Disorders of the Pleura |

Into Fat Air: A Case of Pneumothorax Complicating Liposuction FREE TO VIEW

Bishoy Zakhary, MD; Eric Teller, MD
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NYU, New York, NY

Chest. 2015;148(4_MeetingAbstracts):451A. doi:10.1378/chest.2281576
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SESSION TITLE: Plueral Cases

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 26, 2015 at 11:00 AM - 12:00 PM

INTRODUCTION: Secondary pneumothorax can result from trauma or from medical procedures. Common iatrogenic etiologies include trans-thoracic or trans-bronchial biopsy, thoracentesis, or subclavian central line placement. We report a rare iatrogenic complication of liposuction-induced pneumothorax.

CASE PRESENTATION: The patient is a 33 year old healthy female who underwent out-patient liposuction of fat pads between the scapulae 3 days prior to presentation. The patient developed dyspnea immediately post-procedure but was told that this was to be expected. However, progression of symptoms prompted an emergency room visit. She was hemodynamically stable with a room air saturation of 98%. Physical exam revealed a thin woman with bilateral 2 centimeter skin incisions over the posterior chest wall. A chest x-ray (Fig 1) demonstrated a large right-sided pneumothorax with mediastinal shift to the left and right-sided rib expansion (Fig 2). The patient underwent chest tube placement with near full re-expansion of the right lung. Her hospital course was complicated by an air leak which resolved after three days. She was discharged home on hospital day four and was doing well on follow-up.

DISCUSSION: Liposuction is one of the most common plastic surgeries with over one million procedures performed annually in the United States. It is generally considered a benign procedure with a complication rate of less than one percent. Although a potential risk, several large cases series report a zero incidence of pneumothorax. One case series of large volume liposuctions (defined as a volume removed of 5 to 8 liters) reported a 3% incidence. Our current patient is unique in that the volume of fat removed was less than one liter. The relative rarity of pneumothorax complicating liposuction likely resulted in a delay in diagnosis. However, the patient was thin which has been associated with pneumothorax risk during acupuncture procedures. This case highlights the need for practitioners to be familiar with risk factors for procedural complications and to address alarming symptoms expeditiously.

CONCLUSIONS: Pneumothorax can complicate liposuction. Clinicians should be aware of this rare, but potentially dangerous, complication.

Reference #1: Richards ME. Patient satisfaction after high-volume lipoplasty: outcomes survey and thoughts on safety. Aesthet Surg J 23:345-352, 2003.

Reference #2: He W, et al. Adverse events following acupuncture: a systematic review of the Chinese literature for the years 1956-2010. J Altern Complement Med. 2012 Oct;18(10):892-901.

DISCLOSURE: The following authors have nothing to disclose: Bishoy Zakhary, Eric Teller

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