Abstract Introduction Pneumothoraces have been described in literature as a consequence of Septic Pulmonary Emboli (SPE). This case describes a patient with bilateral pneumothoraces secondary to pulmonary septic embolism and successful treatment with talc pleurodesis. Case Report A 47-year-old female with past medical history of end-stage renal disease presented for full body aches, chest pain, and dyspnea. Two weeks earlier, she had been hospitalized for septic shock due to klebsiella bacteremia. No initial source of infection was found during that admission, and she was treated with cefazolin. Repeat cultures during this most recent admission again revealed klebsiella bacteremia. CT angiography of the chest was obtained to rule out pulmonary embolism. While no embolus was identified, CT revealed numerous bilateral peripherally distributed ground glass nodules, evidence of early cavitation, and feeding vessel sign suggestive of SPE. Later in admission, she became hypotensive during routine dialysis requiring escalation to ICU-level care. Her mental status quickly worsened, and she was later intubated for airway protection. After intubation, she had intermittent self-limited episodes of hypotension and hypoxia. Chest Xray a few days later revealed a right-sided pneumothorax for which a right-sided chest tube was placed. Follow-up imaging incidentally revealed a left-sided pneumothorax, and second chest tube was placed. Repeat CT imaging revealed persistent bilateral pneumothoraces and conversion of ground-glass nodules to pneumatoceles. It was hypothesized that the positive pressure from mechanical ventilation ruptured the existing areas of septic emboli and caused pneumothoraces. Despite placement of chest tubes to suction bilaterally, she had recurrence of pneumothoraces. She required a total of four separate chest tubes for management. Thoracic surgery was later consulted and pursued VATS, a fifth chest tube placement, and talc pleurodesis. There was an initial post-procedural pneumothorax, but it resolved within a matter of days without further intervention and all chest tubes were pulled. Discussion There is still a dearth of case presentations of Pneumothorax Secondary to SPE in literature. Few case reports describe the treatment of these pneumothoraces with pleurodesis. One case reports use of minocycline while another reports use of talc. In both cases, pneumothorax resolved without recurrence. Our case further supports the use of pleurodesis to treat pneumothoraces secondary to SPE. This abstract is funded by: None
Cocjin et al. (Fri,) studied this question.