Subcutaneous Emphysema
48/m SOB/ COUGH / FEVER SINCE 1 MONTH K/C/O DM AND PANCREATITIS SPO2 60% BP 110/70 P 80, T- 101.3F KINDLY COMMENT ON XRAY
Thanks ma'am for sharing this case. Rt sided inhomogenous heziness seen. Rt hemidiaphragm is raised. Left sided pneumothorax with underlying lung collapse and mediastinal shift towards contralateral side. 1st of all needs left sided ICD for life saving. Repeat cxray to see for underlying lung expansion and pathology if any. Cause of cough and fever may get itself. Medical management as per Sputum examination. If remains unexpanded, consider surgical or thoracoscopic repair. Only surprising point is, fever and pneumothorax will cause tachycardia of at least 150 and above. Plz review for it.
Bronchovascular markings are not seen in lt hemithorax suggestive of pneumothorax Collapsed lt lung Rt chest shows prominent bronchovascular markings Trachea is pulled to rt contradictory to collapse lt lung as pneumothorax is extensive and needs urgent ICD Pt is diabetic and having pancreatitis It appears rupurted bullae on lt side
PNEUMOTHORAX LEFT SIDE WITH OPACITIES RIGHT LUNG MORE ON RIGHT APEX WITH MEDIASTINAL SHIFT TO RIGHT SIDE
Xray shows lt sided pneumothorax with collapsed lung pushing mediastinum to the contralateral side. Rt sided chest showing haziness although lung. There is raised rt sided diaphragm or lt sided diaphragm pushed down by the pressure of the air inside the pleural cavity. Now comes the question of the cause of pneumothorax as the rt chest showing cavitory changes may be due to pulmonary tuberculosis as it may happen due to rupture of the subpleural blebs or pt had COPD leading to rupture of the emphysematous bullae. But there would be associated hydrothorax in case of spontaneous secondary pneumothorax if due to pulmonary tuberculosis. Pt needs inter costal water seal drainage as a life saving measure. Check xray after 24 hours to see any improvement of lung expansion Sputum for culture and AFB and to treat accordingly. If lung does no expand bilumen endotracheal tube to be ginen in llateral position still then not expanded then comes surgical repair or partial decortication of lobe of lung.
Pneumothorax left with collapsed lung . Mediastinal shift to right . Right upper zone hazy Right dome of diaphragm elevated Suggest urgent ICD to left side Investigate further
Left sided pneumothorax with underlying lung collapse.R hemidiaphragm raised with haziness in R upper zone.
Left pneumothorax. Imcreased radio lucenct with loss of lung markings.
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