This is a Chest  Xray Of a 36 year old Woman who was previously well  admitted to the hospital complaining of left sided pleuritic type chest pain  associated with shortness of breath for 6 hours.Comment on her Chest Xray?

ANSWER - LEFT SIDED SPONTANEOUS PNEUMOTHORAX
pneumothorax is a potential medical emergency wherein air or gas is present in the pleural cavity.It results in collapsed lung. 
Types Of Pneumothorax 
Closed - where the leak spontaneously closes off 
Open - communication between the lung and the pleural space remains patent 
Tension - communication remains open only during inspiration so that the volume of air in the pleural space slowly or rapidly increases compressing the adjacent lung.This is a medical emergency

Causes
Spontaneously (more commonly in tall slim young males and in Marfan syndrome)
Chest Trauma(penetrating or barotrauma)
Result of other pathological processes
  • emphysema
  • tuberculosis
  • cystic fibrosis
  • Lung Cancer

SPONTANEOUS PNEUMOTHORAX

Iry - rupture of a bleb in the lung
2ry - mostly occurs due to mediastinal emphysema
 
Clinical Features
     Sudden onset of pleuritic chest pain
     Sudden shortness of breath, dry coughs
     Cyanosis
     Tachycardia and sweating
     Reduced chest expansion on the affected side
     Hyper-resonant percussion note - if large pneumothorax
     Reduced or absent breath sounds at the affected site
     Sticky clicking sound, heard in time with the heart beat - in a left sided pneumothorax
    Small pneumothorax may present without any clinical features

INVESTIGATIONS
Chest Xray
  1. Collapse of the lung as extra black space
  2. Mediastinal Shift
  3. In a supine chest X-ray the deep sulcus sign(low lateral costophrenic angle on the affected side)- hep to diagnosis especially in ICU patient.
Arterial Blood gas


TREATMENT
  • Small pneumothoraces are often managed conservatively
  • Large pneumothoraces should be aspirated
  • Intercostal tube insertion
  • Bronchopleural fistula is likely if the lung cannot be expanded with the use of a chest drain
  • If a patient suffers repeated spontaneous pneumothoraces then a pleurodesis or pleurectomy should be considered.

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19 comments

  1. Anonymous Says:
  2. pneumothorax

     
  3. Anonymous Says:
  4. Left pneumothorax

     
  5. Anonymous Says:
  6. hyperventilated left lung with widened intercostal spaces.. pneumothorax not enterntained since there is no visible pleural lining..

     
  7. Anonymous Says:
  8. hyperinflation type of lung view on left side, slight deviated mediastinum shadow, final diagnosis: spontaneous pneumothorax.

     
  9. sarahsan Says:
  10. pneumotorax

     
  11. Anonymous Says:
  12. hyperventilated left lung with widening in intercostal space with opaqe colour which may be most probably spontaneous pneumothorax

     
  13. foroogh Says:
  14. spontaneous pneumothorax

     
  15. sumit Says:
  16. left sided spontaneous pnemothorax with shift of mediastinum to right, with collaps lung shadow left lower parahilar region

     
  17. Anonymous Says:
  18. pneumothorax (left)

     
  19. Anonymous Says:
  20. Pneumothoraz on the left side with mediastinal shift to the right.

     
  21. Anonymous Says:
  22. sponteneous subtotal left pneumothorax

     
  23. Anonymous Says:
  24. left sided pneumothorax

     
  25. My Comment :This is PA view of CXR showing hyperventilated left lung with widened intercostal spaces and the trachea is slightly shifted to the Rt side

    Hello all

    I need help for my OSCE , I'm 5th year medical student if you have any notes or ppts about any topics related to OSCE for Internal medicine please send me at raad103@gmail.com

    Thanks in Advance

     
  26. ganesh Says:
  27. left sided pneumothorax

     
  28. Yousof Says:
  29. Left spontaneous pneumothorax with mediastinum shift that may progress to tension pneumothorax.

     
  30. Yousof Says:
  31. Left spontaneous pneumothorax with mediastinum shift that may progress to tension pneumothorax.

     
  32. left sided spontaneous pnemothorax with shift of mediastinum to right, with collaps lung shadow left lower parahilar region

     
  33. aashvi Says:
  34. Dilseindia provides you in-depth knowledge of chest pen. How chest pen occurs, how to prevent and we also provide detailed information about how to treat this disease. You can get complete information about chest pain at this website. Website : http://www.dilseindia.org

     
  35. Chest pain is considered a chief symptom of heart related problems.
    It can occur due to various causes such as heart attack, pulmonary embolism,
    thoracic aortic dissection, oesophageal rupture, tension pneumothorax and cardiac tamponade.

    I like your blog because I found very Important quotes on your blog. for more information of these types please click on :
    TREATMENT FOR CHEST PAIN

     

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