Anterior approach for pleuropnemonectomy and thoracoplasty in a patient with chronic expanding hematoma: a case report

Abstract

The patient was a 79-year-old woman who underwent artificial pneumothorax for pulmonary tuberculosis 62 years ago. She experienced dyspnea at rest from 3 months ago and needed artificial ventilation due to CO₂ narcosis. Chest CT revealed a huge heterogeneous mass growing from the left thoracic cavity and expanding to the retroperitoneum, compressing the heart and right lung. Under a clinical diagnosis of chronic expanding hematoma of the thorax (CEH), the patient underwent pleuropneumonectomy and the resection of 9 rib seqments through supine position and L-shaped anterior approach, Then, thoracoplasty was completed with musculocutaneous flap to fill and cover residual space. The hematoma measured 25 cm and weighed 2300 g. It is suggested that anterior approach in the supine position is suitable for extrapleural pneumonectomy against CEH.