CTICasesRight Bronchial Anastomotic Dehiscence after Bilateral Lung Transplant
[...]. Right Bronchial Anastomotic Dehiscence after Bilateral Lung Transplant. CTICases. Published September 19, 2026. https://cticases.com/c/hjfw5
Imaging findings
About two weeks after bilateral lung transplantation, a patient who had been doing well had a satisfactory frontal and lateral radiograph in the morning and deteriorated later the same day with extensive chest wall soft tissue gas and a pneumothorax. CT showed extraluminal gas in multiple locations, a large pneumothorax with collapsed lung, gas in the chest wall and pneumopericardium, with the pleural spaces and pericardium communicating anteriorly. The lung apices had been trimmed at implantation. Along the right bronchial anastomosis there was a wall defect with a small tract passing inferiorly toward the right pleural space, confirmed on coronal reformats, while the left anastomosis looked intact. Bronchoscopy confirmed dehiscence. Small tracts through the divided intercostal muscles on both sides allowed air to escape from the pleural space into the chest wall.
Key takeaways
When sudden pneumothorax or extensive extraluminal air appears after lung transplantation, check the bronchial anastomoses first, since they are easy to overlook. A slight telescoping at the anastomosis can be confusing, but a true dehiscence shows a defect with a tract leading out of the airway. After a clamshell thoracotomy the pleural spaces and pericardium communicate for a period, explaining pneumopericardium, and the divided intercostal muscles leave channels that let pleural air track into the chest wall with each breath. Early anastomotic dehiscence has become uncommon with improved surgical technique; anastomotic stenosis, treated with serial dilation, is now the more frequent bronchial complication.
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