Contralateral tension pneumothorax after extubation following thoracoscopic wedge resection: a case report

Contralateral tension pneumothorax is a rare but potentially life-threatening complication after thoracic surgery and may be difficult to distinguish from more common postoperative respiratory complications. We report a case of a 53-year-old female patient who developed a right tension pneumothorax during recovery from anesthesia following a thoracoscopic left wedge resection performed under one-lung ventilation. The patient experienced severe coughing and choking during extubation; immediately after extubation, she initially presented with dyspnea and bilateral wheezing, raising suspicion of bronchospasm. Despite aggressive diagnostic and therapeutic efforts, respiratory abnormalities persisted, and the patient was ultimately diagnosed with a right-sided tension pneumothorax. Following emergency needle decompression, surgical exploration was immediately performed, revealing a ruptured band of right-sided pleural adhesions accompanied by ongoing air leakage. After definitive treatment, the patient made a smooth recovery. This case highlights that when unexplained respiratory abnormalities occur following thoracic surgery, even if initial oxygenation is adequate, the possibility of contralateral tension pneumothorax should be considered, and cough management should be optimized.