[Prolonged iatrogenic pneumothorax with refractory hepatic hydrothorax treated successfully with local anesthetic thoracoscopic talc poudrage].

A 64-year-old woman with liver cirrhosis caused by hepatitis C was presented with aggravated dyspnea. She had refractory hepatic hydrothorax, requiring pleural puncture and drainage of approximately 3,000 ml per week. Four days after the last puncture, she consulted the emergency department and chest films revealed right tension pneumothorax. A drainage tube was inserted to her right pleural cavity, but middle and lower lobes were not expanded, and air leaks persisted. We thought that she was in high-risk of infections, like empyema, and needed surgical treatment to close the pulmonary fistula promptly. Considering her poor general condition, we performed local anesthetic thoracoscopic talc poudrage, and air leaks were controlled successfully. Perioperative period was uneventful.