A case of simultaneous bilateral pneumothorax after thymic tumor surgery

Abstract

This case involved a man in his 60s. He presented to our hospital with a complaint of sudden-onset dyspnea. He received a diagnosis of right-severe and left-moderate simultaneous bilateral pneumothorax based on a chest radiograph. Thoracoscopic extended thymectomy had been performed for a thymic carcinoid tumor 9 years prior to the patient's arrival at our hospital, and bilateral lung dilation was noted with only drainage of the right thoracic cavity; thus, a pleural window communicating between both pleural cavities was suspected. On the eighth day after admission, thoracoscopic partial resection of both lungs and pleural coverings was performed, and simultaneously, closure of the pleural window was conducted. A 4-cm-long pleural window was detected at the anterior mediastinum, which we covered with polyglycolic acid (PGA) sheets and fibrin glue.

Although pleuro-pleural communication is a rare condition, we should consider its possibility in patients with a history of mediastinal surgery, and it is useful to check whether unilateral thoracic drainage can improve bilateral pneumothorax if the respiratory status is not emergent. Surgery should be considered to prevent the recurrence of pneumothorax, and closure of the pleural window should also be considered in addition to bullectomy and pleural covering. The method and effect of such a surgery should be studied in the future.