Caso Clínico / Clinical Case
Pneumotórax espontâneo num pulmão vicariante
A spontaneous pneumothorax in a “buffalo chest”
Anabela Marinho1,
, Beatriz Lima2, Idalina Araújo3, Pedro Bastos4, J. Agostinho Marques5, Isabel Gomes6
Corresponding author
a.n.marinho@tvtel.pt
Correspondência: Anabela Marinho, Serviço de Pneumologia do Hospital de S. João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal. Telefone: 225512100 ou 963311481. Fax: 00351225512215
Correspondência: Anabela Marinho, Serviço de Pneumologia do Hospital de S. João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal. Telefone: 225512100 ou 963311481. Fax: 00351225512215
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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João; Professor Associado Convidado da Faculdade de Medicina da Universidade do Porto" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Chefe de Serviço de Pneumologia do Hospital de S. João; Professor Catedrático da Faculdade de Medicina da Universidade do Porto" "etiqueta" => "5" "identificador" => "af0025" ] 5 => array:3 [ "entidad" => "Assistente Hospitalar Graduada de Pneumologia do Hospital de S. João" "etiqueta" => "6" "identificador" => "af0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência:</span> Anabela Marinho, Serviço de Pneumologia do Hospital de S. João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal. Telefone: 225512100 ou 963311481. Fax: 00351225512215" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A spontaneous pneumothorax in a “buffalo chest”" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-11-28" "fechaAceptado" => "2007-01-29" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570361" "palabras" => array:5 [ 0 => "Pneumotórax" 1 => "pneumonectomia" 2 => "pulmão vicariante" 3 => "fístula broncopleural" 4 => "<span class="elsevierStyleItalic">slurry talc</span>" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570362" "palabras" => array:5 [ 0 => "Pneumothorax" 1 => "pneumonectomy" 2 => "“buffa-lo-chest”" 3 => "air-leak" 4 => "slurry talc" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">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 trata-mento é um desafio, uma vez que a intervenção cirúr-gica, se necessária, é um procedimento de risco. A pleu-rodese química pode ser uma medida simples e eficaz, em casos sem fístula broncopleural importante.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">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 interpreta-ção 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.</p><p id="sp0115" class="elsevierStyleSimplePara elsevierViewall">Estamos convencidos de que a resolução da fístula broncopleural foi facilitada pela talcagem, mesmo sem expansão pulmonar total, que nunca se tinha conseguido.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (4): 613-617</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">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 bron-co-pleural fistula resolution was facilitated by slurry talc, despite complete lung expansion never having been achieved.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (4): 613-617</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Postpneumonectomy Patient With latro-genic Pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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Kurt" 1 => "Grathwohl" 2 => "Stephen Derdak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMicm010281" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "1829" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14602881" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "M.H. Baumann" 1 => "C. Strange" 2 => "J.E. Heffner" 3 => "R. Light" 4 => "T.J. Kirby" 5 => "J. Klein" 6 => "J.D. Luketich" 7 => "E.A. Panacek" 8 => "S.A. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contralateral spontaneous pneumothorax after pneumonectomy: thoracoscopic management with cardiopulmonary bypass" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.J. Birdas" 1 => "D.H. Beckart" 2 => "R.J. Keenan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2004.093294" "Revista" => array:6 [ "tituloSerie" => "Interactive Cardiovascular and Thoracic Surgery" "fecha" => "2005" "volumen" => "4" "paginaInicial" => "27" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17670349" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bb0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent post-pneumonectomy spontaneous pneumothorax: a challenging case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Cesario" 1 => "K. Kawamukai" 2 => "S. Margaritora" 3 => "P. Granone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1569-9293(03)00121-X" "Revista" => array:6 [ "tituloSerie" => "Interactive Cardiovascular and Thoracic Surgery" "fecha" => "2003" "volumen" => "2" "paginaInicial" => "477" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17670099" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bb0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A surgical Intervention Using Percutaneous Cardiopulmonary Support for Contralateral Pneumothorax following Pneumonectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Ishikawa" 1 => "H. Sato" 2 => "C. Hiranuma" 3 => "M. Takizawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Cardiovasc Surg" "fecha" => "2001" "volumen" => "4" "paginaInicial" => "235" "paginaFinal" => "236" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bb0045" "etiqueta" => "9." 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| 2017 June | 31 | 17 | 48 |
| 2017 May | 50 | 9 | 59 |
| 2017 April | 16 | 4 | 20 |
| 2017 March | 21 | 21 | 42 |
| 2017 February | 18 | 2 | 20 |
| 2017 January | 12 | 3 | 15 |
| 2016 December | 22 | 3 | 25 |
| 2016 November | 10 | 4 | 14 |
| 2016 October | 15 | 5 | 20 |
| 2016 September | 3 | 13 | 16 |
| 2016 August | 4 | 2 | 6 |
| 2016 July | 5 | 3 | 8 |
| 2016 June | 0 | 1 | 1 |
| 2016 May | 1 | 4 | 5 |
| 2016 April | 5 | 31 | 36 |
| 2016 March | 6 | 6 | 12 |
| 2016 February | 7 | 14 | 21 |
| 2016 January | 7 | 7 | 14 |
| 2015 December | 5 | 6 | 11 |
| 2015 November | 3 | 2 | 5 |
| 2015 October | 3 | 1 | 4 |
Show all
