CTICasesPneumothorax Ex Vacuo after Endobronchial Valve Placement
Imaging findings
Post-procedure imaging after placement of four bronchial valves in the left upper lobe for emphysema lung volume reduction shows an airless, opacified left upper lobe and an adjacent pneumothorax with absent pulmonary vessels, distributed in the upper and anterior hemithorax with a basal fluid level. The extensive distribution of the pleural gas and fluid indicates the air is within the pleural space (ex vacuo) rather than extrapleural.
Key takeaways
Endobronchial valve lung volume reduction can produce a pneumothorax ex vacuo as the treated lobe collapses, with the gas (largely nitrogen coming out of tissues into the low-pressure space) filling the pleural space around the airless lobe. Management is uncertain: ex vacuo pneumothorax with obstructive atelectasis classically needs no chest tube, but symptomatic patients often get one with variable success, and persistent atelectasis or complicated pneumothorax may prompt valve removal; complete fissures increase both efficacy and the likelihood of collapse.
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