UNASSIGNED: An 11-year-old male neutered cat was referred to The Ohio State University\'s Veterinary Teaching Hospital after being diagnosed with pleural effusion by a referral veterinarian. After thoracocentesis, analysis of the effusion was consistent with chyle. Echocardiography, radiographs and bloodwork were used to diagnose hypertrophic cardiomyopathy phenotype and left-sided congestive heart failure, suspected to be secondary to uncontrolled hyperthyroidism. While initiating medical therapy, repeated thoracocenteses were required. A severe pneumothorax developed, necessitating placement of bilateral thoracostomy tubes. A thoracic CT scan did not reveal a cause for the pneumothorax; therefore, it was suspected to have occurred secondarily to an iatrogenic laceration of the parenchyma during thoracocentesis. An autologous blood patch pleurodesis was considered contraindicated so instead the cat was administered a blood patch using blood from a canine blood donor. The cat\'s respiratory status remained stable without additional intervention. At 30 h after blood patch pleurodesis, the thoracostomy tubes were removed and thoracic radiographs revealed near resolution of the pleural effusion and pneumothorax. The cat remained subclinical and was discharged from the hospital 48 h after the blood patch pleurodesis. Upon follow-up at 4 and 8 weeks after discharge, the cat was alive and had no complications or adverse reactions from the blood patch pleurodesis.
UNASSIGNED: This case documents the first report of a xeno-blood patch pleurodesis performed in a cat using blood from a canine donor. The cat had a successful discharge from the hospital with no adverse reactions from the xeno-blood patch pleurodesis.

Horner\'s syndrome is a rare condition that results when there is an interruption of the sympathetic fibers that run from the stellate ganglion to the eye. The classic triad of Horner\'s syndrome includes unilateral ptosis, miosis, and anhidrosis. Spontaneous pneumothorax is a rare condition that occurs when there is a sudden collapsed lung without any direct cause. A few cases have been reported of spontaneous pneumothorax associated with iatrogenic Horner\'s syndrome. A chest thoracostomy is a procedure that can lead to iatrogenic Horner\'s syndrome. Here, we present the case of a 25-year-old male with a left-sided spontaneous pneumothorax complicated by iatrogenic Horner\'s syndrome secondary to chest thoracostomy.

Subcutaneous emphysema is a type of air leak in which air accumulates within the subcutaneous layer of the skin underneath the dermal layers. The accumulation of air can be seen on imaging in relevant body areas such as the abdomen, chest, face, or neck. During physical examination, crepitus, the sensation or sound of crackling upon palpation, is the most common associated finding. Various causes for subcutaneous emphysema exist, with one such cause being thoracostomy or chest tube placement. The trocar technique, in particular, has been associated with greater complications when compared to other techniques. Here, we present a case of subcutaneous emphysema in a neonate occurring after placement of a chest tube using the trocar technique. At this time, much of the knowledge regarding subcutaneous emphysema related to chest tube placement is in the adult population. Clinicians should be aware of this complication in neonates as the body of knowledge regarding this topic continues to grow.

Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.

Stress cardiomyopathy (SCM) is a clinical phenomenon presenting symptoms suggestive of acute coronary syndrome and defined by acute, but transient, electrocardiogram (ECG) changes and left ventricular wall motion abnormalities. However, no obstructive coronary lesion is identified on catheterization, and pathognomic echocardiogram findings are typically encountered. Multiple causes have been posited in the literature (e.g., severe stress, anxiety, pain, comorbid illness, trauma). We present the case of a 46-year-old female who presented to the emergency department (ED) for delayed left-sided hemothorax (six weeks following a high-speed motor vehicle collision) and developed an acute SCM following large-bore chest tube placement. To our knowledge, no prior cases have been reported immediately following thoracostomy tube placement and hemothorax drainage in the ED setting. We explore possible mechanistic explanations related to our case, which adds to the existing literature on the subject.

BACKGROUND: This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature.
METHODS: The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study.
RESULTS: The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months.
CONCLUSIONS:  Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.

A 34-year-old female smoker, with a history of pelvic endometriosis, presented with initial symptoms of shortness of breath and a choking sensation. She was found to have a right pneumothorax on chest x-ray. Over the next eight months, she ultimately underwent three tube thoracostomies, two video-assisted thoracoscopic surgeries (VATS), wedge resection, and repeated pleurodesis due to pneumothorax recurrence. She was seen multiple times post-surgically with the focus of treatment being smoking cessation rather than contraceptive therapy, despite an early follow-up visit noting that the initial symptoms coincided with her menstruation. The purpose of this article is to bring attention to this rarely diagnosed condition. With added awareness and understanding of the underlying causes and available treatments, medical providers could likely spare many women from similar experiences and dramatically improve the quality of their lives.

The COVID-19 pandemic has impacted every aspect of our lives since its start in December 2019. Among various COVID-19 complications, pleural complications are also increasingly reported but rarely from Nepal. Here, we presented a case of pyopneumothorax in a 52-year-old male patient referred from another center and admitted to the ICU of Nepal Armed Police Force Hospital with a diagnosis of severe COVID-19 pneumonia in the background of alcohol withdrawal syndrome with delirium tremens and generalized tonic-clonic seizures. He developed a rapid decline in respiratory status with a right-sided pneumothorax and underwent an immediate needle thoracostomy, followed by chest tube insertion. On the sixth day of admission, he had thick yellowish pus in the chest drain (pyopneumothorax), and despite the rigorous efforts in treatment, he died on the 15th day of admission. Though relatively uncommon, clinicians should consider pleural complications like pneumothorax, pleural effusion, pneumomediastinum, and empyema in patients with impaired immune status. In such patients, we should ensure prompt diagnosis with the earliest intervention and rationale use of antibiotics.

The following case discusses the atypical presentation of a spontaneous esophageal rupture that presented as acute hypoxic respiratory failure in the emergency department. The patient initially arrived by ambulance with a chief complaint of non-radiating chest pain for approximately one hour. Within minutes after arrival, the patient became hypoxic and bradycardic, requiring supplemental oxygen. A computed tomography (CT) angiogram of the chest showed a pneumothorax, pneumomediastinum, and left lower lobe consolidations concerning for pneumonia. The patient was resuscitated in the emergency department, and a chest tube thoracostomy was performed. Upon admission to the hospital, an esophagogram with contrast showed an esophageal leak at the gastroesophageal junction with the contrast extending into the left pleural space which required surgical intervention. This case highlights the complicated nature and variable presentations of Boerhaave syndrome and the importance of stabilizing the airway, breathing, and circulation in a decompensating patient even when the etiology is not clear at the time of presentation.

Chest tubes are placed in the pleural space to evacuate abnormal fluid or air accumulations. Various types and sizes of chest tubes are available. Imaging including ultrasound, computed tomography, and fluoroscopy should be used to guide chest tube placement. Understanding the anatomy of the pleural space, along with the etiology and classification of pleural space disease, can help optimize chest tube management. This article will review the indications, contraindications, techniques, and postprocedure follow-up of chest tube placement as well as discuss the management and prevention of complications.