A Case of Bilateral Pneumothorax that Occurred during Tracheotomy Performed for a Huge Polypoid Vocal Cord

Abstract

Pneumothorax may occasionally occur because of damage to the pulmonary apex during urgent tracheotomy. The reported frequency of unilateral pneumothorax after tracheotomy is 0.92–1.4%, while that of bilateral pneumothorax is much lower, at 0.4%.

Herein, we report a case of bilateral pneumothorax that occurred during tracheotomy performed for a huge polypoid vocal cord.

Respiratory tract obstruction occurred during the urgent tracheostomy, necessitating provision of breathing assistance. This led to the development of extreme negative pressure in the thoracic cavity and caused the alveolar and mediastinal pleurae to be sucked into the thoracic cavity, resulting in pneumothorax. A respiratory surgeon promptly performed tube thoracostomy on both sides, and the patient’s breathing improved.

Postoperative chest radiography helped in early diagnosis of the pneumothorax. The patient underwent laryngeal microsurgery for bilateral polypoid vocal cord resection under general anesthesia, with bilateral tube thoracostomy.

Histopathology revealed an inflammatory lesion arising from the right vocal cord, with no evidence of malignancy.

When a patient develops symptoms such as pain, dyspnea, decrease in oxygen saturation on pulse oxymetry, or tachycardia after tracheotomy, bilateral pneumothorax should be considered, and chest radiography should be performed for definitive diagnosis.

When pneumothorax occurs, it is necessary to take quick measures, such as drainage of the air by tube thoracostomy.