Presentation
Sudden onset of shortness of breath and rapid breathing.
Patient Data
Multiple large air-attenuation areas in keeping with loculated pneumothorax.
Compressive right lung atelectasis obscuring the medial right hemidiaphragm.
Ground glass opacity within air lucency may represent right pleural effusion.
Depressed lateral portion of right hemidiaphragm forming the "deep sulcus sign".
Marked mediastinal shift to the contralateral left hemithorax.
Widened right rib intercostal spaces and horizontal rib orientation.
Patchy focal opacity in the left mid lung zone.
Multiple air-attenuating lucent areas within the right hemithorax represent loculated pneumothoraces with pleural adhesions rather than subpleural bullae. Presence of air-fluid level within right pleural space indicates right hydropneumothorax.
Right lung is almost completely collapsed.
Large volume right hemithorax with depression of right hemidiaphragm and mediastinal shift to the left indicate tension pneumothorax.
Incidental small lung nodule in the apicoposterior segment of left upper lobe and plate atelectasis in the lingula.
Case Discussion
Loculated hydropneumothorax in a patient with background history of treated pulmonary tuberculosis.
Urgent chest drainage is required for this potentially fatal condition and the referring team should be notified immediately.
The main differential of this radiographic appearance is subpleural pulmonary bullae, which can be differentiated on CT. However lifesaving treatment should not be delayed.
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