A 20-year-old male patient, with no relevant morbid history, presented with a six-day history of sudden onset right chest pain, respiratory distress, and dyspnea.
Radiography showed a right pneumothorax of 100%.
The patient was admitted to the emergency room with a 24Fr pleurostomy tube connected to a non-aspirated trapezil water, achieving pulmonary expansion.
Immediately, the patient developed hypotension up to 90/60 mmHg, tachycardic on average beats per minute, reaching 78% with environmental and sweaty O2.
Optimization was achieved with placement of a mask for retraction with oxygen plus nebulization with FeNO plus Ipatropium bromide 100% reaching 92%.
For this reason, transfer to monitoring in a critical patient unit was decided.
She was admitted to the intermediate care unit with saturation up to 88%, so non-invasive mechanical ventilation support in CPAP mode was initiated.
Portable chest X-ray showed extensive right pulmonary edema with lack of apical expansion and left lung without signs of edema or condensation.
Twelve hours after admission, the patient developed hypotension, requiring noradrenaline to improve perfusion. In the context of probably distributive shock, volume was administered with ringer serum lactate and albumin infusion was initiated, with a good response.
At 36 h of admission, bilateral oxygen saturation persists and opacities persisted at 90% with FiO2 30%. A CT angiography of the chest showed ground-glass opacities compatible with apical edema of right lung expansion and 1.8 cm subpleural.
It was decided to maintain medical management until improving ventilatory parameters to propose surgical resolution.
It persists with air leaking through the pleural drainage and lack of pulmonary expansion so it is connected to aspiration at −6 cmH2O well tolerated.
She was stable and required oxygen at a low level. Non-invasive mechanical ventilation was progressively withdrawn, reaching saturation levels of 98% on the fifth day without supplementary ventilatory support.
However, there is still air leak and lack of pulmonary expansion.
On the fifth day, a new chest X-ray showed almost complete resolution of the edema and lack of expansion of 50%.
Given the resolution of the edema, surgery was decided.
Establishment of a right-sided videotape with a healthy-looking lung.
Mechanical scarification was also performed.
The day after surgery the patient progressed stable, with a pleurostomy debt being rare, without observable air leaking forced eruption or valsalva maneuvers.
Pleural tube was removed 48 h after the procedure without incidents. Control X-rays showed complete expansion.
