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Bilateral pneumothorax resulting from a diagnostic thoracentesis

This is the case of a 61-yr-old male who underwent a three-stage oesophagectomy and substernal gastric interposition as surgical treatment for a tumour 3, node 0, metastasis 0 poorly differentiated squamous cell carcinoma of the middle oesophagus. Unusual posterior mediastinal anatomy (the thoracic aorta and thoracic duct were very deep, and the distance between the trachea and anterior border of the thoracic vertebrae was unusually small) resulted in complex surgery. As a result, attempts at the traditional Foley technique to transpose the stomach via the posterior mediastinum were repeatedly unsuccessful. This necessitated the use of a retrosternal tunnel, i.e. substernal gastric interposition.

A chest radiograph performed 12 weeks following surgery in order to investigate persistent progressive shortness of breath on exertion demonstrated bilateral pleural effusions (fig. 1⇓). An elective diagnostic left-sided pleural aspirate was performed. The patient experienced acute shortness of breath and pleuritic chest discomfort immediately post-procedure. The chest radiograph at this time is shown (fig. 2⇓). A chest drain was inserted (fig. 3⇓).



Fig. 1— 
Chest radiograph demonstrating bilateral pleural effusions (arrows) and surgical clips from previous oesphagectomy (arrow head).





Fig. 2— 
Chest radiograph revealing a left-sided pneumothorax.





Fig. 3— 
Chest …