Unexpected tension Pneumothorax occurring in an elderly patient in the post Anesthesia Care Unit

Tension pneumothorax presents as a medical emergency since it spreads rapidly, disturbs the respiratory and hemodynamic functions and may be complicated by subcutaneous emphysema. Here, we report a case of an acute pneumothorax, pneumomediastinum and widespread subcutaneous emphysema that occurred unexpectedly in a 76 year old man, five minutes after his transfer to the Post Anesthesia Care Unit (PACU) following an uneventful general anesthesia for elective cholecystectomy. The main cause of the pneumothorax is believed to be rupturing of pulmonary alveoli, which might have been associated with an abrupt increase in thoracic cavity pressure. Prompt diagnosis and insertion of an underwater-seal chest drainage produced immediate recovery. The patient was sent back to his room within twenty minutes after the event and was discharged from the hospital seven days later. Anesthesiologists should be aware of the occurrence of pneumothorax in the PACU, regardless of which surgical procedure, patient population, or induction situation is associated with the event.