title: Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior fracture stabilization.
abstract: METHODS
  Case report and clinical discussion.
  
  
  OBJECTIVE
  A rare case of air passage into multiple body compartments after thoracoscopic minimally invasive spine surgery is described.
  
  
  BACKGROUND
  In recent years, there is growing interest in thoracoscopic minimally invasive spine surgery for the treatment of thoracic and lumbar spine fractures. Severe complications due to the operative procedure are rare.
  
  
  METHODS
  We present a case of a 73-year-old woman who developed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior stabilization of a Th12 fracture.
  
  
  RESULTS
  The operative procedure was completed without any obvious intraoperative complications. Routine made postoperative radiograph of the chest revealed a pneumothorax on the right side, bilateral subphrenic free air, and bilateral supraclavicular air. Subsequently, a CT scan showed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and a supraclavicular subcutaneous emphysema. Bronchoscopy, esophagogastroduodenoscopy, and laryngoscopy showed no hollow organ injury or any other pathologic changes. Intraabdominal free air and pneumothoraces could not be detected on thoracic radiographs after 2 days. The patient remained cardiopulmonary stable throughout the hospital course.
  
  
  CONCLUSIONS
  This report documents a rare case of air passage into multiple body compartments after thoracoscopic-assisted treatment of a spinal fracture, which has not yet been described previously. After exclusion of a tracheo-bronchial and hollow organ injury the process was self-limiting. To avoid this complication, special care should be taken to evacuate all intrathoracal air at the end of the endoscopic procedure.
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg/Saar, Germany. chpgar@uniklinikum-saarland.de
authors.forename: Patric
authors.initials: P
authors.lastname: Garcia
authors.forename: Antonios
authors.initials: A
authors.lastname: Pizanis
authors.forename: Alexander
authors.initials: A
authors.lastname: Massmann
authors.forename: Birgit
authors.initials: B
authors.lastname: Reischmann
authors.forename: Markus
authors.initials: M
authors.lastname: Burkhardt
authors.forename: Georgios
authors.initials: G
authors.lastname: Tosounidis
authors.forename: Hauke
authors.initials: H
authors.lastname: Rensing
authors.forename: Tim
authors.initials: T
authors.lastname: Pohlemann
mesh_terms: D034841:Abdominal Cavity / Q000473:pathology / Q000503:physiopathology; D000368:Aged; D001999:Bronchoscopy; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012188:Retropneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D035423:Thoracic Cavity / Q000473:pathology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed