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Thoracoscopic surgery using local and epidural anesthesia for intractable pneumothorax after BMT

Bone Marrow Transplantation volume 46, pages 472–473 (2011)Cite this article

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Although BMT offers potentially curative therapy for hematological malignancies, pulmonary complications occur in 40–60% of these patients and are a major cause of morbidity and mortality.1 Such problems include pneumonitis, GVHD and chronic obstructive pulmonary disease. Bronchiolitis obliterans (BO) is recognized as an important problem after BMT and is known to be a manifestation of GVHD.2 Air-leak syndromes such as pneumomediastinum, s.c. emphysema and pneumothorax have been documented in patients with BO. Patients suffering from pneumothoraces associated with BO sometimes have a fatal outcome because of the difficulty in controlling air leaks. Such persistent air leakage can be managed by nonsurgical or surgical procedures. Nonsurgical procedures include tube thoracostomy or chemical pleurodesis with agents such as tetracycline, talc or silver nitrate. Successful treatment with autologous blood pleurodesis has also been reported in a patient with a pneumothorax due to BO after BMT.3 Surgical procedures include ablation, ligation and excision of bullae or emphysematous lesions, and usually require single lung ventilation under general anesthesia. However, this can result in adverse effects in patients with severe pulmonary disease.

We report a case of intractable pneumothorax due to BO after BMT, successfully treated by a thoracoscopic surgical approach under local and epidural anesthesia.

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Authors and Affiliations

  1. Department of Chest Surgery, NHO Okayama Medical Center, Okayama, Japan

    H Shigematsu, A Andou & R Higashi

  2. Department of Respiratory Medicine, NHO Okayama Medical Center, Okayama, Japan

    K Matsuo & T Satoh

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  1. H Shigematsu
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  2. A Andou
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  3. K Matsuo
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  4. T Satoh
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  5. R Higashi
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Correspondence to H Shigematsu.

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Shigematsu, H., Andou, A., Matsuo, K. et al. Thoracoscopic surgery using local and epidural anesthesia for intractable pneumothorax after BMT. Bone Marrow Transplant 46, 472–473 (2011). https://doi.org/10.1038/bmt.2010.142

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