ARRS 2022 Abstracts

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E1758. Trapped Lung: Review of Imaging Features and Management
Authors
  1. Gaurav Parmar; Yale New Haven Health Bridgeport Hospital
  2. Ayah Megahed; Yale New Haven Health Bridgeport Hospital
  3. Ali Rahmat; Yale New Haven Hospital - YUSM
Background
Trapped lung, also known as unexpandable lung, is defined as failure of lung expansion to fill the thoracic cavity. It is a common complication of pleural disease resulting from inflammatory or malignant process. This unusual but well-known condition is seen post thoracentesis when lung fails to expand. Patients present with either pneumothorax post thoracentesis or develop anterior chest pain preventing the drainage of pleural effusion. Trapped lung should be promptly diagnosed and appropriately managed to avoid the potential high morbidity of multiple invasive procedures when it is misdiagnosed as pneumothorax.

Educational Goals / Teaching Points
This exhibit aims to identify the predisposing factors leading to trapped lung; review the pathophysiology, clinical, and imaging features; and describe management options available for trapped lung.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Active or chronic pleural inflammation can result in the formation of fibrous restrictive covering that prevents the lung from fully expanding when the plural fluid is removed. A similar process can also be seen with malignant pleuro-pulmonary conditions. Trapped lung on post thoracentesis chest X-ray will often show the air in the pleural space with the same size and configuration as the prior pleural effusion. CT of the chest often shows pleural thickening, pneumothorax, or hydropneumothorax with or without loculations. Management of symptomatic trapped lung is primarily surgical decortication using a VATS procedure. Other therapeutic rather palliative management options include intrapleural fibrinolytic therapy, pleuroperitoneal shunt, and implantable pleural catheter.

Conclusion
Recognizing and evaluating trapped lung is crucial, as many of these patients are subjected to frequent invasive procedures such as chest tubes and repeat thoracentesis. Repeated intervention prolongs hospitalization and adds to the patient morbidity. Surgical decortication is the curative treatment that should be offered to symptomatic patients with trapped lung.