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).