Presentation
Code blue. Recent pacemaker insertion
Patient Data
Left pneumothorax. Mediastinal shift towards right, depression of left hemidiaphragm, concerning for tension pneumothorax.
Pacemaker, ETT, nasogastric tubes.
Chest radiograph prior to pacemaker insertion (previous day). Rightward mediastinal shift. Defibrillation pad noted. No pneumothorax
Comparison radiograph from 10 years previous - cardiomediastinal contour is unchanged (likely right lower lobe hypoplasia).
Left sided pneumothorax and left sided intercostal catheter.
Only minor right basal subsegmental atelectasis.
Case Discussion
Left sided pneumothorax complicating pacemaker insertion. Despite the clinical scenario of code blue (possibly related to pneumothorax), the rightward mediastinal shift is unchanged since 10 years previous (possibly right lower lobe hypoplasia), mimicking radiographic features of tension pneumothorax.
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