The
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Trapped Lung B
A
C
*
A
46-year-old woman with end-stage liver disease that was com- Jeffrey Albores, M.D. plicated by recurrent hepatic hydrothorax requiring multiple thoracenteses Tisha Wang, M.D. presented with breathlessness. Chest examination found no breath sounds University of California, Los Angeles on the right side. Radiography of the chest revealed a hydropneumothorax (Panel A; Los Angeles, CA the arrows indicate pneumothorax, and the asterisk hydrothorax). The hydrothorax [email protected] was drained with the use of a pigtail catheter, with persistent pneumothorax (Panel B, arrows). A computed tomographic scan of the chest showed trapped lung (pneumothorax ex vacuo) with thickened visceral pleura and no evidence of endobronchial obstruction (Panel C). Trapped lung is due to fibrous visceral pleural thickening from a chronic inflammatory process that prevents lung reexpansion. The noncompliant lung separates from the parietal pleura, and this space fills with fluid, with resultant hydropneumothorax. Drainage of the pleural fluid leads to pneumothorax ex vacuo because the lung cannot reexpand to fill the chest cavity. Once other causes of pneumothorax ex vacuo, such as endobronchial obstruction, are excluded, the management of trapped lung is surgical, with removal of the fibrosed visceral pleura to allow for the expansion of the underlying lung. In this patient, video-assisted thoracoscopic surgery with decortication and pleurodesis was performed, with complete reexpansion of the right lung.
DOI: 10.1056/NEJMicm1404964 Copyright © 2015 Massachusetts Medical Society.
n engl j med 372;19
nejm.org
May 7, 2015
The New England Journal of Medicine Downloaded from nejm.org on May 8, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
e25
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Trapped Lung B
A
C
*
A
46-year-old woman with end-stage liver disease that was com- Jeffrey Albores, M.D. plicated by recurrent hepatic hydrothorax requiring multiple thoracenteses Tisha Wang, M.D. presented with breathlessness. Chest examination found no breath sounds University of California, Los Angeles on the right side. Radiography of the chest revealed a hydropneumothorax (Panel A; Los Angeles, CA the arrows indicate pneumothorax, and the asterisk hydrothorax). The hydrothorax [email protected] was drained with the use of a pigtail catheter, with persistent pneumothorax (Panel B, arrows). A computed tomographic scan of the chest showed trapped lung (pneumothorax ex vacuo) with thickened visceral pleura and no evidence of endobronchial obstruction (Panel C). Trapped lung is due to fibrous visceral pleural thickening from a chronic inflammatory process that prevents lung reexpansion. The noncompliant lung separates from the parietal pleura, and this space fills with fluid, with resultant hydropneumothorax. Drainage of the pleural fluid leads to pneumothorax ex vacuo because the lung cannot reexpand to fill the chest cavity. Once other causes of pneumothorax ex vacuo, such as endobronchial obstruction, are excluded, the management of trapped lung is surgical, with removal of the fibrosed visceral pleura to allow for the expansion of the underlying lung. In this patient, video-assisted thoracoscopic surgery with decortication and pleurodesis was performed, with complete reexpansion of the right lung.
DOI: 10.1056/NEJMicm1404964 Copyright © 2015 Massachusetts Medical Society.
n engl j med 372;19
nejm.org
May 7, 2015
The New England Journal of Medicine Downloaded from nejm.org on May 8, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
e25
