Other / General Medicine
Sophia A. Artamendi, BS
Medical Student
Florida International University Herbert Wertheim College of Medicine
Lauderhill, Florida, United States
Felix A. Zayas Rodriguez, MD
Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States
Nicole L. Pontee, MD, MS
Assistant Professor
University of Miami Miller School of Medicine/Jackson Health Systems
Miami, Florida, United States
Felix A. Zayas Rodriguez, MD
Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States
Bulging right chest wall and thoracotomy dehiscence with right lung herniation in a patient with bilateral lung retransplantation.
Case Description:
A 58-year-old female with a history of bilateral lung retransplantation for chronic lung allograft dysfunction was admitted to inpatient rehabilitation for deconditioning following her hospitalization and surgery. She was receiving tube feedings via percutaneous jejunogastrostomy (PJG) and, after nutritional adjustments, was able to participate in and tolerate therapy with functional gains.
Several days after admission, the patient developed a cough with blood-tinged sputum overnight and was placed on humidified air. In the morning, she experienced a worsening cough, hypoxemia, and a bulging right chest wall. The rehabilitation team promptly notified the transplant pulmonology service, and the patient was rapidly transferred to acute care. Imaging revealed worsening hydropneumothorax and ground-glass opacities. Care was expedited for thoracotomy re-exploration and hernia repair with Strattice mesh. After the procedure, it was found that there was a thoracotomy dehiscence with right lung herniation.
Discussions:
This case highlights the important role of interdisciplinary coordination in managing medically complex patients during inpatient rehabilitation. Transplant recipients often face multifactorial challenges, and while rehabilitation can optimize functional outcomes, these patients remain at risk for rapid decompensation. Vigilant monitoring, timely recognition of clinical deterioration, and seamless communication between rehabilitation, specialty, and acute care teams were essential to ensuring this patient received lifesaving treatment.
Conclusions:
Patient safety must remain the foremost priority in a rehabilitation setting, especially when caring for medically complex populations such as transplant recipients. This case highlights the importance of structured communication, teamwork, and systems-based planning to enable rapid escalation of care. Through close monitoring and interdisciplinary coordination, this patient received timely intervention and ultimately returned to rehabilitation, where she completed her course successfully.
