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