2019 Volume 41 Issue 5 Pages 497-500
Background. It is difficult to choose an appropriate treatment for patients with high-risk pneumothorax for whom general anesthesia is considered intolerable. Case. An 82-year-old man, who recovered from a shock state due to ruptured hepatocellular carcinoma (HCC) without interventional radiology (IVR) or surgery, was transferred to our hospital with a complaint of dyspnea, three weeks after recovery from rupture. Chest X-ray showed moderate left-sided pneumothorax. A chest tube was inserted into the left pleural cavity. Air leakage continued for two weeks. We performed video-assisted thoracoscopic surgery (VATS) under local anesthesia because of his general condition. At surgery with two thoracic ports, the site of air leakage was found at the left basal segment and was covered with a polyglycolic acid (PGA) sheet after loop-ligation. The postoperative course was uneventful. The patient was discharged and died of HCC 6 weeks later. Conclusion. A patient with high-risk pneumothorax and end stage of HCC was successfully treated by VATS under local anesthesia.
