What question did this study set out to answer?

This study aims to highlight the occurrence and implications of iatrogenic pneumothorax from various surgical sites and propose a monitoring strategy.

April 18, 2026Open Access

Iatrogenic pneumothorax associated with surgeries at anatomically thoracic-adjacent and non-adjacent sites: case report and scoping review

Key Points

This study aims to highlight the occurrence and implications of iatrogenic pneumothorax from various surgical sites and propose a monitoring strategy.
Performed a case report on a patient with pneumothorax post-spinal surgery and conducted a scoping review of related cases.
Utilized lung ultrasound in the PACU to aid in diagnosis due to unavailability of bedside chest X-ray.
Reviewed 18 surgical sites potentially leading to pneumothorax, both adjacent and non-adjacent to the thorax.
Identified a rare case of complete right-sided pneumothorax due to pedicle screw penetration into the thoracic cavity.
Showcased successful immediate closed chest drainage leading to rapid symptom improvement.
Confirmed that pneumothorax can arise from surgeries even distant from thoracic organs, with laparoscopic cases being common.

Abstract

Iatrogenic pneumothorax associated with surgeries at anatomically thoracic-adjacent and non-adjacent sites is characterized by an insidious onset, delayed presentation, and high rates of misdiagnosis, posing significant risks to patients. This study presents a case report and scoping review, and proposes a practical and cost-effective proactive monitoring strategy. We report a rare case of complete pneumothorax following thoracolumbar spinal fixation surgery. The patient developed hypoxemia and diminished right breath sounds in the post-anesthesia care unit (PACU). Bedside lung ultrasound by the anesthesiologist suggested pneumothorax. Given the unavailability of bedside chest X-ray and the thoracic surgeon’s doubt regarding ultrasound diagnostic qualifications, an emergency CT scan was performed, which confirmed right-sided complete pneumothorax caused by pedicle screws penetrating the vertebral body into the thoracic cavity. Immediate closed chest drainage led to rapid symptom relief. The scoping review identified 18 sites of pneumothorax resulting from surgeries at anatomically thoracic-adjacent and non-adjacent sites, including the thyroid, clavicle, breast, liver, stomach, spleen, spine, shoulder arthroscopy, back acupuncture, liposuction, pacemaker placement (involving the hypoglossal nerve and heart), subdural-peritoneal shunt, costal cartilage, kidney, gallbladder, inguinal hernia, and the frontal facial region. Anatomical adjacency is the primary cause of pneumothorax resulting from surgeries at thoracic-adjacent sites. Pneumothorax can also occur in cases where the surgery is distant from chest structures, with carbon dioxide pneumothorax resulting from laparoscopic surgery being the most common. Clinical symptoms remain the primary means of initial detection; however, there is a lack of predictability and proactivity. We suggest the implementation of a low-threshold, symptom-driven lung ultrasound screening protocol in the PACU for patients who present with unexplained hypoxemia, respiratory symptoms, or suspected intraoperative pleural injury, particularly after undergoing surgeries at anatomically thoracic-adjacent or non-adjacent sites. This targeted strategy effectively balances the need for early diagnosis with clinical feasibility.

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