Acute respiratory distress syndrome (ARDS) after talc pleurodesis in a patient with intractable pneumothorax

Abstract

A 64-year-old male patient with a history of pulmonary emphysema and aspergillosis was admitted to our hospital because of right pneumothorax. Although we performed chest drainage, air leakage did not improve. We performed surgery and found air leakage caused by a bulla in S6. Bullectomy was contraindicated due to severe emphysema and adhesion, so we placed a tissue-healing sheet over the lesions and performed pleurodesis using 4 g of sterile talc. On the 5th day after surgery, his respiratory condition worsened and bilateral interstitial shadows were found on CT. Because he was diagnosed with acute respiratory distress syndrome, we administered corticosteroids, oxygen, and antibiotics. Despite these treatments, his condition did not improve and he died on the 15th day after surgery. In addition to talc, several factors (i.e., history of pulmonary aspergillosis, emphysema, general anesthesia, and surgery) may contribute to the progression of ARDS. We should pay close attention when performing talc pleurodesis for patients with any respiratory diseases or a poor general condition.