title: [Intractable pneumothorax successfully treated by talc slurry pleurodesis and video-assisted thoracoscopic surgery in a patient with idiopathic pulmonary fibrosis].
abstract: Pneumothorax associated with idiopathic pulmonary fibrosis (IPF) is intractable and often fatal because the patients are usually under a long-term steroid therapy, and are associated with severely impaired lung function. Further, pneumothorax itself recurs frequently, and acute exacerbation of IPF may develop after a surgical intervention. Here, we describe a case of intractable pneumothorax developed in a patient with IPF who was successfully treated with repeated talc pleurodesis combined with video-assisted thoracoscopic surgery under local anesthesia. A 67-year-old male with IPF who was under a long-term treatment with steroid, developed right-sided pneumothorax. A chest drainage tube was placed in the right pleural cavity, and repeated pleurodesis with minocycline or fibrinogen was challenged, but the outcome turned out to be unsuccessful. Then, talc slurry was applied repeatedly, resulting in a high-grade fever associated with reactive accumulation of pleural effusion. However, air leakage did not cease completely despite the eight-times pleurodesis with talc using 16 g in total. Finally, video-assisted thoracoscopic surgery under local anesthesia was undertaken and the pulmonary fistula was successfully closed.
authors.affiliation: Department of Respiratory Medicine, Toranomon Hospital.
authors.forename: Emiko
authors.initials: E
authors.lastname: Kusano
authors.forename: Sakae
authors.initials: S
authors.lastname: Homma
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohtsu
authors.forename: Susumu
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Masateru
authors.initials: M
authors.lastname: Kawabata
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
authors.forename: Eiyasu
authors.initials: E
authors.lastname: Tsuboi
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshimura
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D006801:Humans; D008297:Male; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy*; D011658:Pulmonary Fibrosis / Q000150:complications*; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
chemical_list: D013627:Talc