Pneumothorax with postoperative complicated pleural adhesion.

A 77-year-old man presented with acute breathlessness. He had a history of smoking 20 cigarettes per day for 45 years, but stopped smoking at the age of 74. He had pneumothorax of the right three times, which was treated surgically two times. On arrival, he was clear and ambulatory. The vital signs were stable: blood pressure was 130/80 mmHg, pulse rate 84 beats per minute, respiratory rate 16 breaths per minute, and body temperature 37.0°C. Physically, auscultation of the lung revealed clear breath sounds except over the left lung field where breath sounds were diminished. The remainder of the physical examination was unremarkable. A plain chest radiograph demonstrated a right pneumothorax with complicated pleural adhesion. Arterial blood gas analysis revealed that PaO2 was 64.2 torr, PaCO2 43.2 torr, and pH 7.418. As the postero-anterior radiograph demonstrated a pneumothorax with pleural adhesion, therefore, a chest CT scan was performed. This demonstrated a pneumothorax with complicated pleural adhesion to some parts of the anterior and posterior parietal pleura (Figure 1). A drainage tube (Aspiration Kit: 6 Fr) was inserted avoiding the pleural adhesion parts not to injure the lung. The complicated pneumothorax was successfully treated with the chest tube.