CTICasesContralateral Pneumothorax Following Thoracentesis
Imaging findings
A patient with complete left lung collapse and pleural effusion underwent thoracentesis via a left axillary approach. A subsequent chest radiograph shows a large pneumothorax on the *contralateral* (right) side, with displacement of the diaphragm, consistent with a tension pneumothorax. This occurred because the right lung had herniated across the mediastinum to fill the space left by the collapsed left lung, and was inadvertently punctured during the procedure. Pigtail catheters were subsequently placed bilaterally.
Key takeaways
In cases of severe unilateral lung collapse with mediastinal shift, the contralateral lung may herniate across the midline to compensate for volume loss. This can create a significant risk of iatrogenic injury to the *contralateral* lung during procedures like thoracentesis, leading to an unexpected pneumothorax. Awareness of mediastinal anatomy and potential lung herniation is crucial for safe procedural planning and execution.
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