Recurrent spontaneous pneumothorax in pregnancy – a case report and review of literature

Abstract

Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks’ gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2.5 kg female infant was delivered. We discuss spontaneous pneumothorax during pregnancy and review the literature.

Recurrent spontaneous pneumothorax in pregnancy-a case report

“…Review of the literature showed that most of the cases of pneumothorax occurred during the last trimester and during the perinatal period. 1,3,7 Pneumothorax in pregnancy presents with the same signs and symptoms as described in our case i.e., pleuritic chest pain and shortness of breath. 7 However, these symptoms are nonspecific and can be attributed to other more common diseases like asthma, paroxysmal tachycardia, or neuralgia.…”

“…4 Various changes occurring in the respiratory physiology during pregnancy like a decrease in functional residual capacity and total lung capacity and an increase in respiratory rate, minute ventilation and tidal volume are responsible for the increased risk of pneumothorax in pregnancy. 3,5,6 In our case, both episodes of pneumothorax occurred during the same pregnancy in the last trimester. Review of the literature showed that most of the cases of pneumothorax occurred during the last trimester and during the perinatal period.…”

“…7 However, these symptoms are nonspecific and can be attributed to other more common diseases like asthma, paroxysmal tachycardia, or neuralgia. 3 Our patient had tachycardia, tachypnoea, decreased air entry with normal oxygen saturation and hyper-resonant percussion note over the affected site. Similar clinical findings were noted in other cases as well.…”

“…Pulmonary lymphangiomatosis and cavitary tuberculosis are some of the rare causes. 3 Some other risk factors include asthma, cocaine use, hyperemesis gravidarum, history of a previous pneumothorax, or an underlying infection. 4 Various changes occurring in the respiratory physiology during pregnancy like a decrease in functional residual capacity and total lung capacity and an increase in respiratory rate, minute ventilation and tidal volume are responsible for the increased risk of pneumothorax in pregnancy.…”

Postpartum Bilateral Tension Pneumothoraces

“…Thus labour entails a ‘perfect storm’ for barotrauma to unmask anatomical defects and rarely ensuing unilateral pneumothorax [6], pneumomediastinum (Hamman’s syndrome) [7], pneumopericardium [8], oesophageal perforation [9] and even diaphragmatic rupture [10] have all been described. In this case, signs of underlying pulmonary lymphangioleiomyomatosis were subsequently identified.…”