Neonatal pneumothorax with chest drain in situ. Persistent high pressures required.
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There is a large right pneumothorax demonstrated on AP and lateral films with a pig-tail catheter in situ with its tip at the apex.
Large right supine pneumothorax with a drain in situ.
The lateral radiograph demonstrates why the drain isn't working. In a neonate, the anterior (and not apical) chest is anti-dependant and that is where the collection of gas in the hemithorax is.
The neonatologist was about to put a new chest tube in when the film was reported - a telephone call to the team and subsequent manipuation of the tube saved the child from another intervention and the pneumothorax was drained successfully.