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Persistent air leak after pulmonary transplantation
  1. Laurence Pearmain1,2,
  2. Piotr Krysiak1,
  3. John Blaikley1,3,
  4. Mohamed Alaloul1
  1. 1Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  2. 2Piper Hanley Group, University of Manchester Institute of Human Development, Manchester, UK
  3. 3Division of infection, Immunity and Respiratory medicine, University of Manchester, Manchester, UK
  1. Correspondence to Dr Laurence Pearmain, laurencepearmain{at}


A 59-year-old man with bilateral apical emphysema underwent a double lung transplant for end-stagechronic obstructive pulmonary disease leaving remnant right apical native tissue due to pleural adhesions. Initial postoperative course was uneventful until the chest drains were removed. This revealed a small pneumomediastinum, which progressively increased in size causing gross surgical emphysema. Re-insertion of the chest drain stabilised the patient so that the cause could be identified and corrected. Two bronchoscopies excluded anastomotic dehiscence as a cause. Therefore the subcostal wound was refashioned under video-assisted thoracoscopic surgery in case there was a defect. Unfortunately this also failed to halt the air leak; therefore another cause was sought. A multidisciplinary team meeting review of the radiology revealed that the patient's native bullous tissue was still inflated. Subsequent bronchoscopy revealed a native bronchial communication, due to variant anatomy, proximal to the surgical anastomosis. This was subsequently occluded using a bronchial valve allowing the patient to make a swift recovery.

  • Pulmonary Emphysema
  • Transplantation

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  • Contributors MA, JB, LP conceived the case report. PK and MA designed the intervention. All authors drafted and approved the manuscript before publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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