Recurrent Pneumothorax With Extensive Subcutaneous Emphysema During the Perioperative Course of Type A Aortic Dissection: A Case Report

Acute type A aortic dissection (AoD) requires urgent surgical treatment, and perioperative complications may result from both the underlying disease and procedure-related factors. Here, we report a 29-year-old man with acute type A AoD who developed right pneumothorax before undergoing emergency aortic repair via median sternotomy. Postoperatively, the pneumothorax recurred and rapidly progressed to extensive cervical, thoracic, and abdominal subcutaneous emphysema (SE). Recurrent pneumothorax persisted despite chest drainage. Subsequent evaluation revealed right apical pulmonary bullae; however, the overall clinical course suggested a multifactorial etiology, including persistent coughing, positive-pressure ventilation, internal jugular venous catheterization, wound air leakage, and drainage-related factors. Mediastinal pleural disruption, along with a low body mass index (BMI) and limited soft-tissue buffering, may have further facilitated air dissection along tissue planes and increased the severity of SE. After 2 weeks of chest tube drainage, the SE gradually resolved, and no further pneumothorax was observed after tube removal. This case emphasizes the importance of prompt recognition, repeated imaging assessment, and individualized drainage management in patients with perioperative pneumothorax and extensive SE undergoing cardiac surgery.