Ann Thorac Surg 2009;88:e68. doi:10.1016/j.athoracsur.2009.09.035
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Spontaneous Bilateral Pneumothorax in Patient With Previous Thoracoscopic Pleurodesis for Right Recurrent Pneumothorax
Luca Bertolaccini, MD, PhDa,*,
Paraskevas Lybéris, MDa,
Emilpaolo Manno, MD, PhDb,
Ferdinando Massaglia, MDa
a Division of General Thoracic Surgery, Maria Vittoria Hospital, Turin, Italy
b Division of Anesthesiology, Maria Vittoria Hospital, Turin, Italy
* Address correspondence to Dr Bertolaccini, Division of Thoracic Surgery, S. Croce Hospital, Via Michele Coppino 26, Cuneo, 12100, Italy (Email: luca.bertolaccini{at}unito.it).
A 34-year-old man presented to the emergency department with sudden onset of severe breathlessness. The patient had undergone video-assisted thoracoscopic pleurodesis for right recurrent pneumothorax 8 years earlier. At the initial examination, he was extremely agitated, cyanotic, and tachypneic. Although he was maintaining his own airway and his trachea was central, air entry was poor into both sides of his chest. Both hemithoraces were resonant to percussion, and scattered crackles were audible on auscultation throughout both lung fields.
Chest roentgenogram showed bilateral pneumothoraces. The left lung was collapsed to the hilar structures; on the right side, the lung showed a massive lateral collapse and the apex was hold by adherences derived from the previous pleurodesis. The trachea was in the midline (Fig 1). After insertion of bilateral 28F chest tubes, the lungs showed immediate reexpansion in both sides, and breathlessness quickly resolved (Fig 2).
This case demonstrates the importance of urgent chest roentgenogram in the emergency department for all patients in respiratory distress, and we would encourage thoracic surgeons to be quite vigorous with mechanical pleurodesis.
