Right-sided pneumothorax in a patient with chronic obstructive pulmonary disease and tuberculosis-affected left lung: a case report

Introduction: A spontaneous pneumothorax occurring in a patient with underlying lung pathology is classified as a secondary spontaneous pneumothorax (SSP). Its main cause is the chronic obstructive pulmonary disease (COPD), more rarely - a tuberculosis infection (TB). Untreated TB could lead to carnification of a part or the whole lung.Case report: A 35-year-old female patient was admitted with complaints of sudden right chest pain and severe dyspnea. The physical examination showed retracted and deformed left chest part, missing breathing sounds in the left and weakened breathing in the right. Chest CT revealed partial right-sided pneumothorax, bullous changes of the right lung and carnification of the whole left lung. Right thoracocentesis was performed. The postoperative period was uneventful. The chest drain was removed on the fifth day. After more detailed examinations the patient was diagnosed with COPD and TB and was transferred to the Department of Pulmonology and Phthisiatry for further treatment.Conclusion: In a patient who has two advanced and complicated lung diseases at the same time (COPD and TB), a spontaneous pneumothorax, even partial, is a life-threatening condition and requires special consideration and urgent therapeutic measures

A primary echinococcosis of the extrahepatic bile ducts: case report

Introducere. Echinococoza continuă sa fie endemică în Bulgaria. Cea mai frecventă formă este cea hepatică. Prezentare de caz. Noi raportăm un caz rar de echinococoză primară a căilor biliare extrahepatice la o pacientă de 70 de ani, cu anamnestic de febră înaltă, icter, greaţă, vomă și durere în etajul superior al abdomenului, pe parcursul a 10 zile. A fost descoperit un chist hidatic complicat, de dimensiuni mari, în lobul stâng al ficatului, fără comunicare cu arborele biliar. S-a efectuat explorarea căilor biliare, capitonarea chistului hepatic, colecistectomie și coledoco-duodenostomie. Nu a fost înregistrată nicio complicaţie. Discuţii. Echinococoza primară a căilor extrahepatice este foarte rară. Cazul nostru este al doilea, descris în Bulgaria. Tratamentul patologiei depinde de stadiu, localizare, dimensiune și de complicaţiile chistului. Concluzii. Tratamentul chirurgical și terapia postoperatorie cu albendazol rămân a fi cele mai bune opţiuni terapeutice.Introduction. Echinococcosis is still endemic in Bulgaria. The most common site of the hydatid cysts is the liver. Case presentation. We report on a rare case of a primary echinococcosis of the extrahepatic bile ducts in a 70 years old female patient with history of high fever, jaundice, nausea, vomiting and pain in the upper abdomen lasting for 10 days. We found a big complicated hydatid cyst in the left liver lobe without communication with the bile tree. Exploration of the bile ducts, capitonnage of the liver cyst, cholecystectomy and choledocho-duodenostomy were performed. We didn’t have any complications. Discussion. A primary echinococcosis of the extrahepatic bile ducts is very rare. Our case was the second of the kind described in Bulgaria. The treatment of the disease depends on the stage, the localization, the size and the complications of the cysts. Conclusions. Surgical treatment and postoperative therapy with albendazole remain the best treatment options

Conventional and digital pleural drainage systems – advantages and disadvantages

Introduction: Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers. Aim: The objective of this study was to compare the two types of pleural drainage mechanisms, conventional and digital, in terms of duration of pleural drainage in days, financial cost, and postoperative air leak duration. Materials and methods: The study focused on 80 patients who underwent various thoracic surgical interventions in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv. They were divided into two groups: group 1 consisted of 42 patients who were postoperatively attached to a conventional non-mobile pleural drainage system, and group 2 consisted of 38 patients in whom a mobile digital pleural drainage system was used. The main analyzed data were duration of pleural drainage, duration of postoperative air leak, hospital stay, and financial costs. Results: The average duration of pleural drainage, regardless of surgery and type of drainage system applied was 4.86±0.8 days. The average duration of pleural drainage in patients attached to the mobile digital drainage system was shorter than that in patients with a conventional pleural non-mobile drainage system, regardless of the type of surgery done. This difference was statistically significant in favor of the digital pleural drainage system. The study also found a statistically significant difference in terms of financial costs in favor of digital draining system. The average cost of a hospital stay for patients attached to a mobile digital drainage system was BGN 119.40±7.15, whereas the average cost of a hospital stay for patients connected to a traditional pleural drainage system (PDS) was BGN 159±10.50. Regarding the duration of postoperative air leak, the difference between the types of pleural drainage mechanism used was not convincing. Conclusions: Digital pleural drainage systems provide clinicians with an opportunity to assess the postoperative air leak more precisely, track its dynamics, shorten hospital stays, reduce postoperative costs, and optimize the time to remove the chest drain. Based on these features, they will undoubtedly continue to enter everyday surgical practice

Surgical treatment of pneumothorax in patients with COVID-19 – results and management

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate.Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome.Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021.Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice.Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients