Anesthesia under cardiopulmonary bypass for video assisted thoracoscopic wedge resection in patient with spontaneous pneumothorax and contralateral post-tuberculosis destroyed lung

provided the original work is properly cited. CC Pneumothorax with contralateral destroyed lung is a rare condition. However, the anesthetic management poses signifi cant risks and can be quite challenging because conventional one-lung ventilation (OLV) for wedge resection in pneumothorax with contralateral destroyed lung is impossible. A 69-year-old man with height 167 cm and weight 57 kg was scheduled for video assisted thoracoscopic surgery (VATS) due to pneumothorax in left lung. A thoracostomy tube was inserted but failed to resolve completely the pneumothorax and persistent air leakage remained. The patient had a history of pulmonary tuberculosis, 16 years ago. A chest X-ray as preoperative evaluation showed pneumothorax with chest tube in the left lung and the right lung was destroyed with marked volume loss with deviation of trachea to right. Computed tomography showed multiple bullae, fibrotic bands and pneumothorax with chest tube in the left lung. Further, a destroyed lung with bronchopleural fistula (BPF) at the right lung was visible (Fig. 1). Due to contralateral post-tuberculosis destroyed lung and BPF, OLV at dependent lung was impossible. VATS for pneumothorax under cardiopulmonary bypass (CPB) was decided after discussion between anesthesiologists and thoracic surgeons.