title: Bilateral pneumothoraces following a right subclavian catheter insertion after thymectomy for a patient with a myasthenic crisis.
abstract: BACKGROUND
  Myasthenia gravis (MG) is an autoimmune disease involving the formation of antibodies against the nicotinic acetylcholine receptors. Thymectomy is the treatment in MG patients with thymoma. We report a case of an MG patient who developed postthymectomy bilateral pneumothoraces after the placement of a subclavian central venous catheter.
  
  
  METHODS
  The 21-year-old patient with MG underwent a thymectomy and, in a later admission, complained of myasthenic crisis symptoms. He was scheduled to receive plasma exchange therapy and electromyography the following day. Plasmapheresis was initiated after the placement of a right subclavian dialysis catheter. Postinsertion chest x-ray revealed bilateral pneumothoraces after a single unilateral attempt to cannulate the right subclavian vein. A right thoracotomy tube was placed with interval resolution of the bilateral pneumothoraces.
  
  
  CONCLUSIONS
  The development of bilateral pneumothoraces in this case was attributed to the possible accidental communication between the 2 pleural spaces, which rarely happens during thymectomy surgery.
authors.affiliation: Department of Anesthesiology, University of Cincinnati, Cincinnati, OH ; Department of Outcomes Research and.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.forename: Tamer
authors.initials: T
authors.lastname: Ghaly
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.forename: Wael Ali Sakr
authors.initials: WA
authors.lastname: Esa
keywords: Central venous catheters; chest tubes; myasthenia gravis; pneumothorax