Timely rescue of a man with severe pneumothorax due to ruptured air sac

Mr. H. was brought to the doctor after suddenly experiencing sharp, stabbing pain in his left chest, radiating to his left shoulder and arm, which worsened with changes in posture or deep breathing.

In addition, according to the patient, he experienced mild shortness of breath and a dry cough. Prior to this, he was completely healthy except for a 30-year history of smoking (one pack every two days) and a diagnosis of pulmonary cysts in 2022. The family noted that his wife had been treated for pulmonary tuberculosis from January to June 2025.

Examination showed that the patient had rapid, shallow breathing, poor left lung ventilation, hyperresonance on percussion, decreased fremitus, and positive Galliard triad.

X-ray images of the patient.

Heart rate was regular at 98 beats/minute, blood pressure 140/90 mmHg, SpO₂ 95%. Low-dose CT scan revealed a large left pneumothorax, causing passive lung collapse of up to 75%, strongly suggesting a ruptured air cyst.

The images also showed air cysts in the upper lobe of the left lung and alveolar dilation adjacent to the lung septa. Echocardiography and pleural ultrasound revealed the heart displaced to the right, loss of pleural slippage, and absence of the B-line.

With a diagnosis of severe pneumothorax due to ruptured air cyst, the doctors immediately performed aspiration drainage using a large needle. After only 30 minutes, the patient's chest tightness and shortness of breath improved significantly, the air in the pleural cavity decreased, and he was transferred to another facility for endoscopic intervention to treat the air cyst. A week later, the patient recovered well, no longer experienced chest pain, and was discharged from the hospital.

According to Dr. Hoang Minh Toai, from MEDLATEC Thanh Xuan Multi-Specialty Clinic, pulmonary air cysts are air-filled sacs located within the lung parenchyma, with thin walls and no respiratory function.

Air cysts can be congenital, but most are acquired due to chronic respiratory diseases such as lung infections, chronic bronchitis, emphysema, lung abscesses, lymphoproliferative disorders, or long-term smoking. Notably, many cases progress silently, with patients only discovering them incidentally during imaging.

Some people may experience respiratory symptoms such as coughing, shortness of breath, breathlessness, dry cough, or cough with sticky phlegm. These symptoms are easily confused with other respiratory illnesses and are therefore often overlooked.

If left untreated, air cysts can cause serious complications such as rupture leading to pneumothorax, a life-threatening emergency, or infection causing pleural effusion. Large cysts can also compress the trachea and esophagus, causing lung collapse or difficulty swallowing and breathing.

Dr. Toai advises that people with a history of heavy smoking, chronic lung disease, a history of air cysts, or recurrent respiratory infections should be closely monitored and undergo regular health checkups.

Regular respiratory checkups help detect abnormalities early, allow for timely intervention, and prevent dangerous complications such as pneumothorax.

Source: https://baodautu.vn/kip-thoi-cuu-song-nguoi-dan-ong-bi-tran-khi-mang-phoi-nang-do-vo-ken-khi-d453187.html