54 year old man presents with worsening breathlessness over 2 days. He is a current smoker and has had periodic breathlessness and wheeze for 4 or 5 years.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a small right pneumothorax in the right upper zone.
The lung parenchyma looks normal, pleural spaces are clear.
This is a spontaneous secondary pneumothorax (SSP) from COPD.
There is no clear evidence base to inform clinical decision making in this situation.
- No intervention (allow time to resolve once visceral pleural defect healed) is possible but a bit controversial in SSP.
- Simple needle aspiration is relatively safe and may be effective.
- Placement of a drain may be dangerous as the pneumothorax is relatively small.
A CT chest is the best way of imaging a pneumothorax – and can guide the safest site for intervention, should this be necessary.
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