Computed tomography-guided tube thoracostomy for massive subcutaneous emphysema following lung resection: a case report

Toshinari Ema, Hiroshi Neyatani, Saki Yamamoto, Shuhei Iizuka, Kazuhito Funai, Norihiko Shiiya


A 70-year-old man underwent right-sided pulmonary bilobectomy (removal of the middle and lower lobes) for stage IIIA non-small-cell lung carcinoma. Following the operation, there was minor air leakage through the intercostal drain from postoperative day 0 to 2, which stopped completely by postoperative day 3. The subsequent postoperative course was uneventful, and the patient was discharged on postoperative day 7 after removal of the chest tube. On postoperative day 9, the patient returned to the hospital with complaints of nasal speech and bulging of the skin over his right breast region. He was diagnosed with postoperative subcutaneous emphysema. A chest computed tomography (CT) scan revealed that the emphysema was not associated with a collapsed lung, and the patient’s relatively small-sized thoracic cavity left limited space for the placement of a chest tube. We performed a CT-guided tube thoracostomy with proper insertion and placement of an intercostal drain at the site of the air leakage, within the compact thoracic cavity. The procedure was effective in draining the trapped air, thus resolving the subcutaneous emphysema successfully.