Yoshiyama Atsushi, Kawashima Mitsuaki, Nagata Sodai, Fukushima Takahito, Aze Koji, Cong Yue, Nakao Keita, Nakao Masayuki, Toyokawa Gouji, Konoeda Chihiro, Hasegawa Kiyoshi, Sato Masaaki
Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0005. Epub 2025 Mar 25.
A pneumatocele is a cystic change in the lung that can develop as a sequelae of infection, inflammation, positive-pressure ventilation, thoracic trauma, and rarely after lung resection. Pneumatocele development triggered by an extrathoracic etiology is rare. Herein, we report a case of a pneumatocele that developed after a deceased-donor liver transplantation.
A 57-year-old woman with a diagnosis of autosomal dominant polycystic kidney disease underwent deceased-donor liver transplantation for polycystic liver disease. She did not have any background lung disease, although her right lower lobe was mostly atelectatic due to a remarkably elevated diaphragm. The liver transplant itself was uneventful. A small hole was made in the right diaphragm during the dissection of the liver, but it was successfully repaired without any injury to the lung. On postoperative day 1, the chest radiograph revealed a round hypertranslucency on the right side, which was initially considered subphrenic air retention, and no further evaluation was made at that time. Given that the hypertranslucency persisted, follow-up computed tomography was performed on postoperative day 18, and revealed an air-fluid level above the diaphragm in the right thoracic cavity. Thoracoscopic investigation revealed an intrathoracic hematoma within a pneumatocele in the right lower lobe, which was not detected in the pretransplant computed tomography. The hematoma was removed, and the pneumatocele was resected.
We experienced a case of a pneumatocele that developed after deceased-donor liver transplantation for multiple hepatic cysts due to autosomal dominant polycystic kidney disease. Although the mechanisms are speculative, the pneumatocele might have been triggered by the sudden alleviation of the elevated diaphragm and reinflation of the atelectatic lung.
肺气囊是肺部的一种囊性改变，可作为感染、炎症、正压通气、胸部创伤的后遗症出现，在肺切除术后很少发生。由胸外病因引发的肺气囊形成较为罕见。在此，我们报告一例在已故供体肝移植后发生肺气囊的病例。
一名57岁诊断为常染色体显性多囊肾病的女性因多囊肝病接受了已故供体肝移植。她没有任何肺部疾病史，尽管由于膈肌明显抬高，其右下叶大部分肺不张。肝移植手术本身顺利。在肝脏解剖过程中，右侧膈肌上开了一个小孔，但成功修复，未对肺造成任何损伤。术后第1天，胸部X线片显示右侧有一个圆形透亮区，最初被认为是膈下积气，当时未作进一步评估。鉴于透亮区持续存在，术后第18天进行了随访计算机断层扫描，显示右侧胸腔内膈肌上方有气液平面。胸腔镜检查发现右下叶肺气囊内有胸腔内血肿，术前计算机断层扫描未检测到。血肿被清除，肺气囊被切除。
我们遇到一例因常染色体显性多囊肾病导致的多发性肝囊肿在已故供体肝移植后发生肺气囊的病例。尽管其机制尚属推测，但肺气囊可能是由抬高的膈肌突然缓解和肺不张的肺重新充气引发的。
