0
Chest Infections |

Bilateral Pneumothorax: A Rare But Serious Complication Of Septic Pulmonary Embolism

Sasan Sani, MD; Nader Kamangar, MD
Author and Funding Information

UCLA - Olive View Medical Center, Los Angeles, CA


Chest. 2014;146(4_MeetingAbstracts):142A. doi:10.1378/chest.1994803
Text Size: A A A
Published online

Abstract

SESSION TITLE: Infectious Disease Cases I

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM

INTRODUCTION: Pneumothorax as a complication of septic pulmonary embolism (SPE) has been described in only a few case reports. We report an unusual case of a patient who presented with SPE and resultant bilateral pneumothoraces.

CASE PRESENTATION: A 28 year-old female with squamous cell carcinoma of the base of her tongue, with prior glossectomy, radiation, and chemotherapy through a peripherally inserted central catheter (PICC), presented with cough, shortness of breath, and fevers. On presentation she required intubation. Thoracic imaging revealed PICC associated thrombosis of the left axillary, innominate and internal jugular veins and right lower lobe pulmonary emboli. Also noted were multiple bilateral cavitary lesions at varying stages of maturity consistent with SPE. Furthermore, CT demonstrated a left sided hydropneumothorax. Broad spectrum antibiotics were initiated and she underwent chest tube thoracostomy. The patient’s PICC was removed and anticoagulation was started. Her course was complicated by the development of a right sided tension pneumothorax, requiring emergent chest tube placement as well as septic shock. The patient’s family requested to pursue comfort measures and the patient subsequently passed away.

DISCUSSION: SPE has an insidious onset and patients usually present with fever, respiratory symptoms, and lung infiltrates. CT findings include peripheral nodules and subpleural lesions, many of which have identifiable “feeding” vessels. SPE can be associated with pleural effusion, empyema, abscess formation, and hemoptysis. Pneumothorax, however, is a rare complication of SPE, with only 7 previously reported cases, of which 5 were related to intravenous drug use and one was secondary to an indwelling catheter. Only one patient suffered bilateral pneumothoraces. We hypothesize that the rupture of the subpleural emboli can create communications between the airway and pleura resulting in pneumothoraces, which can lead to tension physiology in patients on positive pressure ventilation.

CONCLUSIONS: Although rare, SPE should be considered in the differential of a patient presenting with pneumotharaces and bilateral peripheral pulmonary nodules. It is conceivable that pneumothorax associated with SPE is an under-reported complication with serious and, at times, lethal ramifications.

Reference #1: A case of pneumothorax secondary to septic pulmonary embolism due to central venous catheter infection caused by methicillin-resistant Staphylococcus aureus. Hashimoto Y et al. Kansenshogaku Zasshi. 2008 Jan;82(1):51-4

DISCLOSURE: The following authors have nothing to disclose: Sasan Sani, Nader Kamangar

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543