Contralateral pneumothorax after pneumonectomy is a rare but potentially catastrophic complication. Described here is a pneumothorax in the left hemithorax of a postpneumonectomy patient occurring after internal jugular vein catheterization. Chest radiographs before and after chest tube thoracostomy are presented. Ramifications of diagnosis and management of this condition are discussed. Introduction The development of a contralateral pneumothorax after pneumonectomy is a rare but potentially catastrophic complication. Almost all cases occur spontaneously and immediately after pneumonectomy.1,2 Spontaneous postpneumonectomy contralateral pneumothorax has an incidence ranging from a 0.2 - 2%.1,3 The mechanism probably results from occult intraoperative damage to the pleura or by rupture of preexisting bullae or blebs.1,2 Interestingly, iatrogenic pneumothorax in this setting is not well reported in the medical literature. Below is a dramatic presentation of pneumothorax that occurred after left-sided internal jugular vein catheterization. Case Report A 49-year-old white female was 2 months status post right pneumonectomy for lung cancer. She underwent an outpatient left internal jugular vein catheterization in anticipation of chemotherapy. Placement was successfully confirmed by immediate post procedure chest x-ray and the patient was sent home. Approximately 4 hours later she developed sudden onset of dyspnea and chest pain. She arrived in the emergency department in severe respiratory distress and appeared cyanotic, diaphoretic and lethargic. Breath sounds were absent bilaterally. The patient’s chest was dull to percussion on the right, and hyperesonant on the left. There was moderate right jugular vein distention (which was later discovered to be chronic since her pneumonectomy). Chest x-ray confirmed a near total left pneumothorax (see Fig 1).
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