Current Thoracic Surgery

Spontaneous pneumothorax secondary to pulmonary metastasis is a rare but critical condition, particularly when it occurs in the single remaining lung of a patient who has undergone pneumonectomy. We present the case of a 62-year-old male with a history of left pneumonectomy for a malignant mesenchymal tumor who developed a right-sided pneumothorax one year postoperatively. Due to a persistent air leak resistant to tube thoracostomy, a chest CT was performed, revealing a subpleural metastatic lesion. The patient successfully underwent single-port Video-Assisted Thoracoscopic Surgery (VATS) wedge resection and apical pleurectomy under general anesthesia with transient apnea. This case highlights that despite the limited pulmonary reserve in pneumonectomized patients, single-port VATS offers a safe and effective approach for the definitive management of secondary pneumothorax caused by metastasis in the contralateral lung.