Whole-lung lavage complicated with pneumothorax: a case report

Area of Science:

• Pulmonology
• Critical Care Medicine

Background:

• Pulmonary alveolar proteinosis (PAP) management often requires whole lung lavage (WLL).
• One lung ventilation (OLV) is critical for performing unilateral WLL but can be limited by patient factors.

Purpose of the Study:

• To describe a case of severe hypoxemia during OLV in a PAP patient undergoing WLL.
• To identify the cause of hypoxemia and enable completion of left lung lavage.

Main Methods:

• A patient with PAP underwent right lung lavage, followed by an attempted left lung lavage using OLV.
• Severe hypoxemia occurred during attempted left lung lavage, prompting investigation.
• Chest X-ray revealed right pneumothorax, which was treated with a chest tube.

Main Results:

• The patient experienced severe hypoxemia (SpO2 < 80%) during right OLV for left lung lavage.
• Bronchoscopic examination confirmed correct tube placement, and medical interventions were ineffective.
• Resolution of right pneumothorax allowed successful completion of left lung lavage without significant complications.

Conclusions:

• Pneumothorax is a critical complication that can arise during OLV for WLL in PAP patients.
• Prompt diagnosis and management of pneumothorax are essential for patient safety and procedural success.
• This case highlights the importance of vigilant monitoring and reassessment during complex respiratory procedures.