PMC7781711_01
Chest X-ray showed right-sided subcutaneous emphysema (red caret) with a small right-sided pneumothorax (black arrow).
CRIPU2020-8830361.001.jpg
PMC7781711_01_CRIPU2020-8830361.001.jpg
fig1
A portable anterior-posterior chest X-ray showed right-sided subcutaneous emphysema with a small right-sided pneumothorax (Figure 1).
Axial chest CT showed a sentinel pocket of gas adjacent to the right bronchial anastomotic site (black caret); an anterior pneumothorax (blue arrows) is also seen.
CRIPU2020-8830361.002.jpg
PMC7781711_01_CRIPU2020-8830361.002.jpg
fig2
CT of the thorax showed a moderate-sized right pneumothorax with spontaneous decompression into the anterior chest wall with subcutaneous emphysema, a sentinel pocket of air adjacent to the anastomotic site, and interstitial emphysema around the right lower lobe proximal bronchus, all of which were concerning bronchial dehiscence (Figure 2).
Bronchoscopy showed partial dehiscence of the right mainstem bronchus surgical anastomosis (blue arrow) directly opposite to the right upper lobe orifice (red carets) and distal to sutures.
CRIPU2020-8830361.003.jpg
PMC7781711_01_CRIPU2020-8830361.003.jpg
fig3
Bronchoscopy showed partial dehiscence of the right mainstem bronchus surgical anastomosis directly opposite to the right upper lobe orifice and distal to sutures with a surrounding stable hematoma and no bubbling apparent when flushed with saline (Figure 3).
Initial axial chest CT two weeks prior shows interstitial emphysema along the bronchovascular bundle (red arrows).
CRIPU2020-8830361.004.jpg
PMC7781711_01_CRIPU2020-8830361.004.jpg
fig4
Retrospective evaluation of the prior CT thorax two weeks after transplantation showed air tracking along the bronchovascular bundle, suggestive of interstitial emphysema (Figure 4).
Repeat bronchoscopy 32 days posttransplantation showed right mainstem bronchial anastomotic site dehiscence (red arrows).
CRIPU2020-8830361.005.jpg
PMC7781711_01_CRIPU2020-8830361.005.jpg
fig5