Abstract
Intraoperative pneumothorax during breast reconstruction can be difficult to diagnose. Even a small pneumothorax can become a tension pneumothorax under positive pressure ventilation. The clinical finding of venous congestion in a pedicled latissimus dorsi flap, which could not be explained by problems with the vessels, preceded other signs of a tension pneumothorax in the case presented here. Given the difficulties of access to the chest by the anaesthetic team during breast procedures, this has the potential to be a useful adjunct in the diagnosis of this potentially serious intraoperative complication.
Highlights
Pneumothorax is a potentially dangerous intraoperative complication, which can be difficult to diagnose [1]
We present a case of an intraoperative pneumothorax during breast reconstruction which demonstrated a useful clinical sign to aid diagnosis
A 67-year-old patient attended clinic to be considered for delayed breast reconstruction following left mastectomy two years previously for widespread ductal carcinoma in situ
Summary
Pneumothorax is a potentially dangerous intraoperative complication, which can be difficult to diagnose [1]. Medical comorbidities included well-controlled type 2 diabetes mellitus and hypertension She had a good exercise tolerance, with no history of COPD or asthma, and had previously undergone appendicectomy, salpingooophorectomy, and hysterectomy with no anaesthetic complications. Towards the end of the procedure, the flap started to show signs of venous congestion. During this time, the anaesthetist noted slowly progressive hypotension, tachycardia, and low pulse oximeter readings associated with increased ventilation pressures. A left sided tension pneumothorax was diagnosed and needle aspiration of the pleural space performed, with initially good physiological response, but no audible decompression. The chest drain was placed and the patient remained stable After this intervention, the venous congestion seen in the flap rapidly resolved.
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