Atelectasis secondary to two separate video-assisted thoracoscopic wedge resection of the lung lobe and pleurodesis under general anesthesia in the same patient: a case report.

BACKGROUND: Intraoperative atelectasis is a common pulmonary complication during thoracic surgery, yet recurrent mucus-mediated atelectasis during lung re-expansion in the same patient undergoing sequential two video-assisted thoracoscopic wedge resections of the lung lobe and pleurodesis successively is extremely rare. CASE DESCRIPTION: This report describes a 15-year-old previously healthy adolescent who developed recurrent intraoperative atelectasis secondary to extensive viscous mucus plug obstruction during two successive video-assisted thoracoscopic wedge resections and pleurodesis for recurrent spontaneous pneumothorax. Notably, the patient presented no preoperative respiratory symptoms before either operation but exhibited persistent subclinical laboratory inflammatory abnormalities secondary to prior mycoplasma pneumoniae and human rhinovirus infections. Adaptive real-time video-assisted airway surveillance was implemented in the second surgery to dynamically monitor intraoperative mucus formation, enabling timely bronchoscopic lavage and mucus clearance. Atelectasis following thoracic surgery is a common pulmonary complication; however, it is rare for the same patient to experience atelectasis due to airway obstruction by copious, viscous sputum generated during surgery on two separate operation. CONCLUSIONS: Our findings indicate that persistent subclinical airway inflammation induced by prior respiratory infections, combined with surgical stress and one-lung ventilation (OLV)-related pulmonary inflammatory injury, synergistically triggers intraoperative airway mucus hypersecretion, resulting in recurrent obstructive atelectasis. This case highlights the clinical necessity of comprehensive preoperative evaluation of subclinical inflammatory status and individualized intraoperative airway management particularly the utilization of visualized airway monitoring devices for adolescent patients undergoing thoracic surgery.