A case of repetitive pneumothorax involving an adult patient caused by a wire implanted in surgery during infancy

Abstract

A 20-year-old man presented with left pneumothorax. The pneumothorax was healed by thoracic drainage and he was discharged, but the disease soon relapsed. He had undergone thymectomy for a mature teratoma when he was 6 months old, and had an episode of left pneumothorax when he was 18 years old. Chest CT showed the left pneumothorax and metallic wires which immobilized the disected ribs. The wires on the fourth and fifth ribs were broken, and the fifth one had become embedded in the upper lobe of the left lung. We suspected the cause of repetitive pneumothorax to be the broken wire, and an operation was performed via VATS. Through the superior lingular segment, which joins with the chest wall, the head of the wire could be observed below the interlobar visceral pleura. The wire and a sharp bone chip projected from the fifth rib to the superior lingular segment. The wire and bone chip were removed, and the pulmonary fistula was repaired by fibrin adhesive. Wires that are used to immobilize fractured ribs can break and damage the neighboring organ, and so extra attention is needed.