Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionContact Us   |  Subscribe   |  Advertise   |  Login  Page layout
Wide layoutNarrow layoutFull screen layout
Lung India Official publication of Indian Chest Society  
  Users Online: 95   Home Print this page  Email this page Small font size Default font size Increase font size


 
  Table of Contents    
LETTER TO EDITOR
Year : 2019  |  Volume : 36  |  Issue : 3  |  Page : 270-271  

Hydropneumothorax following diagnostic bronchoalveolar lavage: A rarest of rare complication


Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication24-Apr-2019

Correspondence Address:
Dr. Animesh Ray
Department of Medicine, All India Institute of Medical Sciences, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_423_18

Rights and Permissions

How to cite this article:
Sarkar L, Biswas S, Ray A, Sinha S. Hydropneumothorax following diagnostic bronchoalveolar lavage: A rarest of rare complication. Lung India 2019;36:270-1

How to cite this URL:
Sarkar L, Biswas S, Ray A, Sinha S. Hydropneumothorax following diagnostic bronchoalveolar lavage: A rarest of rare complication. Lung India [serial online] 2019 [cited 2019 Jul 16];36:270-1. Available from: http://www.lungindia.com/text.asp?2019/36/3/270/256929



Sir,

A 55-year-old female patient, a known diabetic on oral hypoglycemic agents for the past 2½ years with a history of pulmonary tuberculosis on antitubercular therapy for the last 6 months, presented to our institute complaining of low-grade fever with evening rise of temperature and dry cough with streaky hemoptysis for 15 days, associated with loss of weight and appetite. Contrast-enhanced computed tomography scan of the chest revealed consolidation of the anterior and apicoposterior segments of the left upper lobe. Suspecting persistent disease activity, a repeat bronchoscopic sampling was planned.

After taking consent, the patient underwent bronchoalveolar lavage (BAL) following standard institutional protocol. A volume of 60 ml of normal saline was instilled after wedging the scope in the apicoposterior segment of the left upper lobe. Around 30 ml of the lavage was collected by wall-mounted suction (with the pressure kept below 100 mmHg at all times). It was carried out under light sedation with continuous monitoring. She developed dyspnea, cough, and chest pain, due to which the procedure was abandoned and an urgent chest X-ray was ordered. This revealed a left-sided hydropneumothorax [Figure 1]. The patient was started on high-flow moist oxygen and kept under close monitoring. In view of persistent symptoms with significant tachypnea and hypoxemia, a decision was promptly taken to insert an intercostal chest drain (ICD) for drainage.
Figure 1: Immediately postprocedure chest X-ray showing a large left-sided hydropneumothorax

Click here to view


Noncontrast computed tomography chest [Figure 2] was done following this which showed no evidence of lung parenchymal injury. Fluid analysis was done which was suggestive of a transudative effusion. Serial imaging showed resolution of the hydropneumothorax with adequate lung expansion, and ICD was removed on the 3rd day (post-ICD). The BAL report was negative for tuberculosis and pyogenic and fungal infections. Antitubercular therapy was stopped, and she was discharged and followed up in the outpatient department. Her symptoms did not recur, and the chest X-ray did not show radiological progression.
Figure 2: High-resolution computed tomography chest showing a lesion in the apicoposterior segment of the left upper lobe with subcentimetric mediastinal lymph nodes. There is a left-sided hydropneumothorax with no evidence of parenchymal lung injury. Arrow points to the chink of air in the left pleural sac

Click here to view


To the best of our knowledge, hydropneumothorax following diagnostic BAL has been reported in only two cases. Hudes et al.[1] had described hydropneumothorax following BAL in a 23-year-old female patient with severe asthma on positive-pressure ventilation. Nicholson and Mutlu[2] described an 80-year-old woman who developed hydropneumothorax following BAL and was ultimately proved to have nontuberculous mycobacterial infection.

It has been postulated that high intra-alveolar tension during cough leading to bleb rupture and increased transpulmonary pressure gradient causing visceral pleural tear may result in pneumothorax. Leakage of the instilled fluid into the pleural space could explain the development of hydropneumothorax in such cases. Our patient had a bout of cough during BAL and the return of lavage was 50% of the instilled fluid – suggesting perhaps that the fluid had seeped into the pleural sac through the pleural rent, resulting in a hydropneumothorax.

In conclusion, although BAL by fiber-optic bronchoscopy is considered a safe procedure, it might be complicated very rarely by hydropneumothorax. Awareness of the possibility, close monitoring of symptoms and vitals of the patient after the procedure, and chest imaging are essential to clinch the diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hudes ET, Bradley JW, Brebner J. Hydropneumothorax – An unusual complication of lung lavage. Can Anaesth Soc J 1986;33:662-5.  Back to cited text no. 1
    
2.
Nicholson TT, Mutlu GM. Pneumothorax following bronchoalveolar lavage for the diagnosis of non-tuberculous mycobacterial infection. An “atypical” complication of bronchoscopy? Arch Bronconeumol 2016;52:278-9.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed169    
    Printed3    
    Emailed0    
    PDF Downloaded49    
    Comments [Add]    

Recommend this journal