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41. Radiology Case 8
Indication for Examination: 20-year-old male presents with right-sided chest pain and dyspnea. On exam, there are diminished breath sounds and hyperresonance on the right.
Radiographic Findings
Lack of extension of the right lung to the edge of the chest cavity
Diagnosis
Large right pneumothorax
Learning Points
Priming questions
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What are the best patient positions to evaluate for pneumothorax on X-ray?
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What are some common mimics of pneumothorax?
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What are signs of tension pneumothorax?
Introduction
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Pneumothorax is an abnormal collection of air within the pleural space, which can cause mass effect on the adjacent lung.
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Tension pneumothorax occurs when air accumulates and causes pressure on the mediastinal structures eventually causing decreased venous return and cardiopulmonary collapse [1].
Pathophysiology/Mechanism
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There are many causes of pneumothorax.
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Primary spontaneous pneumothorax is seen in patients with no underlying lung disease, most commonly thin young men.
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Blunt trauma, approximately 30–40% of patients with blunt chest trauma have an associated pneumothorax.
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Iatrogenic
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Barotrauma from ventilation
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Post bronchoscopy
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Post thoracentesis or lung biopsy
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Following central line placement.
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