Contralateral tension pneumothorax during video-assisted thoracic surgery for lung cancer in a patient with obesity and

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Contralateral tension pneumothorax during video‑assisted thoracic surgery for lung cancer in a patient with obesity and rib fractures: a case report and review of the literature Sakiko Kumata1,2*  , Katsunari Matsuoka2, Shinjiro Nagai2, Mitsuhiro Ueda2, Yoshinori Okada1 and Yoshihiro Miyamoto2

Abstract  Background:  Intraoperative contralateral pneumothorax during one-lung ventilation is a rare but life-threatening complication. Although the exact incidence is unknown, only 14 cases with this complication have been reported until now. Case presentation:  A 67-year-old Japanese man with a weight of 80 kg, height of 162.2 cm, and body mass index of 30.4 kg/m2 underwent three-port video-assisted thoracic surgery for lung cancer with one-lung ventilation. He had suffered from traumatic right rib fractures 6 weeks before the referral. Fifteen minutes before the end of the surgery, the systolic blood pressure suddenly dropped to about 50 mmHg, which was immediately recovered by intravenous injection of phenylephrine. This episode occurred during chest closure after the completion of the left upper lobectomy, and one-lung ventilation was soon switched to two-lung ventilation. Contralateral tension pneumothorax was noted by the postoperative chest x-ray. As the patient was complicated with obesity and a past history of rib fractures, increased airway pressure during one-lung ventilation related to obesity together with the persistent compression of the visceral pleura by the fractured ends of the ribs was considered to be the factors responsible for this critical complication. Conclusions:  Patient backgrounds such as obesity and past history of rib fractures should be noted carefully as risk factors for intraoperative contralateral pneumothorax during one-lung ventilation. We present the clinical course and discuss the mechanism of development of this potentially life-threatening complication in the present case with a review of the literature. Keywords:  Tension pneumothorax, Contralateral pneumothorax, One-lung ventilation, Lung cancer, Video-assisted thoracic surgery

*Correspondence: [email protected] 1 Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4‑1 Seiryomachi, Aobaku, Sendai 980‑8575, Japan Full list of author information is available at the end of the article

Background Pneumothorax during general anesthesia is a rare event that occurs in only 0.0012% of patients in Japan [1]. Intraoperative contralateral pneumothorax during one-lung ventilation (OLV) appears to be even more rare with only 14 cases reported until now. Furthermore, among these

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