Secondary Spontaneous Pneumothorax in a Patient With Interstitial Lung Disease Undergoing Routine Outpatient...

We present the case of a 64-year-old female with a past medical history significant for unclassified interstitial lung disease (ILD) from suspected hypersensitivity pneumonitis secondary to chronic mold exposure with steroid responsiveness and prior pneumothorax. The patient developed shortness of breath and pleuritic chest pain after undergoing routine outpatient pulmonary function tests (PFTs). She was immediately transferred to the emergency department and found to have a moderate left basilar pneumothorax. She underwent emergent surgical chest tube placement followed by doxycycline pleurodesis. Repeat chest imaging showed inadvertent retraction of the chest tube and extensive subcutaneous emphysema. The surgical chest tube was replaced by a pigtail catheter with an improvement of subcutaneous emphysema. This case demonstrates the development of a rare but serious complication of pneumothorax that could occur in patients who have ILD undergoing routine PFTs. Clinicians should be aware of this risk when patients who have ILD present for PFTs and counsel them to seek immediate medical attention if they develop signs of acute onset dyspnea after performing PFTs.