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a Division of Thoracic Surgery, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
b Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
c Greater Pittsburgh Neurosurgical Associates, Hillman Cancer Center, Pittsburgh, Pennsylvania
Accepted for publication September 2, 2008.
* Address correspondence to Dr Schuchert, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Shadyside Medical Building, Suite 715, 5200 Centre Ave, Pittsburgh, PA 15232 (Email: schuchertmj{at}upmc.edu).
Pneumocephalus after resection of intrathoracic tumors is an extremely rare event. A delayed presentation of iatrogenic subarachnoid pleural fistula resulted in symptomatic pneumocephalus after resection of a locally recurrent T4N0 nonsmall cell lung cancer involving the chest wall, T2 to T4 rib heads, and intercostal vertebral foramina. Progressive neurologic decline was noted 3 weeks after discharge. Computed tomography of the head and chest confirmed the presence of an apical pleural space, thoracic subarachnoid air, and pneumocephalus. Immediate clinical improvement followed chest tube decompression of the pleural space.
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