Rare observation of bilateral pneumothorax at patient with bullous emphysema of the contralateral lung and mediastinal hernia after pneumonectomy: case report

Background. Pneumothorax is the most common surgical complication of bullous emphysema, and extremely rare in patients with a single lung. We present our clinical study of a patient with bilateral pneumothorax and bullous emphysema of the single lung and mediastinal hernia diagnosed 40 years after pneumonectomy.

Methods. A case report of a patient with bilateral pneumothorax is presented. Patient F., 44 years old, was admitted with complaints on thoracic pain syndrome and respiratory failure. In the previous history of the patient there were mentions of surgery on the left lung without documentary clarification. Routine radiography of the lungs made it possible to diagnose bilateral pneumothorax and postoperative changes of the left hemithorax. Further examination, including computed tomography of the chest and fiber-bronchoscopy, revealed that the patient has emphysematous single right lung, mediastinal pulmonary hernia with the formation of a single pleural cavity, bilateral pneumothorax as a complication and consequence of two previous conditions and due to pneumonectomy in the childhood. The patient underwent a re-draining of the pleural cavity with the elimination of pneumothorax and clinical recovery. The patient refused of antirelapse surgery. Subsequently, he was at the dispensary observation.

Results. The most frequent and regular evolution of the residual pleural cavity after pneumonectomy is to fill it with an effusion with subsequent obliteration. The formation of a mediastinal hernia is an extremely rare phenomenon, that has not yet been studied. The tactics of treatment of such patients should be individual, taking into account the revealed changes, the functional state of the respiratory and cardiovascular systems, and the dynamic of the disease.

Conlusions. Our study demonstrated a rare clinical case of mediastinal pulmonary hernia after pneumonectomy and the development of bilateral pneumothorax after the rupture of a single lung bull. Modern image diagnostics make it possible to identify the nature of existing changes and clarify their nature even in the absence of accurate anamnestic data.

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