Unase Buyukkocak, Nur Doganci, Serdar Han, Salih Somuncu
CaseRepClinPractRev 2007; 8:371-375
Background: Bilateral spontaneous pneumothorax is rare case and is occurred as barometric trauma after mechanical ventilation or secondary to trauma, asthma and infection conditions generally in children.
Case Report: We present a female child (8 year-old) with mental motor retardation, and sialorrhea scheduled for magnetic resonance imaging (MRI) to diagnose puberty praecox. After ketamine premedication she received midazolam 1 mg, ketamine 25 m and atropine 0.25 mg intravenously. Before MRI attempt increase of sialorrhea and decrease of saturation were observed. She was entubated endotracheally when she became cyanotic and transferred to ICU. Because lung expansion was not enough the patient was re-intubated with larger size endotracheal tube. Crepitation, subcutaneous emphysema and bilateral hyper-resonance to percussion were occurred. Breathe sounds were absent bilaterally and convulsion was observed, then the patient was ventilated mechanically with ventilator. PA Chest-X Ray
showed bilateral pneumothorax. Bilateral chest tubes were inserted immediately and lungs were re-expanded. After 90 minutes, respiratory and hemodynamic parameters were stable and the patient was extubated. The day later, chest X-Ray confirmed that both lungs remained expanded and chest tubes were removed. On the third day of hospitalization, she discharged well from the hospital.
Conclusions: Early diagnosis based on clinical and radiological fi ndings and required surgical interventions lead to good health status and prevent complications in case of mortal disease like bilateral pneumothorax. Besides, it will be better if the patient receives at least the same level of monitoring and care (monitored anesthesia care) in the MRI suite as in the operating room.
Keywords: Pneumothorax, Barotrauma, re-expansion, monitored anesthesia care