Presentation
Polytrauma patient. Admitted for more than 2 weeks with multiple fractures. Presents with decreased saturation and productive cough. Pneumonia?
Patient Data
Left basal atelectasis. No lines evident. Left sided rib fixation devices.
There is complete white out of the left hemithorax. There is mediastinal shift to the left.
The left main bronchus lumen tapers and occludes, consequently, the left lung fully collapsed. On coronal imaging there appears to be a meniscus, suggesting mucus plugging as the underlying cause.
Several pneumatocoeles are seen in the lower lobe. Moderate pleural effusion on the left with no features to suggest hemothorax.
Right lung shows normal aeration with a few nonspecific peripheral groundglass opacities. There is no mediastinal abnormality, no lymph node enlargement.
There has been reduction and fixation of rib fractures, from the 4th to 11th on the left. Other fractures involving the transverse processes and neck of the 7th to 12th left ribs.
Left bronchus occlusion and consequent left lung collapse associated with pleural effusion. Mucus plugging?
Improved appearance from previous CXR and CT. ETT is appropriately positioned. Moderate left pleural effusion and left basal atelectasis. The right lung and pleural space are clear. No pneumothorax. The cardiomediastinal contour is within normal limits.
Case Discussion
This case demonstrates a hemithorax white out which shows mild mediastinal deviation to the left inferring lung collapse. Further CT confirmed a left bronchus occlusion and consequent left lung collapse with pleural effusion, likely due to a mucous plugging. Two days after clinical management, the lungs demonstrated normal aeration.
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