Late-onset occult pneumothorax after lung volume-reduction surgery

BACKGROUND: Lung volume-reduction surgery has proved to be a reliable palliative surgical treatment for patients with severe emphysema. Nonetheless, late complications can arise after lung volume-reduction surgery although this matter has been poorly investigated by previous studies. METHODS: We report a series of 6 patients undergoing unilateral lung volume-reduction surgery at our institution between October 1995 and December 2004, who were readmitted several months after discharge because of the occurrence of occult pneumothorax mimicking acute respiratory failure. RESULTS: Occult pneumothorax occurred in 3.3% of the 182 patients treated with lung volume-reduction surgery at our institution. Patients were readmitted after a mean of 94 days (range, 20 to 700 days) from the discharge. Chest roentgenography was unable to detect the occurrence of pneumothorax, which was instead revealed by means of a computed tomographic scan in all patients. The interval between admission and correct diagnosis averaged 22.4 hours. The number of air collections ranged between two and four. Treatment entailed solely blind chest drainage placement in 2 patients and awake video-assisted thoracoscopic surgery in the others, including placement of chest tube under direct vision in 1 patient, repair of lung tears by means of cyanoacrylate glue in 2 and bovine pericardium patch plus cyanoacrylate glue apposition in 1 patient. CONCLUSIONS: In conclusion, we believe that occult pneumothorax should be kept in mind as one of the possible late complications of lung volume-reduction surgery and should be suspected whenever sudden worsening of dyspnea is noticed even in the presence of an uneventful chest roentgenogram. Awake video-assisted thoracoscopic surgery management can represent an effective option in these instances