Shifting Pneumothorax: A Radiographic and Sonographic Evaluation

A 62-year-old woman was admitted for elective bilateral nephrectomies for symptomatic large bilateral polycystic kidneys. In the immediate postoperative period, the patient was hypotensive requiring multiple crystalloid boluses and received stress dose steroids. On postoperative day 4, while on mechanical ventilation, the patient developed a large hydropneumothorax on the left. Sonographic evaluation of the right lung did not show signs of pneumothorax; however, the left lung ultrasound scan revealed signs consistent with pneumothorax. A 28F chest tube was inserted on the left side to drain the hydropneumothorax. On entering the left thoracic cavity with Kelly clamp, there was no air release, only clear serous pleural fluid drained, with absence of air leak from the drainage system. The post-chest tube insertion chest X-ray revealed resolution of the left pneumothorax with development of a new contralateral right pneumothorax, demonstrating a shift of the pneumothorax from the left to the right side. This study reports a case of nonsimultaneous bilateral spontaneous pneumothorax using lung ultrasound in the diagnosis with a literature review and discussion on the possible explanation of this unique phenomenon.