ABSTRACT
A patient developed tension pneumothorax during surgery. A 56-year-old woman with right breast cancer and axillary gland metastasis, was to undergo total right breast extirpation/axillary gland dissection, flap collection from the latissimus dorsi muscle, and reconstruction with this flap. During total right breast extirpation/axillary gland dissection, there were no problems, but the arterial blood oxygen saturation (SpO2) fell after the start of flap collection. After the start of reconstruction, SpO2 was reduced again. In the right lung field, no respiratory sound was heard, and chest X-ray showed right tension pneumothorax. A right thoracic drain was inserted and surgery was completed as scheduled. Thoracic CT did not reveal any abnormal findings, such as a brassiere, the day after surgery.
Subject(s)
Breast Neoplasms/surgery , Intraoperative Complications , Pneumothorax/surgery , Anesthesia, General , Breast Neoplasms/complications , Female , Humans , Intraoperative Complications/surgery , Lymph Node Excision , Mammaplasty , Middle Aged , Pneumothorax/etiology , Plastic Surgery Procedures , Surgical FlapsABSTRACT
We report a case of transfusion-related acute lung injury (TRALI) with anti-leukocyte antibodies detected both in the patient's serum and in the causative fresh frozen plasma. The patient was a 72-year-old Japanese woman who had undergone colectomy and stoma closure under general anesthesia. Intraoperatively she received 8 units of red cell concentrate and 12 units of fresh frozen plasma. At the end of surgery she was fully awake and extubated. Shortly after extubation her oxygen saturation dropped (90%) and she developed dyspnea. A chest X-ray revealed bilateral diffuse pulmonary edema without cardiac enlargement. The patient was re-intubated and placed on respiratory support with positive end-expiratory pressure ventilation. Her pulmonary edema improved and she was extubated again at 20 hours after surgery. Antibodies to human leukocyte antigen were detected in serum from the patient and in serum samples of the freshly frozen donor plasma; a crossmatch test of the patient's lymphocytes and donor serum was positive. We believe that anti-leukocyte antibodies caused TRALI via an immune-mediated mechanism.
