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Published on: July 10, 2012
Pneumatocele after lung transplantation
Masashi Furukawa1, Ernest G Chan2, Jenalee N Coster2
1Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. furukawam@upmc.edu.
Insights
Pneumatoceles, air-filled sacs, can develop after lung transplants due to pneumonia. This case shows conservative management can resolve them, but rupture and pneumothorax are risks.
Area of Science:
- Pulmonology
- Transplant Surgery
- Critical Care Medicine
Background:
- Pneumatoceles are rare complications following lung transplantation, often associated with pneumonia or trauma.
- This case involves a 44-year-old male with pulmonary veno-occlusive disease and pulmonary hypertension who underwent double lung transplantation.
- The patient experienced severe primary graft dysfunction and bilateral lower lobe pneumonia with Staphylococcus aureus and Burkholderia cepacia infections.
Purpose of the Study:
- To report a case of pneumatocele formation after lung transplantation.
- To discuss the management and outcome of a post-transplant pneumatocele.
- To highlight the potential complications and conservative treatment approach for post-lung transplant pneumatoceles.
Main Methods:
- A double lung transplant recipient with primary graft dysfunction and pneumonia was treated with antibiotics (trimethoprim-sulfamethoxazole, meropenem, minocycline) and prone positioning.
- Venovenous extracorporeal membrane oxygenation (ECMO) and ventilator support were utilized for respiratory management.
- Conservative management was chosen for the developing pneumatocele, followed by percutaneous drainage for spontaneous pneumothorax.
Main Results:
- The patient developed a pneumatocele at the pneumonia site, which initially increased in size.
- Conservative treatment, including prone positioning and medical therapy, led to gradual respiratory improvement.
- The pneumatocele spontaneously ruptured, causing asymptomatic pneumothorax, which was successfully managed with percutaneous drainage. The pneumatocele resolved, and the patient was discharged with a shrinking pneumatocele.
Conclusions:
- Pneumatoceles can occur at pneumonia sites after lung transplantation.
- Conservative management may be effective for post-transplant pneumatoceles, but vigilance for complications like rupture and pneumothorax is crucial.
- This case underscores the possibility of spontaneous resolution and successful conservative treatment for post-lung transplant pneumatoceles.
Abstract:
Pneumatoceles are a known complication of pneumonia or trauma, especially in young children. A 44-year-old male with pulmonary veno-occlusive disease and pulmonary hypertension underwent double lung transplantation with cardiopulmonary support. The patient had experienced severe primary graft dysfunction and bilateral lower lobe pneumonia. Posttransplant bronchoalveolar lavage fluid identified Staphylococcus aureus and Burkholderia cepacia. We started trimethoprim-sulfamethoxazole, meropenem, and minocycline. We also switched him to a prone position every 12 h for 3 days. The respiratory condition gradually improved with systemic therapy, prone position, oxygenation with ventilator, and venous-venous extracorporeal membrane oxygenation. Pneumatocele developed at the site of pneumonia. Although the pneumatocele was gradually increasing the size, we decided to continue conservative treatment. The pneumatocele spontaneously ruptured, and asymptomatic pneumothorax developed. We performed percutaneous drainage for pneumothorax, and the pneumatocele resolved. After he was discharged from the hospital, that pneumatocele shrank and disappeared. Pneumatocele can occur at the site of pneumonia after lung transplantation. It may be curable with conservative treatment, but the possibility of sudden rupture and pneumothorax should be considered.
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