Pregnancy with hypoplastic left lung complicated by pneumothorax and pulmonary embolism

Abstract

We report a case of a 34‐year‐old lady with past history of asthma and pulmonary tuberculosis, who presented 5 weeks pregnant with acute dyspnea. Her chest X‐ray showed left‐sided complete lung collapse and concomitant right‐sided pneumothorax. The pneumothorax was initially managed conservatively with a chest tube but due to its persistence despite suction, was subsequently changed to a PneumostatTM, with which she was later discharged. She had a normal echocardiography (ejection fraction [EF] 67%) at 5 weeks of gestation but developed pulmonary hypertension (EF 55%, pulmonary arterial pressure 40.7 mmHg) as the pregnancy progressed. She delivered a healthy baby at 35 weeks via elective lower section caesarean section with spinal anesthesia. We followed her up postnatally and noted the presence of left‐sided pulmonary embolism, hypoplastic left lung, and left pulmonary artery. The management of this complex case involved a multidisciplinary effort between general medical, respiratory, obstetric, and cardiothoracic teams.

Anesthetic considerations for cesarean section in a parturient complicated by Scimitar syndrome-like pathophysiology

“…c On the day before cesarean section, chest X-ray in supine position confirmed no significant displacement of the diaphragm, when considering the impact of the posture on diaphragm position; however, it revealed further increase of vascular shadows in the right lung field. d No abnormal findings in the lung field and no significant change of the diaphragm level, compared with those the day before the operation, were confirmed, immediately after the cesarean section ventilation [4,6,7]. Muammer et al reported that spinal anesthesia (SA) for cesarean section had no negative effects, on both FVC and FEV 1.0 , even in a woman with CF, who had severely impaired pulmonary function [7].…”