Pneumothorax after Shoulder Arthroscopy: A Rare but Life-threatening Complication

Abstract

Introduction: Arthroscopy has become a major diagnostic tool and treatment option for shoulder pathology. However rare, respiratory complications such as a pneumothorax have been reported in patients undergoing shoulder arthroscopy. Surgery - as well as anesthesiology-related factors and respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications.

Case report: We report the case of a 42-year-old male patient who underwent an arthroscopy of the left shoulder. The anesthesia, the surgical procedure as well as the post-operative course went uncomplicated. The patients were discharged 6 h after the end of the surgical procedure. 4 h after discharge, however, the patient developed severe respiratory distress and signs of hemodynamic shock due to an ipsilateral (tension) post-operative pneumothorax. The available literature is reviewed focusing on the possible pathogenic mechanisms implying the development of this complication.

Conclusion: The presence of a pneumothorax after shoulder arthroscopy is a rare but dangerous complication. It can primarily be attributed to rupture of parietal pleura, rupture of visceral pleura, and alveolar rupture or trauma during anesthesia. In our patient, we speculate that a rupture of parietal pleura was the underlying cause. This can be related to the surgical methodology (portal placement and continuous pump infusion with intermittent suction) and subacromial distention used during the procedure. Awareness, prompt recognition, and treatment are necessary.

Keywords: Shoulder arthroscopy; complications; pneumothorax.

Figure 1

Diagnostic imaging of the post-operative pneumothorax (arrows). A tension component is notable (note the mediastinal shift to the right).

Figure 2

By chest tube (arrow) treated pneumothorax. The pneumothorax is no longer visible in this image.