• Ct scan
• EFAST
• Emergency
• Pneumothorax
• Polytrauma
• Ultrasound

• Humans
• Retrospective Studies
• Multiple Trauma/diagnostic imaging
• Multiple Trauma/physiopathology
• Male
• Trauma Centers
• Ultrasonography/methods
• Pneumothorax/diagnostic imaging
• Female
• Hemodynamics
• Adult
• Middle Aged
• Tomography, X-Ray Computed
• Aged
• Sensitivity and Specificity

• Humans
• Pneumothorax/diagnostic imaging
• Machine Learning
• Tomography, X-Ray Computed/methods
• Male
• Female
• Middle Aged
• Adult
• Aged
• Algorithms
• ROC Curve
• Young Adult
• Adolescent
• Radiomics

• constrained optimization
• deep transfer learning
• diagnostic radiology
• pneumothorax detection
• semantic segmentation

• Computed tomography-guided percutaneous transthoracic needle biopsy
• Crossing pleural tail sign
• Nodule-pleural relationship
• Pneumothorax

• Humans
• Pneumothorax/etiology
• Pneumothorax/prevention & control
• Pneumothorax/epidemiology
• Female
• Male
• Retrospective Studies
• Image-Guided Biopsy/adverse effects
• Image-Guided Biopsy/methods
• Middle Aged
• Tomography, X-Ray Computed
• Incidence
• Risk Factors
• Aged
• Pleura/pathology
• Pleura/diagnostic imaging
• Biopsy, Needle/adverse effects
• Biopsy, Needle/methods
• Lung Neoplasms/pathology
• Adult
• Solitary Pulmonary Nodule/pathology
• Solitary Pulmonary Nodule/diagnostic imaging
• China/epidemiology

• NO. KC2312 Science Foundation of Peking University Cancer Hospital
• PX2022048 2022 Scientific Research and Cultivation Plan of Beijing Municipal Hospital
• 320.6750.2020.-19-33 Clinical Research Special Support Fund project of Wu Jieping Medical Foundation
• 2022YFC2401705 National Key R&D Program of China
• National Key R&D Program of China

• COVID-19
• Chronic lung disease
• Influenza
• Pneumonia
• Pneumothorax

• Humans
• COVID-19/complications
• COVID-19/epidemiology
• Pneumothorax/etiology
• Pneumothorax/epidemiology
• Influenza, Human/complications
• Influenza, Human/epidemiology
• Male
• Female
• Middle Aged
• Retrospective Studies
• Republic of Korea/epidemiology
• Aged
• Adult
• SARS-CoV-2/isolation & purification
• Risk Factors
• Hospitalization
• Proportional Hazards Models
• Seasons
• Young Adult
• Aged, 80 and over

• NRF-2021R1A5A2030333 National Research Foundation of Korea

• false negative
• false positive
• lung sliding
• pneumothorax
• transthoracic ultrasound

• SARS-CoV-2
• animal model
• ferret
• hypoxia
• oxygen measurement

• Animals
• Ferrets
• COVID-19/metabolism
• COVID-19/virology
• Oxygen/metabolism
• Lung/metabolism
• Lung/virology
• Lung/pathology
• SARS-CoV-2
• Disease Models, Animal
• Hypoxia/metabolism
• Hypoxia/virology
• Male
• Female

• Ministry of Science and Culture of Lower Saxony, Germany

• computer aided diagnosis
• explainable artificial intelligence (XAI)
• primary spontaneous pneumothorax
• vascular-penetration defects

• Pneumothorax/diagnostic imaging
• Deep Learning
• Humans
• Image Processing, Computer-Assisted/methods
• Tomography, X-Ray Computed

• Chronic obstructive pulmonary disease
• Comorbidities
• Incidence
• Secondary spontaneous pneumothorax

• Humans
• Pulmonary Disease, Chronic Obstructive/epidemiology
• Pulmonary Disease, Chronic Obstructive/complications
• Taiwan/epidemiology
• Pneumothorax/epidemiology
• Pneumothorax/etiology
• Male
• Female
• Aged
• Middle Aged
• Comorbidity
• Risk Factors
• Adult
• Incidence
• Databases, Factual
• Propensity Score
• Aged, 80 and over

• demographics
• management approaches
• primary spontaneous pneumothorax
• secondary spontaneous pneumothorax
• smoking

• Humans
• Diagnostic Imaging
• Communication
• Databases, Factual
• Radiologists

• P30 CA008748 NCI NIH HHS

• Humans
• Pneumothorax/diagnostic imaging
• Pneumothorax/etiology
• Diagnostic Imaging

• COVID‐19 pneumonia
• bronchopleural fistula
• pneumothorax
• respiratory complications

• Detectron2
• X-ray
• artificial intelligence
• image recognition
• lung diseases classification
• machine learning
• magnetic resonance imaging

• Humans
• Pneumothorax/diagnostic imaging
• Artificial Intelligence
• Deep Learning
• Radiography
• Tomography, X-Ray Computed
• Sprains and Strains

• Project of University Social Responsibility Ministry of Education, Taiwan

• dynamic adaptive windowing
• implicit feature alignment
• medical image analysis
• pneumothorax segmentation
• transformer

• Humans
• Pneumothorax/diagnostic imaging
• Bronchi
• Tomography, X-Ray Computed
• Trachea
• Image Processing, Computer-Assisted

• chest tube
• pneumothorax
• spontan pneumothorax
• thoracostomy tube
• vats video assisted thoracoscopic surgery

• Anesthesia
• arthroscopy
• complication
• orthopedic procedure
• pneumothorax
• trauma.

• emergency medical service
• general surgery
• pneumothorax
• primary spontaneous pneumothorax
• spontaneous pneumothorax
• thoracic sugery

• Bronchial tuberculosis
• Secondary pneumothorax
• Spontaneous pneumothorax

• Clinical examination
• Differential diagnosis
• Internal underlying disease
• Medical history
• Red flags

• Humans
• Low Back Pain/diagnosis
• Low Back Pain/etiology
• Diagnosis, Differential
• Back Pain/diagnosis
• Back Pain/etiology
• Risk Factors
• Physical Examination/adverse effects

• University of Bern

Artificial intelligence (AI) techniques can be a solution for delayed or misdiagnosed pneumothorax. This study developed, a deep-learning-based AI model to estimate the pneumothorax amount on a chest radiograph and applied it to a treatment algorithm developed by experienced thoracic surgeons. U-net performed semantic segmentation and classification of pneumothorax and non-pneumothorax areas. The pneumothorax amount was measured using chest computed tomography (volume ratio, gold standard) and chest radiographs (area ratio, true label) and calculated using the AI model (area ratio, predicted label). Each value was compared and analyzed based on clinical outcomes. The study included 96 patients, of which 67 comprised the training set and the others the test set. The AI model showed an accuracy of 97.8%, sensitivity of 69.2%, a negative predictive value of 99.1%, and a dice similarity coefficient of 61.8%. In the test set, the average amount of pneumothorax was 15%, 16%, and 13% in the gold standard, predicted, and true labels, respectively. The predicted label was not significantly different from the gold standard (p = 0.11) but inferior to the true label (difference in MAE: 3.03%). The amount of pneumothorax in thoracostomy patients was 21.6% in predicted cases and 18.5% in true cases.

COVID-19 is a multi-system disease caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). One of the main highlights of the disease is the development of pneumonia complicated by adult respiratory distress syndrome. While spontaneous pneumothorax has been reported in some patients with COVID-19, bronchopleural fistula has seldom been reported as the primary cause in these cases. We describe the rare case of a young patient who developed a pneumothorax complicating COVID-19 and was found to have a bronchopleural fistula and empyema secondary to Staphylococcus aureus superinfection.

and importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD).

He presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up.

ICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment.

This would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy.

•

High level of clinical acumen is required to early anticipate the spontaneous pneumothorax in acute exacerbation of COPD.

• Hospitalization
• Humans
• Intensive Care Units
• Length of Stay
• Respiration, Artificial/adverse effects
• Respiratory Distress Syndrome/therapy
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/therapy
• Retrospective Studies

The diagnosis of patients with Birt–Hogg–Dubé (BHD) syndrome is always delayed (even for more than 10 years). Improving the understanding and diagnosis of this disease is vital for clinicians and radiologists. In this study we presented the chest computed tomography (CT) findings of BHD syndrome and offered suggestions for BHD cases with spontaneous pneumothorax.

Twenty-six BHD patients from 11 families (10 men, 16 women; mean age: 46 ± 12 years, 20–68 years) were included. The clinical features of the patients included pneumothorax, renal lesions, and skin lesions. Twenty-three patients underwent chest CT imaging. The cyst condition of each patient derived from reconstructed chest CT imaging was recorded, including the cyst number, size, volume, pattern, and distribution.

Pneumothorax occurred in 54% (14/26) of patients. Among them, 43% (6/14) had pneumothorax more than twice. However, typical skin and renal lesions were absent. Four patients had renal hamartoma. CT showed that 23 (100%) patients had lung cysts. Pulmonary cysts were bilateral and multiple, round, irregular, or willow-like. And 93.6% of the large cysts (long-axis diameter ≥ 20 mm) were under the pleura, and near the mediastinum and spine. The long-axis diameter, short-axis diameter and volume of the largest cysts were associated with the occurrence of pneumothorax (all P < 0.05).

Chest CT imaging can reveal some characteristic features of BHD syndrome. The occurrence of pneumothorax in BHD patients is closely related to their pulmonary cystic lesions.

Background: Since the onset of the COVID-19 pandemic, there have been many reported cases showing the consequences—or the collateral damages—of COVID-19 on patients with non-COVID-related diseases. This study aimed to compare the clinical manifestations and treatment results of non-COVID-related pneumothorax patients before and during the pandemic. Methods: We retrospectively reviewed non-COVID-related pneumothorax patients who visited our hospital before the onset of the pandemic and during the pandemic. The primary outcome was the difference in the amount of pneumothorax between the two periods, and the secondary outcome was the difference in the treatment results between them. Multivariable logistic regression was conducted to find risk factors related to massive pneumothorax. Results: There were 122 and 88 patients in the pre-pandemic and pandemic groups, respectively. There was no significant difference between the two groups with respect to the preoperative demographic variables. However, the median amount of pneumothorax was significantly higher in the pandemic group (pre-pandemic: 34.75% [interquartile range (IQR) 18.30–62.95] vs. pandemic: 53.55% [IQR 33.58–88.80], p < 0.0001) and massive pneumothorax were more frequent in the pandemic group (52.3% vs. 30.3%, p = 0.002). Furthermore, more patients experienced re-expansion pulmonary edema after treatments during the pandemic (p = 0.0366). In multivariable analysis, the pandemic (OR: 2.70 [95% CI 1.49–4.90], p = 0.0011) was related to the occurrence of massive pneumothorax. Conclusion: During the pandemic, patients presented with a larger size of pneumothorax and had more re-expansion pulmonary edema, even in a country that handled the COVID-19 pandemic relatively well.

• COVID-19
• SARS-CoV-2
• collateral damage
• pandemic
• pneumothorax
• spontaneous pneumothorax
• tension pneumothorax

• Minimally invasive surgery
• pleural abrasion
• pneumothorax
• recurrence

• COVID-19
• Echocardiography
• Lung ultrasound
• POCUS
• Point-of-care

• COVID-19
• Critical Illness
• Echocardiography
• Humans
• Lung/diagnostic imaging
• Point-of-Care Systems
• SARS-CoV-2
• Ultrasonography

• Medical University of Vienna

• Diffuse cystic lung disease
• Pneumothorax
• Primary pneumothorax
• Secondary pneumothorax
• Smoking

• COVID‐19
• bronchopleural fistula
• persistent pneumothorax
• tension pneumothorax
• unusual complication

• adult thoracic medicine
• occupational & industrial medicine
• respiratory medicine (see thoracic medicine)

• Cohort Studies
• Comorbidity
• Humans
• Incidence
• Male
• Pneumoconiosis/complications
• Pneumoconiosis/epidemiology
• Pneumothorax/epidemiology
• Pneumothorax/etiology
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Taiwan/epidemiology

• Kaohsiung Medical University Hospital
• Kaohsiung Medical University

• Bronchial Diseases
• Chest Tubes
• Humans
• Pleurodesis
• Pneumothorax/etiology
• Pneumothorax/therapy
• Retrospective Studies
• Treatment Outcome

Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Although the portable chest X-ray remains the primary modality of diagnosis for pleural disorders in the ICU. It can be nonspecific and may miss subtle findings. Ultrasound has become a useful tool to the bedside clinician to aid in diagnosis and management of pleural disease. The majority of pleural space disorders resolve as the patient’s illness improves. There remain a few pleural processes that need specific therapies. While uncomplicated parapneumonic effusions do not have their own treatments. Those that progress to become a complex infected pleural space can have its individual complexity in therapy. Chest tube drainage remains the cornerstone in therapy. The use of intrapleural fibrinolytics has decreased the need for surgical referral. A large hemothorax or pneumothorax in patients admitted to the ICU represent medical emergencies and require emergent action. In this review we focus on the management of commonly encountered complex pleural space disorders in critically ill patients such as complicated pleural space infections, hemothoraces and pneumothoraces.

• Pleural disease
• criticall illness
• empyema
• hemothorax
• pleural effusion of extra vascular origin
• pneumothorax

Pneumothorax is not an uncommon occurrence in ICU patients. Barotrauma and iatrogenesis remain the most common causes for pneumothorax in critically ill patients. Patients with underlying lung disease are more prone to develop pneumothorax, especially if they require positive pressure ventilation. A timely diagnosis of pneumothorax is critical as it may evolve into tension physiology. Most occurrences of pneumothoraces are readily diagnosed with a chest X-ray. Tension pneumothorax is a medical emergency, and managed with immediate needle decompression followed by tube thoracostomy. A computed tomography (CT) scan of the chest remains the gold standard for diagnosis; however, getting a CT scan of the chest in a critically ill patient can be challenging. The use of thoracic ultrasound has been emerging and is proven to be superior to chest X-ray in making a diagnosis. The possibility of occult pneumothorax in patients with thoracoabdominal blunt trauma should be kept in mind. Patients with pneumothorax in the ICU should be managed with a tube thoracostomy if they are symptomatic or on mechanical ventilation. The current guidelines recommend a small-bore chest tube as the first line management of pneumothorax. In patients with persistent air leak or whose lungs do not re-expand, a thoracic surgery consultation is recommended. In non-surgical candidates, bronchoscopic interventions or autologous blood patch are other options.

• ICU
• Pneumothorax
• barotrauma
• critical care
• mechanical ventilation
• respiratory failure

• Shoulder arthroscopy
• complication
• pneumothorax

Bilateral primary spontaneous pneumothorax (PSP) is a rare case of lung disease.

A 20-year-old man with a complaint of shortness of breath is suspected of having PSP and tuberculosis. The patient underwent water seal drainage installation in both lung cavities, but showed no improvement. Multiple blebs were found after a few days. A wedge resection with VATS became an option. The patient had improved lung function after the procedure.

The WSD installation showed lungs improvement. However, when trained for lung expansion, the lung condition became bad. After wedge resection with the help of VATS on multiple blebs, the lung had a significant improvement.

Wedge resection could be considered in PSP patients with multiple blebs.

•

The prevalence of bilateral primary spontaneous pneumothorax (PSP) is very low, around 1–2%.

• Multiple blebs
• Primary spontaneous pneumothorax
• VATS
• Wedge resection

• Oxygen
• Pneumothorax
• Predictor

• Drainage
• Humans
• Oxygen Saturation
• Pneumothorax/etiology
• Pneumothorax/therapy
• Recurrence
• Retrospective Studies

• EfficientNet-B4
• Medical image segmentation
• Pneumothorax
• ResNet-50
• SE-ResNext-50
• Test-time augmentation
• Transfer learning
• U-Net

• pneumothorax (ptx)
• presentation delay
• risk factors for pneumothorax
• secondary pneumothorax
• trans bronchial biopsy