Recurrent pneumothorax following abdominal paracentesis

Our plain-English summary of Recurrent pneumothorax following abdominal paracentesis, by P.J. Stafford (Postgraduate Medical Journal, 1990).

The study

• Author: P.J. Stafford
• Journal: Postgraduate Medical Journal
• Published: 1990;66(774):319-20
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax. This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease.

In plain English

This article was a case report about one patient. A 62-year-old man developed fluid in the abdomen (ascites) caused by peritoneal mesothelioma of the epithelioid type, diagnosed from tissue taken at laparoscopy. He had chronic obstructive airways disease and had earlier had the upper lobe of his right lung removed for tuberculosis. The report stated he had no history of exposure to asbestos, although his chest X-ray showed a small pleural plaque on the right diaphragm. Within 48 hours of having abdominal fluid drained (paracentesis), he developed a collapsed left lung (pneumothorax). It kept recurring and was treated with tetracycline to seal the space around the lung. When fluid was drained again one month later, a left pneumothorax occurred within 72 hours. A second tetracycline treatment failed, so talc was used. No further pneumothoraces occurred despite two more drainages. The author suggested that draining may let the diaphragm move more and tear an adhesion or air blister. The author concluded this complication should be considered, especially in patients with existing lung disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of a single patient
• Who was studied: One 62-year-old man, a civil servant, treated at Newham General Hospital, London, with chronic obstructive airways disease, ischaemic heart disease and a past right upper lobectomy for tuberculosis
• Exposure: No asbestos exposure was reported. A small right diaphragmatic pleural plaque was seen on chest X-ray. The exposure studied was abdominal paracentesis (drainage of ascites).
• Main results:
  • The patient was diagnosed with malignant mesothelioma of the epithelioid type, from peritoneal lesions seen at laparoscopy
  • The chest X-ray showed a small right diaphragmatic pleural plaque and no pleural effusions
  • A left pneumothorax developed within 48 hours of the first paracentesis, in which about 4 litres of fluid were drained over 72 hours
  • Paracentesis was repeated one month later and was again followed by a left pneumothorax, this time within 72 hours
  • After talc pleurodesis, no further pneumothoraces occurred despite 2 more paracenteses
• The authors' conclusion: The author proposed that paracentesis may cause pneumothorax by increasing movement of previously splinted diaphragms, raising the chance that a diaphragmatic adhesion or bulla ruptures. The author concluded that this complication should be considered when paracentesis is performed, especially in patients with preexisting pulmonary disease.
• Limitations the authors state:
  • The author noted that no intrapulmonary tumour or pleural spread of mesothelioma was seen on X-ray, but that spontaneous pneumothorax may occur before such spread becomes visible on chest X-ray

Topics

Medical terms in this study, explained in our Lexicon: Pneumothorax, paracentesis, Ascites, Pleural Effusion, Peritoneal Mesothelioma.

Related studies

• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Recurrent pneumothorax: an unusual presentation of malignant mesothelioma — S.I. Handa, A.G. Wilkinson (1989)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps — R. Thomas, N.M. Rahman, et al. (2020)
• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• Surgically treated pneumothorax. Radiologic and pathologic findings — K.G. Jordan, J.S. Kwong, et al. (1997)

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