{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:59:01Z","timestamp":1767797941661,"version":"3.49.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a \u201cbuffalo chest.\u201d Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.<\/jats:p>\n                  <jats:p>We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.<\/jats:p>\n                  <jats:p>Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.<\/jats:p>\n                  <jats:p>Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.<\/jats:p>","DOI":"10.1055\/a-2695-2498","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T23:14:34Z","timestamp":1758150874000},"page":"069-074","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Pneumothorax After Minimally Invasive Repair of Pectus Excavatum: Report of a Rare Life-Threatening Complication"],"prefix":"10.1055","volume":"74","author":[{"given":"Marco","family":"Agamennone","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Science, University of Genoa (DINOGMI), Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Lena","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Science, University of Genoa (DINOGMI), Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Donati","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Science, University of Genoa (DINOGMI), Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Calevo","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Istituto Giannina Gaslini IRCCS, Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Torre","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Science, University of Genoa (DINOGMI), Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0022-3468(98)90314-1","article-title":"A 10-year review of a minimally invasive technique for the correction of pectus excavatum","volume":"33","author":"D Nuss","year":"1998","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1097\/SLA.0b013e3181effdce","article-title":"Twenty-one years of experience with minimally invasive repair of 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Mendogni","year":"2020","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s11748-014-0489-4","article-title":"A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure","volume":"64","author":"S Matsuoka","year":"2016","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1016\/j.athoracsur.2013.12.063","article-title":"Spontaneous bilateral pneumothorax resulting from iatrogenic buffalo chest after the Nuss procedure","volume":"98","author":"K Sakamoto","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1245049","DOI":"10.3389\/fsurg.2023.1245049","article-title":"Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum","volume":"10","author":"J Lee","year":"2023","journal-title":"Front 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Amjadi","year":"2007","journal-title":"Chest"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1159\/000196062","article-title":"Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax","volume":"59","author":"W Mitlehner","year":"1992","journal-title":"Respiration"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0003-4975(10)63520-5","article-title":"Chest dimensions in young adults with spontaneous pneumothorax","volume":"25","author":"R M Peters","year":"1978","journal-title":"Ann Thorac Surg"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1055\/s-0037-1620273","article-title":"Risk of primary spontaneous pneumothorax according to chest configuration","volume":"66","author":"C H Park","year":"2018","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref15","first-page":"3291628","article-title":"Is pectus excavatum a risk factor for spontaneous pneumothorax? \u201cHaller Index measurements in patients with primary spontaneous pneumothorax\u201d","volume":"2019","author":"A K\u0131l\u0131\u00e7g\u00fcn","year":"2019","journal-title":"Can Respir J"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jss.2024.09.050","article-title":"Are adolescents with chest wall deformity potential primary spontaneous pneumothorax patients?","volume":"303","author":"B Ozdemir Ciflik","year":"2024","journal-title":"J Surg Res"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1016\/j.jpedsurg.2020.11.027","article-title":"Complications and trends in minimally invasive repair of pectus excavatum: a large volume, single institution experience","volume":"56","author":"M Torre","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.21037\/jtd-23-957","article-title":"Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification","volume":"16","author":"N Janssen","year":"2024","journal-title":"J Thorac Dis"}],"container-title":["The Thoracic and Cardiovascular 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