Previous article Table of Contents  Next article

LETTER TO EDITOR
Year : 2014  |  Volume : 8  |  Issue : 5  |  Page : 124-125

Pneumothorax following flexible fiberoptic bronchoscopy: A rare occurrence


1 Department of Anesthesia and Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India
2 Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Sukhen Samanta
17 Dr. A N Paul Lane, Bally, Howrah - 711 201, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.144105

Rights and Permissions
Date of Web Publication6-Nov-2014
 


How to cite this article:
Soni KD, Samanta S, Aggarwal R, Samanta S. Pneumothorax following flexible fiberoptic bronchoscopy: A rare occurrence. Saudi J Anaesth 2014;8, Suppl S1:124-5

How to cite this URL:
Soni KD, Samanta S, Aggarwal R, Samanta S. Pneumothorax following flexible fiberoptic bronchoscopy: A rare occurrence. Saudi J Anaesth [serial online] 2014 [cited 2022 Aug 10];8, Suppl S1:124-5. Available from: https://www.saudija.org/text.asp?2014/8/5/124/144105

Sir,

Pneumothorax following flexible fibreoptic bronhoscopy is rare. It occurs 1 in 450 bronchoscopy. [1] We report a case of such event in a trauma victim. A 34-year-old male patient with alleged history of road traffic accident admitted in our trauma center. On initial examination, his airway was patent, he was breathing at the rate of 22 breaths/min with air entry diminished over the right lung. Initial hemodynamics were stable with heart rate of 96 beats/min and blood pressure of 126/88 mmHg. Contrast-enhanced computed tomography scan chest revealed the fracture of 1 st , 2 nd , 3 rd , and 7 th ribs on the right side with hemopneumothorax and multifocal contusions in all lobes of the right lung. A right-sided intercostal tube drain (ICD) was placed. Pneumothorax and hemothorax resolved subsequently. He was shifted to the general ward. After 4 days of admission, patient developed acute respiratory distress with fall in oxygen saturation (90%) and was transferred to trauma intensive care unit (ICU). On initial evaluation, his chest X-ray showed [Figure 1] right lung collapsed with mediastinal shift toward the right side. A flexible bronchoscopy was contemplated in view of provisional diagnosis of mucus plug obstructing the major airways. A flexible bronchoscopy was carried out and a large mucus plug was aspirated from the right bronchus thereby clearing the airway. The patient was kept on positive pressure ventilation after the procedure. Immediately following the flexible bronchoscopy a large air leak became apparent in right-sided ICD. A follow-up chest X-ray showed a new large pneumothorax and collapse whole lung [Figure 2]. Ventilatory settings were adjusted to minimize the leak and the ICD was connected to negative pressure of 15 mmHg. A second ICD was inserted in order to control the leak and expand the lung. After 2 days, air leak controlled and lung got expanded. Patient was shifted to high dependency unit for further care.
Figure 1: Chest X-ray showed collapsed right lung with mediastinal shift toward the right side

Click here to view
Figure 2: Chest X-ray demonstrated a new large pneumothorax and collapse of whole the right lung

Click here to view


Flexible fiberoptic bronchoscopy is a safe procedure carried out in patients admitted to ICUs. Its indication varies between diagnostic to therapeutic interventions including regular bronchoalveolar lavage for microbiological sampling, diagnosis of pulmonary hemorrhage, use in cases of difficult intubation, as a control in percutaneous tracheostomies, and aspirations of secretions. [2] Its use in clearing the airway because of mucus plug is considered as a standard practice particularly in patients where physiotherapy has failed to do so. However, its complications are infrequent. Most frequent complications cited in the literature are supraventricular tachycardia (3.8%), transient hypoxemia (6.7%), and slight bleeding of the bronchial mucosal membrane (2.4%). [2] Pneumothorax following flexible bronchoscopy has been reported infrequently in literature. Pue et al. have reported pneumothorax following flexible bronchoscopy in 0.16% of cases. Predominantly, it followed transbronchial biopsy procedure. [3] de Blic et al. analyzed prospectively in 1328 flexible bronchoscopy procedures in children and noted 0.1% incidence of pneumothorax. [4] In both the above analysis, none has reported pneumothorax following aspiration of secretion or mucus plug in case of chest injury following trauma. Moreover, flexible fiberoptic bronchoscopy was used here as a diagnostic modality to identify the cause of persistent pneumothorax and bronchial injuries. Mechanism that might have led to pneumothorax in our patient can be attributed to initial lung injury. Probably, the mucus plug had sealed the existent bronchial rent underlying lacerated lung and corrected the initial hemopneumothorax. As soon as the mucus plug got aspirated during flexible bronchoscopy the lung laceration got expose to high airway pressures and caused escaping of air into the pleural cavity. To conclude, although flexible bronchoscopy is a safe procedure, it mandates close monitoring during and after the procedure. It is important to have a high index of suspicion and a follow-up chest X-ray to identify a potentially dangerous complication.

 
  References Top

1.
Casal RF, Ost DE, Eapen GA. Flexible bronchoscopy. Clin Chest Med 2013;34:341-52.  Back to cited text no. 1
    
2.
Estella A. Analysis of 208 flexible bronchoscopies performed in an intensive care unit. Med Intensiva 2012;36:396-401.  Back to cited text no. 2
[PUBMED]    
3.
Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest 1995;107:430-2.  Back to cited text no. 3
    
4.
de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: Prospective study of 1,328 procedures. Eur Respir J 2002;20:1271-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References
   Article Figures

 Article Access Statistics
    Viewed2014    
    Printed31    
    Emailed0    
    PDF Downloaded129    
    Comments [Add]    

Recommend this journal