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Pneumothorax is an uncommon but a well-recognized
complication of hemodialysis catheter or central line
insertion in internal jugular vein or subclavian vein.
Subclavian catheterization is more likely than internal
jugular catheterization to be complicated by pneumothorax
and hemothorax1. Data regarding spontenous
pneumothorax during hemodialysis are not available, and
in our opinion this is probably the first case report. A 58-
year-old tribal man was admitted in medicine department
for complain of weakness, puffiness of face, oedema in
lower limb. His investigation revealed total leucocyte count
Spontaneous Pneumothorax Complicating Hemodialysis
SUNIL KUMAR1, SK DIWAN1, AP SINGH1, S. KOPPATIWAR1
1. Department of Medicine, Jawahar Lal Nehru Medical College, DMIMS, Sawangi, wardha.
Correspondence : Dr. Sunil Kumar, Associate professor, Department of medicine. DMIMS, Sawangi, wardha; E-mail –
sunilkumarmed@gmail.com
Fig.-1
16000/cmm, neutrophil 80%, Hb 6 gm/dl, serum creatinine
6.5 mg/dl, blood urea 138 mg/dl, and serum potassium 5.2
mEq/l. His fasting blood sugar was 96 mg/dl and post-
prandial glucose was 138 mg/dl. Due to deteriorated renal
function he underwent hemodialysis with a double lumen
hemodialysis catheter in right internal jugular vein by seldinger
technique under full aseptic precaution in the dialysis unit of
the medicine department. He was doing well. On day 18th
during the process of hemodialysis he complained of acute
breathlessness with diaphoresis. Blood sugar and blood
pressure were checked which were normal. On chest
examination breath sound was absent on right side. Chest x-
ray was obtained which revealed pneumothorax (fig). Water
sealed intercostal tube was inserted, pneumothorax improved
as well as his breathlessness. We searched the literature,
textbook, pubmed, medlar, there was no any case report or
article regarding this and its mechanism. Probable
hypothesis may be secondary to pulmonary embolisation
either due to central venous catheter infection2 or
sometimes hemodialysis machine itself which doesnot
censor micro air emboli. The pneumothorax was thought to
be due to rupture of the subpleural lesions. Any of the
above explanations or some other unknown mechanisms
may explain its association we may not accept or reject any,
and further research is needed.
Conflict of interest: None
References:
1. David C M, Michael K G. Preventing Complications of
Central Venous Catheterization. N Engl J Med 2003;
348:1123-33.
2. C C Sheu, J J Hwang, J R Tsai, T H Wang, I W Chong, M S
Huang. spontaneous pneumothorax as a complication of
septic pulmonary embolism in i.v. drug user: a case report.
Kaohsiung J Med Sci 2006; 22:89–93
J MEDICINE 2012; 13 : 125
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