Secondary pneumothoraxes following thoracentesis for malignant pleural effusions: A two-case report of ex vacuo pneumothorax

• Published in: Nihon Kokyuki Geka Gakkai zasshi (Kyoto, 1992) Vol. 36; no. 5; pp. 575 - 579
• Main Authors: Nakazawa, Junji, Niizeki, Hiroto, Kyogoku, Noriaki, Narasaki, Hajime, Uemura, Shion, Yagi, Yuki
• Format: Journal Article
• Language: Japanese; English
• Published: The Japanese Association for Chest Surgery 15.07.2022
• Subjects: ex vacuo pneumothorax; malignant pleural effusions; secondary pneumothorax; thoracentesis
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.36.575

Ex vacuo pneumothorax is a rare complication following thoracentesis, in which an increased negative intrapleural pressure around the vulnerable pleura results in pneumothorax because of the inability of the lung to completely re-expand after fluid removal. Over the last decade, two cases of ex vacuo pneumothorax were reported at our hospital. These pneumothoraxes occurred because of the inability of the lung to re-expand after drainage of malignant pleural effusions. Although the treatment of ex vacuo pneumothorax is controversial, surgical treatments were required because the air leakage from chest tubes was significantly large in these cases. Thoracoscopy revealed several aerial fistulas but no bullae. Also, the vulnerability of the pleura due to malignant pleurisy was noted; thus, sticking a fibrin sheet or polyglycol sheet with fibrin glue for the vulnerable pleura rather than excising the areas of aerial fistula was appropriate. After the repair of aerial fistulas, air leakage was under control and the postoperative courses were favorable.