Pneumatocele after lung transplantation

Pneumatoceles are a known complication of pneumonia or trauma, especially in young children. A 44-year-old male with pulmonary veno-occlusive disease and pulmonary hypertension underwent double lung transplantation with cardiopulmonary support. The patient had experienced severe primary graft dysfunction and bilateral lower lobe pneumonia. Posttransplant bronchoalveolar lavage fluid identified Staphylococcus aureus and Burkholderia cepacia. We started trimethoprim-sulfamethoxazole, meropenem, and minocycline. We also switched him to a prone position every 12 h for 3 days. The respiratory condition gradually improved with systemic therapy, prone position, oxygenation with ventilator, and venous-venous extracorporeal membrane oxygenation. Pneumatocele developed at the site of pneumonia. Although the pneumatocele was gradually increasing the size, we decided to continue conservative treatment. The pneumatocele spontaneously ruptured, and asymptomatic pneumothorax developed. We performed percutaneous drainage for pneumothorax, and the pneumatocele resolved. After he was discharged from the hospital, that pneumatocele shrank and disappeared. Pneumatocele can occur at the site of pneumonia after lung transplantation. It may be curable with conservative treatment, but the possibility of sudden rupture and pneumothorax should be considered.