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.