Heimlich Valve as an Ambulation Management of Persistent Pneumothorax on Patient with Pulmonary Tuberculosis: A Case Report and Literature Review

Document Type : Case Report

Authors

1 Department Pulmonology and Respiratory Medicine, Faculty of Medicine Lambung Mangkurat University Member of Indonesia Respiratory Society

2 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Lambung Mangkurat University/Ulin General Hospital, Banjarmasin, South Kalimantan, Indonesia

3 Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, South Kalimantan, Indonesia

Abstract

Tuberculosis (TB) is still a major medical and social problem with high morbidity and mortality, especially in developing countries like Indonesia. Tuberculosis lesions are mainly localized in the lungs, but other organs can also be affected. Secondary spontaneous pneumothorax (SSP) is one of the important complications of pulmonary TB. Insertion of chest drain is recommended treatment in most SSP cases. In complicated and persistent pneumothorax, the Heimlich valve can be considered. A Heimlich valve may be old-fashioned, but this one-way valve is quite effective and allows air evacuation from the thoracic cavity with minimal risk. A 53 years old man was admitted due to shortness of breath associated with left-sided chest pain. The patient revealed previous TB treatment four years ago. Physical examination found vesicular breath sounds diminished with hyper resonance to percussion on the left, wheezing on the right, and SaO2 92% room air. Chest x-ray found left-sided pneumothorax and fibrosis at the apex of the right lung. Urgent drainage was performed, and an X-ray examination of aeration of the collapsed lung was observed. However, an evaluation showed persistence of pneumothorax despite being in a chest tube for 19 days, and consequently, prolonged drainage was needed. Due to a lack of resource-limited settings, we started treating pneumothorax with a Heimlich valve to prevent prolonged hospitalization. After two months, the chest tube with the Heimlich valve was successfully removed. To summarize, the Heimlich valve is an inexpensive and good alternative for treating persistent pneumothorax for ambulatory management.

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