2017 Volume 31 Issue 4 Pages 549-553
A 19-year-old man presented at a nearby hospital with right chest pain and dyspnea. He was diagnosed with right spontaneous pneumothorax and treated with pleural drainage. However, the pneumothorax did not improve, and he was transferred to our hospital for surgery. After the induction of anesthesia, we observed 70% oxygen saturation with one-lung ventilation on the left side. We confirmed that the intubation tube had been placed in the proper position, that no bronchial obstruction had been caused by sputum retention, and that there were no abnormal breathing sounds. Therefore, we considered ventilation-perfusion imbalance to be the cause of desaturation, and continued the operation with additional continuous positive pressure ventilation of the right lung. However, oxygen levels did not improve after the operation. Following a detailed examination, we diagnosed him with pulmonary thromboembolism, since the D-dimer level was elevated and CT showed thrombi in the left main pulmonary artery. We treated the patient with anticoagulation therapy and implanted a temporary inferior vena cava filter. Furthermore, antithrombin III deficiency was suspected following an examination for a potential thrombotic predisposition. This case illustrates the need to consider the risk of pulmonary thromboembolism even in younger patients.
