Flickering diaphragm sign, an indicator of laparoscopy-associated pneumothorax secondary to pleural breach

• Main Authors: Syed Nusrath, Sujit Chyau Patnaik, Asiel Christopher, Ajesh Raj Saksena, Subramanyeshwar Rao Thammineedi, R Pratap Reddy
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Anaesthesia
• Subjects: laparoscopy-associated pneumothorax; pleural breach; pneumothorax
• Online Access: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2020;volume=64;issue=3;spage=233;epage=235;aulast=Nusrath
• ISSN: 0019-5049; 0976-2817

During laparoscopic mobilisation of the oesophagus around hiatus in transhiatal oesophagectomy; commonly the pleura is breached causing iatrogenic pneumothorax. Often small breaches in pleura goes unnoticed till the attention is drawn by anaesthetist when pressures drop with building up of end-tidal CO2(etCO2) and other haemodynamic changes occur. We describe the flickering movements of the diaphragm associated with the pleural breach, a useful sign to alert the surgeon and anaesthetist to detect pneumothorax earlier than it is clinically evident.