Tension Pneumothorax during Liver and Kidney Transplantation in a Patient with Adult Polycystic Kidney Disease

Administering anesthesia to patients undergoing liver transplantation often yields intraoperative hemodynamic instability. During this type of major surgery, many factors may contribute to hemodynamic collapse, including myocardial infarction, pulmonary embolus, bleeding, and preload reduction owing to inferior vena cava clamping. Pneumothorax, a potentially dangerous condition, can arise unexpectedly during anesthesia. Diagnosis is based on exclusion, as the initial vital sign changes, including cardiorespiratory decompensation, are non-specific. Here, we describe the case of a patient with adult polycystic kidney disease who developed intraoperative cardiovascular collapse and hypoxemia owing to tension pneumothorax during liver and kidney transplantation. We highlight the etiology of intraoperative tension pneumothorax, the sequence of hemodynamic changes, and the importance of early diagnosis and treatment.