Case study describes bilateral pneumothoraces after a single unilateral attempt to cannulate the right subclavian vein

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Intravenous literature: Abd-Elsayed, A.A., Ghaly, T., Farag, E. and Esa, W.A. (2013) Bilateral pneumothoraces following a right subclavian catheter insertion after thymectomy for a patient with a myasthenic crisis. The Ochsner Journal. 13(2), p.256-8.

Abstract:

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease involving the formation of antibodies against the nicotinic acetylcholine receptors. Thymectomy is the treatment in MG patients with thymoma. We report a case of an MG patient who developed postthymectomy bilateral pneumothoraces after the placement of a subclavian central venous catheter.

CASE REPORT: The 21-year-old patient with MG underwent a thymectomy and, in a later admission, complained of myasthenic crisis symptoms. He was scheduled to receive plasma exchange therapy and electromyography the following day. Plasmapheresis was initiated after the placement of a right subclavian dialysis catheter. Postinsertion chest x-ray revealed bilateral pneumothoraces after a single unilateral attempt to cannulate the right subclavian vein. A right thoracotomy tube was placed with interval resolution of the bilateral pneumothoraces.

CONCLUSION: The development of bilateral pneumothoraces in this case was attributed to the possible accidental communication between the 2 pleural spaces, which rarely happens during thymectomy surgery.

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