Introduction
Intraoperative pneumothorax is a rare and potentially catastrophic
clinical phenomenon that can be quite challenging to diagnose during a
surgical procedure. A delay in presentation makes the situation even
more complicated and unusual. In the general pediatric population, the
overall incidence of spontaneous pneumothorax is 3.4/100,000 patients,
with males having a 10-fold greater incidence than
females.1,2 The incidence of pneumothorax in the
perioperative period can be variable based on the type of surgical
procedure.
Posterior spinal surgery is associated with the risk of several
perioperative respiratory complications including pleural effusion,
pneumothorax, hemothorax, pulmonary edema, chylothorax, and prolonged
mechanical ventilation.3 During deep dissection
between the transverse processes or instrumentation and placement of
pedicle hardware, an inadvertent tear in the parietal pleura can result
in entrainment of outside air into the pleural space. Differentiating
between a pneumothorax and the myriad of other potential intraoperative
respiratory or airway issues is difficult, and can delay accurate
diagnosis. Treatment of a pneumothorax in the prone position is
complicated by limited access to the typical sites of pleural
decompression. In this report, we describe an unusual presentation of a
pneumothorax in a pediatric patient with idiopathic scoliosis undergoing
posterior spinal fusion. Written Health Insurance Portability and
Accountability Act authorization was obtained from both the patient and
parent.