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Persistent pneumothorax due to right lung collapse and bronchial obstruction from hematoma

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Multitrauma MVA. Intubated and bilateral pleural caths at scene.

Patient Data

Age: 20 years
Gender: Male

Large right pneumothorax with complete collapse of the right lung despite the presence of a large bore ICC. Left ICC is in situ and left pneumothorax with deep sulcus sign. Airspace opacity on left is likely contusion and aspiration. Rightward mediastinal shift. Right bronchial cutoff suspicious of a bronchial injury or intraluminal lesion.

ETT and NGT well positioned.

Fracture of the right clavicle.

Case Discussion

Bronchoscopy found a large hematoma in the right main bronchus which was removed and allowed re-expansion of the right lung.

In this case, suspicion of an obstructing lesion should be raised given the presence of ICCs and persistent tension PTX (provided the ICCs are not kinked and are intrapleural).

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