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Images in thorax
The pressure-dependent air leak after partial lung resection
  1. Amit Chopra1,
  2. Peter Doelken1,
  3. Marc A Judson1,
  4. Terrill Huggins2
  1. 1Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
  2. 2Department of Medicine, Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Amit Chopra, Department of Medicine, MC-91, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA; chopraa1{at}

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Case report

A 72-year-old man with a right middle lobe lung adenocarcinoma underwent lobectomy with removal of tube thoracostomy 3 days after the thoracic surgery. He presented approximately 3 weeks after surgery with increasing dyspnoea. A chest X-ray (CXR) revealed a moderately large, loculated basilar pneumothorax (figure 1A). A small bore tube thoracostomy was placed with reduction of the pneumothorax. However, a moderate-sized pneumothorax with a persistent air leak persisted for approximately 2 weeks after chest tube placement requiring ongoing hospitalisation (figure 1B). Pleural manometry was performed sequentially, first with the chest tube open to water seal and then with chest tube clamped demonstrating that the air leak was pressure-dependent. Based on the manometric findings (figure 2), the chest tube was clamped and the pneumothorax remained radiographically stable. The tube thoracostomy was removed and the patient was discharged home. At 1-year follow-up, his CXR showed stable pneumothorax (figure 3).

Figure 1

Chest X-ray. (A) Right basilar loculated pneumothorax …

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  • Contributors All co-authors have contributed in drafting of this manuscript.

  • Competing interests MAJ: consultant for Janssen, Celgene, Questcor, Mistubishi-Tanabe, Novartis.

  • TH: Grant for IPF trial from InterMune, Roche and Boerhinger Ingelheim. No direct COI related to manuscript.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.