Presentation
Persistent pneumothorax. History of COPD.
Patient Data
Large right pneumothorax.
Right chest tube and right pleural pigtail catheter.
Extensive right chest wall emphysema.
Interval wedge resection and talc pleurodesis.
Right apical pneumothorax decreased in size from presentation.
There is a tracheal deviation to the right.
Extensive right pleural thickening is most prominently seen above the right upper lobe apex and within the horizontal fissure.
Loculated gas-fluid collection in the medial right lower zone.
The spine sign (loss of more-black sign) is seen on the lateral view.
Small foci of air are seen over the right scapula, representing resolving soft tissue emphysema.
Case Discussion
Pneumothorax is the accumulation of gas within the pleural space. Negative pleural pressure normally keeps the lung expanded with the visceral and pleural spaces as opposed to only a thin layer of pleural fluid between. Pneumothorax increases the pleural pressure and allows elastic recoil of the lung leading to collapse. Inadequate ventilation can lead to hypoxemia. COPD is a risk factor for pneumothorax.
In this case, the loculated gas-fluid collection indicates the presence of hydropneumothorax.
Ipselateral mediastinal shift excludes tension pneumothorax.
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