CXR Case 107

A 51 year old man known to the respiratory team is admitted with a sudden onset of significantly worse dyspnoea. He is hypoxic requiring 4L of oxygen to maintain SpO2 ~94%.

CXR CASE 107 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There are bilateral pneumothoraces.
There are increased lung markings suggestive of underlying lung parenchyma infiltrate such as pulmonary fibrosis.
Bilateral small pleural effusions.


CLINICAL CORRELATION

This is bilateral spontaneous secondary pneumothorax (SSP).
The hypoxaemia supports the assumption of underlying lung disease. This patient needs bilateral chest drains.


CLINICAL PEARLS

Bilateral pneumothorax is quite rare and should prompt consideration that there may be a mediastinal pleural defect – either iatrogenic from intervention, or rarely ‘buffalo chest‘ – where both pleural spaces are in communication.

Note: Buffalo’s have no mediastinal pleura – i.e. a single pleural space. This explains why Native Americans were able to kill 400 kg buffalo with a single arrow to the chest, causing a tension pneumothorax…


TOP 150 CXR SERIES



Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

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