Pneumothorax (asthma)

Case contributed by Dr Jeremy Jones

Presentation

Acutely unwell with respiratory compromise requiring intubation and ventilation.

Patient Data

Age: 13
Gender: Male
Modality: X-ray

ET tube and NG tube in situ and in appropriate positions. The lungs are hyperexpanded with flattening of the diaphragms. Appearances suggest background asthma. At the right apex, the lung edge can be seen with no lung markings peripherally. Features here are of a pneumothorax.

Modality: Annotated image

With a bit of windowing and zoom, the right apical pneumothorax becomes much more obvious.

Case Discussion

The lungs are hyperexpanded and in a young patient, this should trigger thoughts of asthma. With asthmatic patients, look for a cause of their exacerbation (e.g. viral chest infection), but also look for secondary complications (e.g. pneumothorax, pneumomediastinum, surgical emphysema).

In the case of pneumothorax, use a good monitor, good viewing conditions and window to give yourself the best chance of finding it. Pneumothoraces are most likely to be apical in these patients, so give it a bit of zoom too.

Pneumothoraces are more common in asthmatics, but may also be the result of over-ventilation, either by hand-bagging or mechanical-ventilation.

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Case Information

rID: 27447
Case created: 3rd Feb 2014
Last edited: 9th Dec 2016
System: Paediatrics
Inclusion in quiz mode: Included

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