A case of left pneumothorax followed by adult respiratory distress syndrome (ARDS)

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We report a 55-year-old male patient with a left pneumothorax followed by ARDS, who had a history of pulmonary emphysema. On admission to our hospital, after the diagnosis of left pneumothorax, tube drainage of the left thorax was performed. He suffered severe hypoxemia, and a CT scan of the lung revealed consolidation and a honey comb pattern in the left lung. He was diagnosed with ARDS, and started treatment with corticosteroids and sivelestat sodium hydrate. He received conservative treatment, but the left pneumothorax did not improve. On the 19th day after admission, he underwent video-assisted thoracic surgery. The surface of the left lung became hard and thick like the liver, and large and small bullae were detected. A bulla of the left upper lobe was resected and air-leaking sites were sealed by bioabsorbable PGA sheets and fibrin glue. Histological examination revealed the proliferation of myofibroblasts and hyperplasia of type II pneumocytes, which were consistent with the diagnosis of the proliferative stage of ARDS.