Abstract Case Summary A 62-year-old male with a medical history of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) presented with chest pain following an episode of choking on toothpaste. A chest CT revealed a large right pneumothorax and severe bullous lung disease. The patient underwent chest tube decompression, right-sided video-assisted thoracoscopic surgery (VATS) for bleb resection, and pleurodesis with talc. However, following the procedure, he developed multifocal patchy airspace disease, which was initially attributed to acute respiratory distress syndrome (ARDS) or a potential adverse reaction to the talc pleurodesis. Despite aggressive management of ARDS, the patient’s condition failed to improve. He was ultimately recommended for and underwent a double lung transplant, and a tracheostomy was later placed. Clinical Decision Making The patient’s symptoms developed after what seemed like a benign event – coughing while brushing his teeth – however he had persistent chest pain which prompted medical attention. The chest CT revealed a large pneumothorax, suggesting that the aspiration episode, likely caused by toothpaste, had triggered the rupture of a bleb in the setting of severe bullous lung disease. His treatment included chest decompression, bleb resection, and pleurodesis. However, imaging later revealed severe interstitial and alveolar lung opacities, which raised the possibility of ARDS or an adverse reaction to the talc pleurodesis. While talc is generally considered safe for pleurodesis, it can cause complications such as ARDS or other adverse reactions, which contributed to the worsening of the patient’s lung condition. Conclusion Tooth brushing, an activity typically seen as harmless, may pose a hidden risk for aspiration events that can lead to catastrophic outcomes, particularly in patients with underlying lung disease. Though pleurodesis with talc is generally safe, it is not without risks, including the potential for ARDS and other adverse reactions. This case underscores the importance of early recognition, timely management, and intervention, which were crucial to the patient’s survival. Ultimately, this patient required a double lung transplant, highlighting the severe consequences of such seemingly innocuous events. This abstract is funded by: None
Sarkar et al. (Fri,) studied this question.