A CASE OF PNEUMOTHORAX WITH MEDIASTINAL HERNIATION OF LUNG

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  • 縦隔ヘルニアに合併した気胸の１例

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Abstract

The patient was a 17-year-old man who had previous history of pneumonia which needed several admissions during ages of 2 and 6. In October 2005, he visited another hospital because of dyspnea and was diagnosed as having left pneumothorax by a chest x-ray film. Despite intrathoracic drainage air leakage did not cease, and the patient was transferred to the hospital. Chest CT scan showed shrinkage of the right lung, a large cyst in the right upper lobe, and the displacement of cardiac shadow toward the right. The left lung was treated by intrathoracic drainage, but it yielded only insufficient expansion. Further the left lung showed excessive expansion which went over the superior anterior mediastinum and prolapsed to the opposite side. Pleurography identified a portion in the left upper lung field from where air leaked continuously. From these findings left pneumothorax associated with mediastinal herniation was diagnosed. During surgery we found a bulla with air leakage in the left S6, and performed placation suture for the bulla under thoracotomy. The patient was discharged from the hospital on the 9th postoperative day after uneventful postoperative course. Postoperative examination of respiratory function demonstrated that he had mixed ventilation impairment. The patient has been free from recurrence of pneumothorax as of 9 months after the operation, and is followed for mediastinal herniation.

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