Pneumothorax - supine

Case contributed by Dr Carlos Felipe Hurtado Arias

Presentation

Patient hospitalized in the intensive care unit for severe pancreatitis and acute respiratory distress syndrome (ARDS). A central venous catheter is passed through the right subclavian artery, but during its positioning, a pneumothorax occurs.

Patient Data

Age: 35 years
Gender: Male
X-ray

A large right pneumothorax with complete collapse of the lung is identified. Deep sulcus sign.

Alveolar opacities of the left lung that have increased in extension and density when compared with previous studies. The cardiac silhouette is normal size.

There is a closed drainage thoracostomy tube inserted in the middle third of the right hemitorax and with its distal end in the middle third of this hemitorax. The endotracheal tube has its distal end 4 cm from the carina. Central venous catheter of right subclavian insertion, with its distal end in the superior vena cava.

Case Discussion

Pneumothorax after insertion of central venous catheters is a frequent complication, although this is decreasing with increasing use of ultrasound guidance. 

This x-ray was carried out immediately after the insertion of the central venous catheter, which documents a large right pneumothorax, compromising the whole right lung and displacing almost all the mobile structures of the mediastinum to the left. This was consistent with the clinical picture of the patient: ventilatory and hemodynamic deterioration after the percutaneous procedure.

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Case information

rID: 64813
Published: 10th Dec 2018
Last edited: 10th Dec 2018
System: Chest
Inclusion in quiz mode: Excluded
Excluded from licensing
Institution: Universidad Tecnológica de Pereira

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