Korean J Pain.  2012 Jan;25(1):33-37. 10.3344/kjp.2012.25.1.33.

Ultrasound-guided Aspiration of the Iatrogenic Pneumothorax Caused by Paravertebral Block: A Case Report

• Park JS
• Kim YH
• Jeong SA
• Moon DE

• KMID: 2278113
• DOI: http://doi.org/10.3344/kjp.2012.25.1.33

Abstract

Thoracic paravertebral block is performed for the treatment of patients with chronic pain, such as complex regional pain syndrome (CRPS) and post-herpetic neuralgia. Thoracic paravertebral block can result in iatrogenic pneumothorax. Because pneumothorax can develop into medical emergencies and needle aspiration or chest tube placement may be needed, early diagnosis is very important. Recently, thoracic ultrasonography has begun to be used to diagnose pneumothorax. In addition, ultrasound-guided aspiration can be an accurate and safe technique for treatment of pneumothorax, as the needle position can be followed in real time. We report a case of iatrogenic pneumothorax following thoracic paravertebral block for the treatment of chronic pain due to CRPS, treated successfully by ultrasound-guided aspiration.

Keyword

aspiration; paravertebral; pneumothorax; ultrasonography

MeSH Terms

Chest Tubes
Chronic Pain
Early Diagnosis
Emergencies
Humans
Needles
Neuralgia
Pneumothorax

Figure

• 

  Fig. 1 Initial chest x-ray shows pneumothorax in left hemithorax (white arrow) and partially collapsed left lung.

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  Fig. 2 Initial ultrasound images of the second intercostal space. White arrow indicates parietal pleura without lung sliding sign. Blanked arrow indicates horizontal artifacts.

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  Fig. 3 Ultrasound image during aspiration of air in the interpleural space. Arrowhead indicates the needle tip bellow the parietal pleura.

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  Fig. 4 A picture which shows aspiration using 18 gauge angiocatheter, 3 ways valve and 50 ml syringe. A angiocatheter is placed in the second intercostal area. A large block dot indicate the nipple of patient.

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  Fig. 5 Chest-x ray after air aspiration shows shows decreased size of pneumothorax (arrowhead).

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  Fig. 6 Ultrasound image after air aspiration. This shows that lung sliding sign is seen of the plural line (white arrow) and comet-tail artifact from the pleural line to the edge of the screen (arrowhead).

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