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• W2766402699 abstract "SESSION TITLE: Disorders of the Pleura SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Pneumothorax after bronchoalveolar lavage (BAL) is rare, but there is association with spontaneous pneumothorax in nontuberculous Mycobacterial (NTM) and low BMI.1,2 We describe a case of bilateral pneumothoraces after diagnostic bronchoscopy with BAL. CASE PRESENTATION: A 79 year old female with bronchiectasis presented for evaluation of malaise with diagnostic flexible bronchoscopy. Friable mucosa and thick white secretions were noted and BAL was performed in lingula and RML with 120 ml of normal saline in each lobe. Post-procedure she developed chest pain and dyspnea. Chest x-ray (CXR) showed bilateral pneumothoraces, left more than right. A left-sided 14 Fr chest tube was placed with noted air leak. A repeat CXR showed resolving left pneumothorax but enlargement of right pneumothorax, and a right side 14Fr chest tube was placed. Repeat CXR showed resolution of pneumothoraces. BAL grew mycobacterium avium complex and she was started on antibiotics. DISCUSSION: Pneumothorax post flexible bronchoscopy without transbronchial biopsy occurs rarely, typically in elderly patients with underlying pulmonary disease.1There is association of spontaneous pneumothorax in patients with NTM and low BMI. Research on spontaneous pneumothorax in rats has shown that a malnourished state may weaken the structure of the alveoli or cause structural changes predisposing to rupture at a time of increased intra-thoracic pressure such during cough.2 During BAL there may be increased intra-alveolar pressure from fluid being aspirated, creating local gas trapping, and increase transpulmonary pressures due to cough, especially with wedged bronchoscope.3 CONCLUSIONS: Our patient developed bilateral pneumothoraces after BAL likely due to a combination of factors including underlying NTM disease, weakened alveoli from a malnourished state, and transient increases in intra-alveolar pressures.1-3 Therefore while pneumothorax is considered a rare complication post bronchoscopy with BAL certain populations may be at an increased risk.3 Reference #1: Nicholson, TT et al. Pneumothrorax following brochoalveolar lavage for the diagnosis of non-tuberculous Mycobacterial infection- An “atypical” complication of bronchoscopy?Arch Bronch.2016;52:278-9. Reference #2: Corless JA et al. Simultaneous bilateral spontaneous pneumothoraces in a young woman with anorexia nervosa.Int J Eat Dis.2001;30:110-112. Reference #3: Setu, P et al. Bilateral pneumothorax after bronchoscopy without biopsy. A rare complication: Case presentation and literature review.J of Bron & Int Pul.2012;19(1):57-60. DISCLOSURE: The following authors have nothing to disclose: Nadia Pletukhina, Vivian Keenan, Naveen Tyagi, Shilpa DeSouza, Sepideh Sedgh No Product/Research Disclosure Information" @default.
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• W2766402699 date "2017-10-01" @default.
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• W2766402699 title "Bilateral Pneumothoraces After BAL in a Thin Female With Nontuberculous Mycobacterium" @default.
• W2766402699 doi "https://doi.org/10.1016/j.chest.2017.08.546" @default.
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