How should a radiology resident on call approach this case?
1. Volume loss vs volume gain in which lung? Volume loss in left and volume gain in the right lung. 2. If it was pneumothorax on the left then the mediastinal shift would have been to right. 3. Also pneumothorax is radiolucent and not radiodense as here.
Name one risk of chest tube in the patient above.
Broncho-pleural fistula is a risk when a chest tube is inserted, and is very hard to treat.
What else could the admitting team have done different?
Withdraw the tube, hyperventilate and repeat rapid portable bedside chest x-rays to see if the left lung would have re-expanded without rushing in a chest tube. If still in doubt, perform a right lateral decubitus radiograph to exclude a left pneumothorax first before chest tube insertion.
Name 2 common causes of reexpansion pulmonary oedema.
Tension pneumothorax and chest tube causing lung re-expansion. Large pleural effusion with large volume fast thoracentesis.
UniLat pulmonary oedema from rexpansion
The endotracheal tube is too deep. There is a left pleural pigtail catheter. There is unilateral left lung re-expansion pulmonary edema.