, if necessary, is a very high risk procedure.

Chemical pleurodesis can be a simple and effective measure in cases with no major air leak. We describe the case of a 21-year-old female with spontaneous pneumothorax in a single lung, which posed several diagnostic and therapeutic problems. The presence of a “buffalo chest” made the initial chest x-ray interpretation difficult. The patient had an important air leak without complete pulmonary expansion and thoracic surgery was considered of risk. Accordingly, instillation of talc slurry through one of the thoracic drains was undertaken with eventual resolution. We are convinced that bronco-pleural fistula resolution was facilitated by slurry talc, despite complete lung expansion never having been achieved.

Key-words:
Pneumothorax
pneumonectomy
“buffalo-chest”
air-leak
slurry talc
Resumo

O pneumotórax contralateral após pneumonectomia é uma situação rara. É necessário um alto índice de suspeição para um correcto diagnóstico, na ausência de exames complementares de diagnóstico. O tratamento é um desafio, uma vez que a intervenção cirúrgica, se necessária, é um procedimento de risco. A pleurodese química pode ser uma medida simples e eficaz, em casos sem fístula broncopleural importante.

Descrevemos o caso clínico de uma doente de 21 anos com pneumotórax espontâneo em pulmão único, que colocou várias dificuldades, diagnósticas e terapêuticas. A presença de pulmão vicariante dificultou a interpretação inicial do RX torácico. A doente apresentava fístula broncopleural de alto débito, sem expansão pulmonar completa, mesmo após colocação de um segundo dreno torácico, e a cirurgia torácica foi considerada de risco. Foi efectuada instilação de talco através de um dos drenos torácicos, com posterior resolução.

Estamos convencidos de que a resolução da fístula broncopleural foi facilitada pela talcagem, mesmo sem expansão pulmonar total, que nunca se tinha conseguido.

Palavras-chave:
Pneumotórax
pneumonectomia
pulmão vicariante
fístula broncopleural
slurry talc
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Copyright © 2007. Sociedade Portuguesa de Pneumologia
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