Persistent pneumothorax due to right lung collapse and bronchial obstruction from haematoma
Multitrauma MVA. Intubated and bilateral pleural caths at scene.
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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.
Bronchoscopy found a large haematoma 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).