Presentation
Progressive dyspnea post fall. Hypoxia and tachypnea. Background COPD, previous VATS pleurodesis for left sided spontaneous pneumothorax.
Patient Data
Chest x-ray demonstrates a large right pneumothorax (~8.3cm width) with collapse of the right lower lobe. Widening of intercostal space on right. Patchy ground-glass densities are noted in the right upper lobe, and to lesser extent, left upper lobe.
Interval chest x-ray after chest tube insertion demonstrates re-expansion of right lung with markedly reduced pneumothorax measuring ~7mm width at apical region. Subcutaneous emphysema present in the right chest wall. Ground-glass densities again noted in the bilaterally, more prominent in the left lower zone.
Case Discussion
This case demonstrates traumatic tension pneumothorax caused by blunt trauma to the chest, on a background of known emphysema and previous spontaneous pneumothorax on the contralateral side.
The patient presented to ED with severe dyspnea after a recent fall. She had clinical signs of right sided tension pneumothorax. After chest x-ray confirmation, chest tube was inserted at the right 5th intercostal space at mid-axilla line, via blunt dissection technique. This was followed by rapid resolution of hypoxia. The interval chest x-ray demonstrates re-expansion of the right lung and the chest tube is seen traveling superiorly towards the apex and looping down with the catheter tip sitting at the medial right midzone.
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