An unusual cause of secondary spontaneous pneumothorax in a 27-year-old man

Secondary spontaneous pneumothorax: a rare complication of pulmonary embolism

An 85-year-old lady presented with a left middle cerebral artery territory infarct. Several days into her admission she became hypoxic and haemodynamically unstable. A CT pulmonary angiogram showed bilateral pulmonary emboli, right-sided parenchymal cavitation due to infarction and an associated large pneumothorax. She was treated successfully with an intercostal drain and anticoagulation. This case describes the rare phenomenon of secondary spontaneous pneumothorax due to pulmonary infarction from pulmonary embolism. The factors associated with the development of infarcts from pulmonary thromboemboli are poorly understood although a number of predisposing conditions and pathological features have been suggested. Pulmonary infarction occurs in around 10% of cases of pulmonary emboli but the complication of secondary spontaneous pneumothorax would appear to be much less common. One should consider pulmonary embolism as the cause of pneumothorax where there is significant clinical suspicion.

Computed tomography angiography for evaluation of pulmonary embolism in an experimental model and heartworm infested dogs

This study was performed to characterize pulmonary embolism with computed tomography pulmonary angiography in experimental pulmonary embolism and heartworm infected dogs. In the experimental group, there were pulmonary changes after pulmonary embolism induction as follows: hypoattenuating round filling defects in pulmonary arteries, arterial dilations with straight and abrupt cut-off appearances in the pulmonary embolism regions, pulmonary infarctions, a cavity formation and spontaneous pneumothorax, and emboli migration. In the heartworm-infected group, three out of eight dogs developed pulmonary embolism, especially in the right caudal arteries. Arterial dilations with typical tortuosity were also identified, mainly in the right caudal arteries in five dogs. Computed tomography pulmonary angiography can be an important imaging modality in the diagnosis of pulmonary embolism and the evaluation of pulmonary arterial and parenchymal changes in dogs.

Pneumothorax secondary to pulmonary thromboembolism in a dog

OBJECTIVE

To describe a case of spontaneous pneumothorax secondary to pulmonary thromboembolism possibly associated with pituitary dependent hyperadrenocorticism.

CASE SUMMARY

A 7-year-old spayed female Collie weighing 26 kg was referred for evaluation of spontaneous pneumothorax. An exploratory thoracotomy was performed and revealed 2 lung lobes to be diffusely hemorrhagic and they were resected. Histologic examination of multiple sections documented diffuse thromboembolism. A 2-3 cm thrombus was visualized distal to the bifurcation of the pulmonary artery during an echocardiographic examination postoperatively. The dog was discharged to the owner after recovery from surgery. The thrombus had resolved at the 4-week recheck examination. Diagnosis of pituitary dependent hyperadrenocorticism was confirmed based on follow-up endocrine testing.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first report of pulmonary thromboembolism causing spontaneous pneumothorax in the dog.