How should a radiology resident on call approach this case?
1. Volume loss vs volume gain in which lung? Volume loss is in the left and volume gain is in the right lung. 2. If it was a tension pneumothorax on the left then the mediastinal shift would have been to the right. 3. Also a pneumothorax would be hyper lucent rather than hypolucent.
List one complication of a chest tube in the patient above.
Broncho-pleural fistula is a risk when a chest tube is inserted, and is a difficult complication to treat.
What else could the admitting team have done differently?
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.
List 2 common causes of re-expansion pulmonary oedema.
1. Tension pneumothorax and inserting a chest tube causing lung re-expansion. 2. A large pleural effusion with large volume rapid thoracentesis.
The endotracheal tube is too deep. There is a left pleural pigtail catheter. There is unilateral left lung re-expansion pulmonary oedema.