Tuesday, April 19, 2011

Interesting CXR (9)

A man presented with acute onset of shortness of breath and clinical findings are of pneumothorax and an emergency chest tube insertion was done. However he remains in respiratory distress despite the procedure.
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What do you think he is not improving and what does the CXR actually show?
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15 comments:

Darren Lee said...

Clue: Those are not bullae (If that's the first thing comes into your mind) ;)

康宁 said...

looks like herniation of bowel into the chest?

Shay said...

Herniation of transverse colon to thorax. Seemed pretty dilated. Compressing lung. But no collapse.

Shay said...

Given the sudden onset and the location of hernia which did not fit into any 'common' congenital diaphragmatic herniae. I would be wondering whether this guy had history of trauma before leading to diaphragmatic rupture and hence the current presentation .

Anonymous said...

Ruptured right diaphragmatic membrane leads to herniation of colon into the right thorax

Darren Lee said...

Wait..it's not herniation. I definitely think it's a good differential (looking at the right lower lung zone), but how to explain the middle part?

It's still a respiratory condition, probably more common in patients with underlying chronic lung disease.

Isaac Chan said...

just guessing:

pomblage? - old surgical treatment for TB.

Isaac Chan said...

or Aspergillosis? in immunodeficiency patient.

Isaac Chan said...

...reverse halo sign

Zzzyun said...

lung cysts?

Znew said...

Loculated pneumothorax.

Respiratory distress still present because the chest tube did not drain the air in the pleural cavity completely.

Chronic lung diseases usually cause adhesion between parietal and visceral pleura, segmenting the pleural space into sections.

Darren Lee said...

Znew:

Absolutely correct! ^^

Anonymous said...

Great..I really learnt a alot here. Thanks!!

Shay said...

Loculated pneumothorax.

Shay said...

wow.

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