Two Cases of Contralateral Pneumothorax during Lung Resection

Abstract

We have experienced two cases of contralateral pneumothorax during one-lung ventilation at pulmonary lobectomy. Case 1. An 82-year-old man developed hypoxemia during left upper lobectomy, triggered by a sealing test. Despite bronchoscopy performed to check the location of a tube and to aspirate sputum, no improvement was gained. A portable chest X-ray scan was performed, and right tension pneumothorax was observed and then improved with the insertion of a drain. Case 2. A 69-year-old man had prolonged hypoxia during left lower lobectomy, but the cause could not be identified. Postoperative portable chest X-ray showed right pneumothorax, and hypoxia was improved by insertion of a drain. We often encounter hypoxemia during surgery using a double-lumen tube. It can occur due to tube malposition, displacement, or tube occlusion from sputum secretion in many cases. Intraoperative contralateral pneumothorax is rare, but delayed diagnosis can be fatal. When intraoperative hypoxemia is observed without improvement by normal means, it is important to suspect contralateral pneumothorax first and respond promptly.