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Minerva Respiratory Medicine 2022 September;61(3):152-6

DOI: 10.23736/S2784-8477.21.01964-1


language: English

The place of blood patch pleurodesis in the management of inoperable spontaneous pneumothorax

Marouane LAKRANBI 1, 2, Maroua RHAOUTI 1 , Fatima E. LAMOUIME 1, Sani RABIOU 3, 4, Maha TACHAOUINE 1, Yassine OUADNOUNI 1, 2, Mohammed SMAHI 1, 2

1 Department of Thoracic Surgery, University Hospital of Fes, Fes, Morocco; 2 Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fes, Morocco; 3 Niamey General Referral Hospital, Niamey, Niger; 4 Faculty of Medicine, University of Niamey, Niamey, Niger

Spontaneous pneumothorax is the sudden onset of a collapsed lung caused by a collection of air in the pleural space, with no post traumatic or post iatrogenic cause. Autologous blood pleurodesis (ABP) has been used, for decades, for frail elderly patients and who had exhausted alternative options. Through 3 clinical cases, we presented our experience managing inoperable spontaneous pneumothorax using blood patch pleurodesis. The case 1 is represented by a 54-year-old man, presented to the Emergency Department with sudden-onset dyspnea and right-sided chest pain. Chest X-ray and chest CT showed large pneumothorax and emphysematous lung with signs of right inferior lobe condensation and average sized pneumothorax. The case 2 is represented by a 65-year-old man with a history of mitral valve disease and chronic cigarette smoking presented to another hospital with acute dyspnea and right chest pain where the diagnosis of a tension pneumothorax over an emphysematous lung was made. He was then admitted to our structure with dyspnea, and chest examination was in favor of a right pneumothorax. Chest X-ray showed the persistence of the right pneumothorax. The case 3 is represented by a 78-year-old female with no remarkable medical history was admitted to the Emergency Department for acute-onset dyspnea. Chest X-ray revealed a large right hydro-pneumothorax, for which the patient underwent right axillary drainage. The evolution postintervention was marked by the persistence of a basal pleural pocket and prolonged air leak. Pleurodesis, whether chemical or mechanical, has proven to be an excellent method to treat spontaneous pneumothorax as well as persisting air leaks. It showed very promising results with minimal morbidity comparable to those of chemical pleurodesis and has the potential to be the gold-standard in certain clinical scenarios. The favorable outcomes of our three patients, confirm the utility, safety and the low cost of blood patch pleurodesis in patients with secondary spontaneous pneumothorax unfit for surgery.

KEY WORDS: Pneumothorax; Blood patch, epidural; Pleurodesis

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