Presentation
Patient with chest pain and difficulty breathing for 1 day. The pain started spontaneously in the right anterior axillary line while he was lying in bed, associated with shortness of breath, which worsened during physical activity.
Patient Data
The radiographic study of the chest, the anteroposterior projection, particularly the lateral one, shows an air loculation within the posterior aspect of the right major fissure. There are no other types of lesions or pleural effusion. The mediastinum is on the axis, the volume is within limits.
Diagnostic completion by CT examination without MDC.
Axial chest CT images show a regularly shaped air loculation, with an obtuse angle between the cystic wall and pleura (length ten cm and anterior-posterior diameter 4 cm). The top and bottom portion of the cystic lesion continues to the right major fissure. Sagittal CT images show the anteroinferior portion of the localized air loculation tapers into the right major fissure. Small blebs are also visible on the right adjacent to the aforementioned air loculation. There are initial signs of centrilobular emphysema in the upper lobes. Mediastinum is normal.
Case Discussion
Spontaneous interlobar pneumothorax is uncommon but early diagnosis can help prevent complications and improve outcomes. Chest X-ray is often diagnostic for a larger pneumothorax, but if the amount of air in the pleural space is minimal, a dedicated CT scan may be required for identification and to resolve diagnostic doubts on the chest radiological examination.
Interlobar pneumothorax might be secondary to rupture of a small emphysematous bulla or could be also iatrogenic.
Case courtesy: Dr. Fabio Denicolò, Dr.ssa Eleonora Renzi
Radiographer: TSRM Fabio Imola
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