Capnothorax (Carbon Dioxide Pneumothorax)

Etiology

  • Laparascopy (see Laparoscopy): CO2 insufflation into peritoneal space during the procedure may result in gas traversing diaphragm to enter the pleural space, resulting in capnothorax

Physiology

  • CO2 Insufflation into Peritoneal Space During Laparoscopy: gas traverses diaphragm to enter the pleural space

Clinical

  • Appearance of “Pneumothorax” (on CXR/Chest CT)
    • Dyspnea
    • Chest Pain
    • Respiratory Failure

Treatment

  • Observation with Supportive Care: typically resolves rapidly (within minutes-one hour) without treatment -> chest tube is typically not required

Prevention

  • Maintenance of Moderate-to-Low Intra-Abdominal Pressure (<12 mm Hg) During Laparoscopy: can help limit the development of capnothorax

References

  • Circulatory and Respiratory Complications of Carbon Dioxide Insufflation. Dig Surg 2004;21:95–105 [MEDLINE]