Recurrent bilateral hydro-pneumothorax in metastastic osteosarcoma: one-stage treatment by bilateral uniportal VATS.

<bold>Background:</bold> Bilateral simultaneous VATS is rarely performed. We report a case with osteosarcoma and recurrent bilateral hydro-pneumothorax (HPNX) who underwent uniportal talc pleurodesis and pleural biopsy. Case report: A 15 y.o. female presented with shortness of breath, chest pain and desaturation. Chest X-ray showed left PNX. PMH included osteosarcoma of the right femur and metastases to bones and lungs. She was on chemo-radiotherapy and anti-depressive therapy. A chest tube (CT) was inserted but during admission she developed concomitant right PNX (Fig. 1a) treated with CT. Two months later patient developed minimal right PNX which was managed conservatively. After 4 months she developed the third right PNX which was treated with CT. Thirty days later she presented with left HPNX treated with another CT. As the patient had 5 bilateral PNX (3R, 2L) within 7 months requiring 4 CT, pleurodesis was offered. She underwent 3 cm one-stage bilateral uniportal VATS talc pleurodesis and pleural biopsy under general anesthesia. Postoperative X-ray showed good lung expansion (Fig 1b). CT were removed on 4th postop day and the patient discharged. At 6 month follow up lungs were expanded with no recurrence of effusion despite progression of the disease (Fig 1c). <bold>Conclusion:</bold> Uniportal VATS is useful to perform one stage bilateral simultaneous talc pleurodesis for recurrent HPNX <fig><object-id>erj;64/suppl_68/PA1418/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>