Occurrence of Tension Pneumothorax following Fogarty Embolectomy Catheter use for Lung Isolation in a Neonate with Congenital Pulmonary Airway Malformation

Abstract

A pneumothorax can arise in a variety of clinical settings in the operating room, from bleb rupture to iatrogenic injury. Should it expand in size and cause increase in intrapleural pressures with resultant diminished venous return, it becomes referred to as a tension pneumothorax. We report a case of a premature infant presenting for repair of congenital pulmonary airway malformation who suffered an iatrogenic tension pneumothorax during lung isolation with fogarty embolectomy catheter used for single lung ventilation in a neonate. via c-section was noticed to have respiratory difficulty shortly after birth. Radiologic investigations revealed a right-sided chest mass with slight mediastinal shift (Figure 1). A diagnosis of CPAM was made, and the child was scheduled for right upper lobectomy. He was otherwise healthy with no abnormal laboratory or clinical findings. The case was discussed with the surgical team, and it was decided to proceed with lung isolation and single-lung ventilation (SLV). Atropine was administered intravenously, and anesthesia was induced with propofol and rocuronium. Mask ventilation was instituted using minimal pressures with 2% sevoflurane and 100% oxygen. Direct laryngoscopy (DL) was performed and a 4 Fr Fogarty embolectomy catheter (FC) easily inserted until resistance was met. An initial attempt with Case RepoRt