Simple SummaryPostoperative residual pleural space and postoperative air leaks after lung resection are two different clinical entities requiring completely different approaches. Residual postoperative pleural space is a part of the pleural cavity that is not fully reoccupied by the remaining lung after pulmonary resection. No treatment is needed in the asymptomatic residual pleural space without any persistent air leak, and chest drain removal can be safely planned. On the contrary, an active and prolonged air leak after lung resection is an absolute contraindication to chest drain removal that may culminate in hypertensive pneumothorax, subcutaneous emphysema, and severe respiratory symptoms. In order to further contribute to an appropriate differential diagnosis between these two settings, we propose a radiological sign that is observed only in the case of residual plural space. In this case, in fact, the lung takes the form of a round balloon due to the hyperinflation condition, which is governed by the Young–Laplace equation describing the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of wall tension.In this paper, we propose a radiological sign for an appropriate differential diagnosis between postoperative pleural space and active air leak after lung resection. In the case of residual pleural space without any active air leak, the lung takes the form of a round balloon due to the hyperinflation condition, which is governed by the Young–Laplace equation describing the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of wall tension. The two principal mechanisms by which a lung forms a spherical image are shear-controlled detachment induced by shear stress on the membrane surface, and spontaneous detachment induced by a gradient in Young–Laplace pressure. On the contrary, the lung maintains its tapered shape in the case of an active air leak because the continuous air refill does not allow a complete parenchyma re-expansion.
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