Basal pneumothorax and trapped lung post thoracentesis

Case contributed by Dr Henry Knipe

Presentation

Chronic left pleural effusion. Post thoracocentesis.

Patient Data

Age: 80
Gender: Male

Left basal pneumothorax with air-fluid level and mensiscus indicating that this is actually a hydropneumothorax. Left chest wall subcutaneous emphysema. Left upper and lower lobe atelectasis. Right upper lobe granuloma. 

Case Discussion

Most pneumothoraces post ultrasounded-guided thoracentesis (which are uncommon in themselves) result from unavoidable stress-related parenchymal-pleural fistulas that result from trapped (unexpandable) lung rather than being procedure related (e.g. direct lung puncture, poor technique). 

Radiographic signs of trapped lung include:

  • visceral pleural peel (thickening)
  • basilar pneumothorax
  • ipsilateral volume loss
  • lobar atelectasis

Often treatment of these pneumothoraces with chest tubes is unsuccessful and most will slowly resolve in their own time. 

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Case Information

rID: 30898
Case created: 8th Sep 2014
Last edited: 5th Apr 2017
System: Chest
Inclusion in quiz mode: Included

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